Affordable Care Act and Medicaid Funding in Texas

Texas has had its fair share of disputes and disagreements when it comes to contemporary policy issues regarding its stance as a state as well as, what the United States federal government does regarding said issues. Among them is the Affordable Care Act (ACA) or Obamacare as it is widely known for which its purpose is to make health insurance affordable and available for more people with low income (Healthcare.gov). Also, the issue of whether or not Medicaid which “provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities” should be funded (Medicaid.org). Texas does not always agree with others seeing as politically, it stands on a different spectrum from other states and the views are more closed off and its level of open-mindedness to change is very minimal. Certain topics such as healthcare bring an uprise of uncertainty on whether or not it should be funded and if so, then the type of steps one should take to get it and if a person meets the prerequisites required to be considered as a possible recipient of Medicaid and health care privileges.

Texas Judge Reed O’ Connor ruled that the ACA was unconstitutional which then would cause the health care system to suffer. By doing so, the coverage of many would plummet since the funding of Medicaid and Medicare comes from the ACA and the federal government would not be able to pay for it since the ACA had a plan of payments in place and without it would turn chaotic (Cheslow). Throughout history, previous presidents such as Clinton have tried to come up with a healthcare solution but failed at it. Obama tried to avoid failure at all cost seeing as Clinton’s Catastrophic Health Care Act of 1988 caused a reputation of a badly run system to occur which then lead Obama to create a system which would protect peoples benefits no matter what it took (Berkowitz 521). Texas on the other hand is a state that limits its ability to ask for certain additional benefits since it would risk losing doctors who work with certain types of health insurance which then would lead to higher cost for people and could cause legal consequences to take place on behalf of the state (Spaulding 313).

The Affordable Care Act is seen as an outdated system that does not fit well with current issues and it is only seen as an “incremental expansion” and not a “revolutionary change” (Berkowitz 521). Medicaid funding is different within each state some choose to expand while other states like Texas which is a “non-expanding state” declined the expansion for adults but allowed the expansion to move forward for children in 2014 (Spaulding 304). By doing so, an abundant amount of people would be left to pay out of pocket and thus leads us to fall into the “health care coverage gap” that has formed throughout the years that plenty of people have fallen into in the United States (Waller). Texas currently has the biggest coverage gap in the country (Norris). Medicaid was supposed to help fill the gap seeing as it was a program that both state and senate used to provide health care for people with low incomes but seeing as Judge O’ Connor ruled it invalid the program then was questioned and for now, the law remains in effect (Waller).

The federal government updated the ACA and made sure that everyone would be covered. Children would be covered by using the Children’s Health Insurance Program (CHIP) which gives “health coverage to eligible children.” (Medicaid.org). Adults would be covered by using Medicaid. Instead of getting rid of both programs, the federal government made its attempts in being fair to everyone despite some states completely disagreeing with it all together Texas being one of those states who just could not accept the changes being made (Lambrew 863). Texas as well as other states fought the “Obama administration’s mandate” from expanding Medicaid. The Supreme Court ruled that states are not required to follow the mandate (Waller). Texas has only given Medicaid to people with disabilities that have an “income below 75 percent of the poverty level”, pregnant women with income levels less than 200 percent, and to parents with income less than 19 percent of poverty.” (Sommers 1).

What Texas fails to realize is that Medicaid expansion can actually benefit the economy. While Texas debates on whether or not to accept money provided by the federal government it would actually help “stimulate Texas economy” and “support tens of thousands of jobs”. Texas would not have to pay out of pocket since the federal government would take care of those expenses and all Texas has to do is accept participation in the Affordable Care Act’s Medicaid expansion (Families USA 1). The federal government would only be paying for 59 percent and Texas would pay the rest. Then as time progresses new funds would then be available to the state. To close the health care gap, Texas should move forward in Medicaid expansion and funding seeing as the undeniable truth is that many are suffering through paying for medical expenses themselves.

To mend the issues Texas has with the federal government on funding Medicaid, the gap afflicting a great deal of damage should be closed since it heavily impacts the people of Texas seeing as its turmoil has caused trouble over the years and people are the ones left suffering in attempts to pay back “medical bill debt” which then leads to “worse health outcomes.” (Lambrew & Mishory). Congress did not mean to “create the gap” yet it made attempts in helping close said gap and the ruling from the Supreme Court made the ACA create a “seamless system of affordable health insurance coverage for Americans.” (Lambrew & Mishory). Despite having an ability to change the policy and proceed “to accelerate the closing of the Medicaid gap.” (Lambrew & Mishory) there are solutions to better help and encourage the movement to expand Medicaid funding to states such as Texas and by doing so there would be a greater change and improvement not only for Texas’ overall economy but for its people as well. By expanding Medicaid, a door opens for millions of people who have been declined access to Medicaid and its benefits for so long.

