Children’s Defense Fund-Texas Testimony Senate Finance Hearing on 1115 Waiver

Good afternoon my name is Adrienne Lloyd and I am a Senior Health Policy Associate at the Children’s Defense Fund-Texas. I appreciate the opportunity to share comments during this afternoon’s Senate Finance committee hearing regarding Texas’ Medicaid program.

We are glad that Texas has secured stable funding for hospitals and other safety net providers through the state’s 1115 waiver.  I am here this afternoon to emphasize that this funding, though critical for the sustainability of hospitals and providers, is not a solution for the over 1 million Texans in the coverage gap who still have no affordable pathway to coverage and thus are left to make decisions between pursuing preventative and life-saving medical care and paying rent or facing insurmountable medical debt. To paint this picture, within our current system, uninsured Texans in the coverage gap can access free testing for a range of cancers through FQHCs or other community health partner programs, but if these screenings were to detect a dangerous cancer, being uninsured means they could not even get an appointment to be seen by a specialist, much less afford any treatment.

As Mr. Cook, an uninsured Texan who lives in the Panhandle and falls in the coverage gap explained it, “right now, I can get patched up at the emergency room, but my body needs to get fixed.” Because he’s too young for Medicare and doesn’t earn the minimum required to access insurance on the ACA Marketplace, Mr. Cook cannot get “fixed.” 

We need a Texas-sized solution for these Texas-sized problems that will help Texans get healthy and “fixed” instead of waiting for them to get sick and then “patching them up” through costly emergency room visits. We urge the legislature to extend Medicaid coverage to eligible Texans up to 138% of the FPL. This state-level policy action would mean the federal government would cover nearly all the costs of this extension (90%). This decision would bring an estimated $75-125 million federal dollars to our state budget over two years, not to mention the downstream positive effects to our state’s overall economy.

Texas has the highest rate of uninsurance in the country, nearly twice the rate of the national average. We urge the legislature to make this fiscally responsible decision to reduce our state uninsured rate by accepting Medicaid expansion funding in the 2023 legislative session. Thank you.