Report from TACHC, TAFP says Supreme Court ruling could worsen growing consequences to Texas’ refusal to expand Medicaid coverage

Tags: texas association of community health centers, affordable care act, health care reform, medicaid

More than 1 million Texans might lose their health insurance if the Supreme Court rules against the Obama administration this month in King v. Burwell. Such a ruling would deny premium subsidies to Texans and residents of 35 other states that refused to establish state exchanges under the Affordable Care Act.

Texas’ decision not to expand Medicaid coverage under the Affordable Care Act already leaves more than a million low-income, uninsured Texans without access to Medicaid or to federal subsidies to help them purchase insurance. A new report, “How will Texas’ Affordable Care Act Implementation Decisions Affect the Population? A Closer Look,” written by health care law and policy experts at George Washington University and commissioned by the Texas Association of Community Health Centers and TAFP examines the effects of that decision and the compounded damage to the state’s economy and health care infrastructure that would accompany a Supreme Court ruling in favor of the plaintiff.

“The combined effects of not expanding Medicaid and the potential impact of King v. Burwell will hit Texas’ health care system hard,” according to the report. “County‐level estimates show that prior to implementation of the ACA, 38 counties experienced hospital annual uncompensated care levels of $50 million or greater, and four counties showed losses greater than $200 million. Texas’ failure to adopt the Medicaid expansion, coupled with the loss of premium subsidies as a result of a decision against the government in King would reverse the progress that has been made in reducing the number of uninsured Texans. Furthermore, hospitals could find that the demand for charity care actually rises, as thousands of previously‐insured people with serious health conditions turn to their hospitals for help.”

In the recently concluded 84th Texas Legislature, lawmakers made it clear that despite a 9 to 1 federal funding match for expanding Medicaid to all citizens up to 138 percent of the federal poverty level, the expansion of Medicaid under the ACA was “simply not worth discussing.” According to the report, the state would have received an estimated $128 billion in additional federal funding from 2015 to 2024 by deciding to expand Medicaid.

In an interview with the Dallas Morning News, TAFP CEO Tom Banning said the Texas Legislature has wasted several opportunities to expand coverage. “We spent more time this last session talking about who can carry guns in Wal-Mart than about an issue with real-world economic implications for Texas employers, patients and taxpayers.”

A decision in King v. Burwell is expected before the end of June.

Read the report on the TACHC website,

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