The most obvious plan to expand Medicaid would be to further increase the federal funding for Medicaid expansion but Texas no matter how much money the federal government is willing to give it Texas is not easily “swayed” by the idea (Lambrew & Mishory). The next option would be to link new programs to the funding of Medicaid expansion by leaving it up to the state to decide on whether or not it would be willing to make that change. By doing so there would be a prevention of “new federal grant funding from being used to substitute for state and federal Medicaid expansion dollars.” (Lambrew & Mishory). From a debate regarding the ACA on “replacing behavioral health services” that would be provided by the expansion on Medicaid (Lambrew & Mishory). Different types of programs all have made an exception to try and fit everyone’s needs and “compliment Medicaid and other coverage programs” to better help those in any way they can such as Ryan White’s HIV/AIDS Program that managed to change their concept to better fit the mold of the people they are helping instead of turning them down completely because of their medical insurance (Lambrew & Mishory). By doing this with different medical programs the financial field will become leveled rather than paying more for said new funds which would then impact Medicaid poorly by choosing not to expand.

Plan number two consists of having cities or counties pay for the expansion of Medicaid instead of the state itself. By doing so “state governors and legislatures” would be disregarded and “local jurisdictions” would be allowed to have Medicaid expansion with their own borders if that is what they choose to do (Lambrew & Mishory). To set this plan into motion “local towns, cities or counties” would have to take their share from what they receive from the Medicaid expansion in their “jurisdiction” and manage the funds according to how they would like the program to be run. They would also have to get into contact with the Centers for Medicare and Medicaid Services (CMS) to set up “eligibility systems” for their specific areas. CMS would then review people to see if they qualify for the new program or not. By doing so the program would still follow the ACA’s “guidelines for alternative benefits plans.” (Lambrew & Mishory). This program would be able to help insure and cover people who once stayed in the Medicaid gap. A con to this plan would be those living in suburban areas or expanding cities would be unable to withhold this since their areas are already speaking of the Medicaid expansion and would not be considered part of the plan. People who live in rural areas would also not benefit from this seeing as they “typically lack the tax base to support initiatives such as this” (Lambrew & Mishory). Despite all the positives, there are possibilities of this becoming a “political fight” with those who are against the ACA, which then would lead to the possibility of state officials not wanting to pass this program (Lambrew & Mishory).

The last and final plan would be to penalize non-expanding states (Lambrew & Mishory). By doing this “policymakers” would come up with the legislative choice to penalize states who choose not to expand Medicaid. “The penalty amount” would be “meaningful and not coercive” and would be “1 percent of state budgets” (Lambrew & Mishory). Which would be a minimal amount than what the ACA has past written (Lambrew & Mishory). Congress created this in the “early 1970s” to “sanction states that failed to actively implement Medicaid’s early and periodic screening, diagnosis, and treatment benefits (EPSDT)” (Lambrew & Mishory). Every time a state failed to expand Medicaid the federal budget would shift and it would be the one plummeting since the states chose not to abide by the rules. Although this type of approach would “face severe political and policy constraints” seeing as some “states would claim that the penalty ultimately falls on impoverished people” living in states who are “least generous towards their poorest populations” (Lambrew & Mishory). This may be a reason why EPSDT was not very prominent in imposing the law (Lambrew & Mishory).

Although every plan has its faults, along with pros and cons on why they would fit Texas’ Medicaid expansion, they would very much help set alternatives to the current system as well as impact the people, seeing as now they have options and they would no longer feel as if they have nowhere to turn to. Linking new programs to fund Medicaid expansion (Lambrew & Mishory) would be beneficial to those who choose upon expanding by giving people alternatives and different routes instead of having to apply for Medicaid and being declined. This option ensures that people can turn to other options instead of caging them into only applying to Medicaid knowing that there are slim to no chances of obtaining it since the requirements do not apply to them. By allowing the cities and counties to expand Medicaid it will eliminate the need to rely on the state and the cities can make up their own regulations without having the state intervene with its decisions. Penalizing non-expansion states would allow for said states to finally come to terms with allowing for the expansion to happen.

Texas should come to terms and realize that by not expanding the need for Medicaid a lot of people suffer because of the decision to not expand. Many families suffer through not being able to pay for medical bills. This will definitely affect people in the future as debts pile up if Texas does not stop becoming “one of the most restrictive Medicaid systems in the country” (Waller). The ACA and federal government are only trying to help in making sure no one is left unaccounted for when it comes to healthcare and being able to afford it through Medicaid. It is up to Texas now to see if they want to continue going through with staying on the list of states that have not yet agreed to expand Medicaid or break free from it and change for the better.