We all know the U.S. Supreme Court ruled last week on the constitutionality of the Patient Protection and Affordable Care Act (PPACA). One decision for the state of Texas regards expanding the current Medicaid program. The U.S. Supreme Court ruled that states have the option to expand their Medicaid program, but there is no enforceable requirement.

Texas leads the nation in uninsured population at approximately 27 percent, with 1.2 million children having no medical insurance coverage. In North Texas, that number is closer to 30 percent. Even though we are glad Texas has lower unemployment rates than other states, many of our workers are in the food service, retail and agricultural sectors with no health insurance benefits. In other words, we have a large number of working uninsured or working poor in Texas. As a result, estimates were that 4.1 million Texans would become insured under PPACA.

That number could drop substantially if Texas chooses not to expand Medicaid as low income individuals cannot afford private insurance. The Urban Institute Health Policy Center estimates 5.8 million uninsured non-elderly residents in Texas. The Bloomberg Government Study estimates the federal and state portions of Medicaid will send approximately $45.9 billion to Texas from 2014 through 2018. This amount does include hospitals, nursing homes, managed care plans and home health. These are significant dollars for Texas as three states have more than a million uninsured people potentially eligible for Medicaid with incomes below 133 percent of the federal poverty level ($31,000 for a family of four). California and Florida are the other states facing the same decision.

Author Ralph Charell once said, “It is through cooperation rather than conflict that your greatest successes will be derived.” We are blessed to have state legislative leaders serving Texas with conscientious service. We know they will support expansion of the Medicaid program so fellow Texans can have coverage for medical treatment. We are all stakeholders in this decision and we must work collaboratively with our legislative leaders to balance our state budget while providing the best health care for all Texans.