The political battle over the Affordable Care Act will leave many victims within our state. How can we account for the 1.2 million Texas residents trapped within a coverage gap as a result of our state’s non-expansion of Medicaid coverage? There are no winners in a fight such as this. With our top state leaders aggressively opposed to Medicaid expansion under the Affordable Care Act, we must attempt to put aside political differences and focus on a uniquely “Texas Solution.”



Texas has the flexibility to craft a Medicaid program that meets our citizens’ needs. The state could enhance Medicaid coverage to non-pregnant adults under the age of 65 with income levels below 133 percent of the federal poverty level (FPL). The federal government would then fund 100 percent of these newly eligible residents in 2014, 2015 and 2016. In future years, the reimbursement would never go below 90 percent. If the reimbursement drops below 90 percent, Texas could drop the extended coverage with no financial penalty.

This would give us the flexibility to develop delivery systems and set payment rates reflecting local conditions and needs. We could design a benefit package similar to commercial plans, including cost sharing in the form of copayments for participants with incomes above 100 percent of the FPL. Additionally, we could implement integrated care delivery systems, including savings programs and specific payment strategies similar to other payers. We could also develop medical homes to coordinate care for chronic illness effectively lowering costs.

A bipartisan, cooperative approach to implement this “Texas Solution” would assist more than one million residents and provide a positive economic impact within our state. If you could take a moment, imagine one million residents without access to healthcare. Do you really believe they would be the only ones suffering? Friends, families, physicians, hospitals and other providers would be forced to carry this massive burden.

What lies ahead for healthcare in states without Medicaid expansion is tough decision-making. It has never been more important for us to work together than in 2014. This coverage expansion through a “Texas Solution” would help so many caught in the political crossfire over the Affordable Care Act.

NOTE: A special press conference launching the “Texas Left Me Out” campaign will take place tomorrow morning at the Texas Capitol in Austin. The campaign of the Cover Texas Now Coalition is an effort to connect the many state residents caught in the “coverage gap” with healthcare options. More than 30 organizations will present a letter to the Texas Legislature highlighting the urgency of this problem. To learn more, please click here.