Should Texas expand Medicaid? The numbers tell the story

Many people cheered when state Sen. Jane Nelson, chair of the Health and Human Services Committee, indicated an interest in looking for ways to accept the billions of dollars available to the state to expand Medicaid to cover 1.5 million uninsured Texans. Hospitals, counties, chambers of commerce, and advocacy groups have been urging the state to seize this opportunity because of the health and economic benefits. A trove of data has been produced by state agencies, think tanks and researchers that builds a persuasive case for expansion. Consider the points below as a handy pocket guide to the data:

People

5 ————- The number of Americans who die every hour due to lack of health insurance[1]

1st ———— Texas’ ranking for the percentage of residents without health insurance[2]

6 million —– The number of Texans without health insurance[3]

1.5 million — The number of Texans who would gain insurance under the Medicaid expansion[4]

$26,951 —— Maximum annual income for a family of three to qualify for Medicaid expansion[5]

Costs

$100 billion —— Federal dollars available to Texas for Medicaid expansion, 2014-23[6]

$15 billion ——— State dollars needed for Medicaid expansion, 2014-23[7]

$101.4 billion —– Amount of money available to the state for general purpose spending in the budget under development for 2014 and 2015^[8]

$1.2 billion ——– Amount of state revenue required for Medicaid expansion for 2014 and 2015[9]

87 cents ———– The amount of each Medicaid expansion dollar paid for with federal as opposed to state funds[10]

$1.29 ————– The amount of money returned to state coffers for every $1.00 Texas spends on Medicaid expansion, 2014-23[11]

$1.8 billion ——- Additional tax revenues received by Texas on account of Medicaid expansion, 2014-17[12]

$1.5 billion ——- Local taxes paid to five largest Texas hospital districts to pay for care to low income and uninsured residents, 2011[13]

$2.5 billion ——- Additional tax revenues received by local governments, including hospital districts, on account of Medicaid expansion, 2014-17[14]

300% ————– The increase in cost when non-emergency care is provided in hospital emergency rooms instead of offices or clinics[15]

$3.1 billion ——- Losses absorbed by Texas hospitals for charity care to low income patients, including emergency room care, 2011[16]

$1,017 ———— Estimated additional annual insurance premium per family to cover the costs of the uninsured, 2008[17]

Texas Economy

$90.2 billion —– Benefit to Texas economy due to increased productivity resulting from better health, in 2012 dollars, 2014-23[18]

$23.2 billion —– Benefit to Texas economy in output through redeployment of local government and private funds used for uncompensated care, in 2012 dollars, 2014-23[19]

$67.9 billion —– Value of economic activity in Texas as Medicaid expansion dollars are spent in the health care sector and recirculated through the economy, 2014-17[20]

231,000 ———- Number of jobs likely to be created because of Medicaid expansion by 2016[21]

$50,818 ———- The average salary for the jobs likely to be created because of the Medicaid expansion, 2014-17[22]

Legislators should use this data to make decisions about Medicaid expansion. Our health and human services professionals worked with the federal government to devise the 2011 Medicaid Transformation Waiver, avoiding political bickering to arrive at a win-win solution. We can do it again. Too much is at stake for ideology or Texas vs. Washington rhetoric to get in the way of covering 1.5 million uninsured Texans and generating widespread economic benefits at the same time.

Elena M. Marks is the Baker Institute Scholar in Health Policy and the chair of the board of directors of Community Health Choice, a nonprofit organization serving more than 200,000 members. She is an attorney with a master’s degree in public health and currently works as a consultant to the health care industry. From 2004 through 2009, Marks served as the director of health and environmental policy for the City of Houston.

Footnotes

[1] Health Insurance and Mortality in U.S. Adults, Wilper et al., Am J Public Health Dec 2009 99(12): 2289-2295 available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775760/

[2] U.S. Census

[3] LBB, Texas State Government Effectiveness and Efficiency Report, January 2013 p 160 available at http://www.lbb.state.tx.us/GEER/Government%20Effectiveness%20and%20Efficiency%20Report%202012.pdf#AuthorizeCountiesToFund

[4] Presentation by HHSC Commissioner Tom Suehs to the Senate Health & Human Services and Senate State Affairs Committees on the Affordable Care Act, August 2012 available at http://www.hhsc.state.tx.us/news/presentations/2012/080112-Senate-HHS-ACA-Presentation.pdf

[5] https://www.federalregister.gov/articles/2013/01/24/2013-01422/annual-update-of-the-hhs-poverty-guidelines

[6] HHSC spreadsheet sent via email 9/4/12

[7] HHSC spreadsheet sent via email 9/4/12

[8] Texas Comptroller’s Biennial Revenue Estimate, January 2013, available at http://www.window.state.tx.us/finances/Biennial_Revenue_Estimate/bre2014/BRE_2014-15.pdf

[9] HHSC spreadsheet sent via email 9/4/12

[10] HHSC spreadsheet sent via email 9/4/12

[11] Perryman, October 2012 available at http://www.perrymangroup.com/reports/MedicaidExpansionwithTables12_1003.pdf

[12] Hamilton, January 2013, Table 2, available at http://texasimpact.org/2013-Medicaid-Expansion-Report?utm_source=Press+Release%3A+Medicaid+Report&utm_campaign=Medicaid+press+release&utm_medium=email

[13] Financial statements for hospital districts in Harris, Dallas, Bexar, Tarrant and Travis counties

[14] Hamilton, January 2013, Table 2, available at http://texasimpact.org/2013-Medicaid-Expansion-Report?utm_source=Press+Release%3A+Medicaid+Report&utm_campaign=Medicaid+press+release&utm_medium=email

[15] LBB, Texas State Government Effectiveness and Efficiency Report, January 2013, p160 available at http://www.lbb.state.tx.us/GEER/Government%20Effectiveness%20and%20Efficiency%20Report%202012.pdf#AuthorizeCountiesToFund

[16] LBB, Texas State Government Effectiveness and Efficiency Report, January 2013, p163 available at http://www.lbb.state.tx.us/GEER/Government%20Effectiveness%20and%20Efficiency%20Report%202012.pdf#AuthorizeCountiesToFund