Texas Medicaid 1115 Waiver Public Hearing – Verbal Testimony by Dr. Laura Guerra-Cardus

Hello, my name is Dr. Laura Guerra-Cardus. I am the Deputy Director for the Children’s Defense Fund. Thank you for the opportunity to comment.

CDF works in local communities to help families connect with available coverage options.  Affordable healthcare for both children and their parents is central to improving children’s wellbeing, financial security, and ability to thrive.  It is for this reason that we urge HHSC to modify its 1115 waiver application to include actual healthcare coverage for Texans.

We want to be clear that we support the other items included in the waiver, specifically funding for uncompensated care costs to hospitals and mental health providers.  Even with Medicaid expansion, we will still need help covering the costs of other uninsured Texans.  In relation to coverage, this funding is not an either/or choice but represents the kind of additive, comprehensive solutions Texas needs for a well-functioning healthcare system.

However, we want to push back on the idea, as some have suggested, that this is not the forum to talk about expanding healthcare coverage. It is, in fact, not only appropriate but necessary to talk about coverage as part of any 1115 waiver extension application.

When this waiver was first designed it was under the assumption that Texas would be expanding Medicaid. Our original waiver, particularly a solid portion of our DSRIP projects, was in fact testing ways to deliver healthcare to uninsured working-age adults who were expected to soon get coverage under Medicaid expansion. Not only does a central part of our waiver’s original purpose demonstrate a connection to health care coverage, but without a coverage solution, many of the lessons we have invested in and learned over the last decade will go unused.

More importantly, under the Social Security Act, the primary goals of the Medicaid program focus on improving people’s health and these waivers are required to further the goals of the Medicaid program. Our application’s large focus on helping hospitals stay afloat after they are left caring for sicker, less well Texans who show up in the emergency room – while critical to include – does not meaningfully improve the health of the people of Texas. Everyone listening today knows that people need access to preventive care, treatment for chronic illnesses such as diabetes and hypertension, and an affordable way to pay for healthcare.  I once forgot to renew my health benefits and realized it when my son left the hospital after a fluke, yet terrifying illness and needed follow-up care.  My heart stopped, upon learning that he might not be able to get the care he needed. This is how we are asking 5 million of our fellow Texans to live on a daily basis. There is no way to stay healthy without access to healthcare coverage because no one can afford to pay out of pocket for all their healthcare needs.

There are many vehicles for expanding Medicaid in Texas, and this waiver is one of them.  I urge HHSC to listen to the many Texans who are expressing support for a more robust and beneficial approach to the waiver by including real coverage. Coverage expansion is the single most effective step Texas can take to improve the health and the health outcomes of Texans.