Health Care

Advocates Worry Texas Won't Expand Medicaid

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Texas has opposed the Affordable Care Act from the start. There's been little movement on setting up its insurance marketplace because officials said they were waiting for the Supreme Court ruling. Local health care workers are worried that even after the ruling, the state won't set up an exchange and might even turn down the Medicaid money from the federal government.


In Texas, one in four people are uninsured, and the state's leadership has been vociferous in its opposition to the health-care law. Carrie Feibel, of member station KUHF in Houston, reports that despite the Supreme Court's ruling, political opposition to the Affordable Care Act remains strong. And that leaves many public-health advocates nervous about how the Lone Star State will implement the law.

CARRIE FEIBEL, BYLINE: Gov. Rick Perry said, in a statement, that the ruling is a stomach punch to the American economy. He called the law itself a monstrosity. Attorney General Greg Abbott says he's not giving up the fight.

ATTORNEY GENERAL GREG ABBOTT: I am against this tax. And I will work with the State of Texas, and members of Congress, to repeal this unprecedented tax imposed on Texans.

FEIBEL: Neither man said anything about how Texas will implement the law. So far, Texas has taken no official action to set up a health insurance exchange. But the big question now is the optional Medicaid expansion. What will Texas do?

KATY CALDWELL: I am a little nervous.

FEIBEL: Katy Caldwell is executive director of Legacy, a safety net clinic near downtown Houston.

CALDWELL: We are not known for our great Medicaid benefits.

FEIBEL: Caldwell says advocates like herself are hatching plans to lobby the legislature when it convenes in January. Since Medicaid is a state-federal partnership, if Texas opts in, the state could pull down $27 billion in federal money over the first decade. [POST-BROADCAST CORRECTION: The correct number, by the state's estimate, is $164 billion in the first decade of the program. Texas would need to provide $27 billion for the expansion program.]

CALDWELL: It's shocking to me that we would turn down that amount of money - and assistance - from the federal government to provide something as basic as health care.

FEIBEL: An estimated 1.4 million uninsured Texans could be covered under the Medicaid expansion alone. In the meantime, most Houstonians are still absorbing what the court ruling means for each of them. Scot More has insurance right now through his job working with the homeless.

SCOT MORE: I'm actually shocked, but pleasantly shocked. I totally expected them to throw everything out, or at least big chunks.

FEIBEL: More is HIV-positive. He says the court ruling guarantees that even if he loses his current coverage, other insurers won't be able to reject him for his pre-existing condition.

MORE: You know, I personally am getting really tired of my - who I am, and my health, being a political tool, you know. I'm a person. I'm not a policy.

FEIBEL: For NPR News, I'm Carrie Feibel in Houston.


MONTAGNE: And these stories are part of a partnership with NPR, its member stations and Kaiser Health News.

Copyright © 2012 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

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Correction July 10, 2012

This story erred in citing the amount of federal money Texas could tap if it expands Medicaid under the Affordable Care Act. The correct number, by the state's estimate, is $164 billion in the first decade of the program. Texas would need to provide $27 billion for the expansion program.



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