Austin Chronicle: Little Hope for Expanding Texas Medicaid in the Coming Year
Open enrollment for health insurance on the Affordable Care Act marketplace began Nov. 1, and a trio of local political leaders joined staff at the Foundation Communities Prosper Center in South Austin to encourage Texans to get covered between now and mid-January.
It's a big task. Texas is one of just 12 states that has not expanded Medicaid eligibility to all residents with incomes of up to 138% of the federal poverty level – a decision that has cost 2 million Texans coverage and has left 1 in 5 residents uninsured. Texas also has one of the worst rates of maternal mortality in the country.
The state government's refusal to expand Medicaid has also exacerbated significant racial disparities in health care. Austin City Council Member Vanessa Fuentes said that there are currently 100,000 Latino residents of Travis County alone who don't have health insurance, and many of those residents face further barriers to care as well. "We don't have a full-service hospital east of I-35," Fuentes said. "In my part of Southeast Austin, we just had our first freestanding pharmacy built in the last year, and we're just now building health care clinics in Del Valle and Hornsby Bend. So we already had the odds stacked against our community as it is, which makes it even more important that we ... talk about the health insurance marketplace."
There was a period earlier last year when it felt like congressional Democrats might be able to use their majorities to address some of those disparities, but that didn't happen. Sen. Joe Manchin of West Virginia and Republican allies killed an effort to expand the Affordable Care Act marketplace via the Inflation Reduction Act, as well as a Rep. Lloyd Doggett-led push by House members from nonexpansion states to pass legislation allowing interested counties and cities to bypass hostile state governments and expand coverage themselves.
Doggett, who has been a co-sponsor of Medicare for All legislation since 2019, wrote in an email to the Chronicle that he does not foresee Congress making any significant progress on health care in the lead-up to the next presidential election. "I will continue seeking support for closing the coverage gap through any achievable proposal," Doggett wrote. "I am also working to advance more modest measures such as 12-months postpartum coverage and continuous year-round coverage for children."
Still, the Prosper Center event, which also featured music from James Bookert of San Gabriel and remarks from Travis County Judge Andy Brown, had a celebratory tone. This is the 10th year that people have been able to get insurance through the ACA marketplace, and over the last decade Prosper Center has helped some 46,000 people sign up for plans – including thousands through a partnership with the Health Alliance for Austin Musicians.
Given the relatively short time, mostly over the holidays, during which people can sign up for coverage through the marketplace – the window closes January 15 – raising awareness about the free services offered by the Prosper Center and others to help people navigate the marketplace is critically important. It may be even more important this year, Doggett noted, because Republicans' unwillingness to pass another COVID-19 relief package means people may soon be forced to pay exorbitant sums of money for treatments and vaccinations.
"We need all the young people in this community who are thinking, 'Well, I'm healthy right now, I don't really have a problem ...' to be part of this and to come out and get health insurance," Doggett said.