The United States House of Representatives will be busy tonight. The Rules Committee will be meeting tonight at 1 AM to discuss Donald Trump’s Big Beautiful Bill. I would provide a link to this legislation, but they are keeping it under wraps. It is like getting hit by a Tesla. You won’t hear it coming, but you will feel the impact.
A key reason for these late night shenanigans is the need to pass a bill that will allow the Republican majority to continue the Trump tax cuts that are expiring without, officially, raising the debt. There are two ways to accomplish this. The first is to fudge the actual numbers. The second is to gut the social safety net. This is not the kind of debate that is televised to a national audience at 1 PM.
The Patient Protection and Affordable Care Act (Obamacare) provided for the expansion of Medicaid. As noted in my post of June 26, 2017 Dayenu, the de-stigmatization of Medicaid and the subsequent expansion to include the working poor may have been the most important part of this legislation. The Supreme Court ruled on June 28, 2012 that the states could choose to expand Medicaid, or not. Ten states have yet to expand Medicaid, the most notable being Texas. So it is no surprise that tonight, a Congressman from Texas, Chip Roy (R-TX), will be leading the charge towards bigger tax cuts and less health care. It is always Texas.
It might be instructive to look at some numbers for Texas in general and Chip Roy’s District 21 in particular. To be fair, Mr. Roy is very clear on his views. He has posted “The Case for Healthcare Freedom” on his website. He envisions a world where you have a hundred grand in your HSA so that you could negotiate your appendectomy at the Cleveland Clinic. The real world, especially for those who live in Texas, is very different.
The population of Texas 30,029,577
Percent Uninsured 16.6% #1
Number of uninsured Texans 4,984,909 #1
Fun fact – There are more people uninsured in Texas than the combined population of Delaware, South Dakota, North Dakota, Alaska, Vermont, and Wyoming.
Number on Medicaid/Chip in Texas 5,800,000
Chip Roy’s District
Percent of population uninsured & under age 65 14%
Percent of population uninsured age 18 and under 9%
Number of uninsured in District 21 86,377
Percent of population on Medicaid & under age 65 6.5%
Percent of children on Medicaid/Chip 15.3%
Number on Medicaid/Chip 43,200
The Commonwealth Fund produces The Scorecard For State Health System Performance. This is the link to the 2023 report. Texas rates, as usual, near the bottom. For those keeping score, Texas usually rates in the second half or lower on such charts as life expectancy and health rankings.
There has been an effort to pull Texas away from the likes of Mississippi, Louisiana, and Alabama. Expanding access to health care has been a real struggle. The Texas Standard has detailed the benefits of expanding Medicaid and, unfortunately, why it probably won’t happen in 2025. It is estimated that over 600,000 Texans do not qualify for either Medicaid or a tax credit subsidy under Obamacare. This is not a problem that the current Texas government nor its Congressional delegation has any interest in solving. Organizations such as the Heartland Institute work tirelessly to leave Texas where it is. This is the link to their Research and Commentary: Texas Medicaid Expansion.
Medicaid expansions benefitted insurers, hospitals, and providers while the population’s health worsened and average life expectancy declined in expansion states, Dr. Brian Blasé and David Balat of the Texas Public Policy Foundation found. “The ACA significantly expanded insurance coverage between 2013 and 2017, but Americans’ health worsened during this period and life expectancy declined for three consecutive years from 2014 to 2017,” the authors write.
Of course, by their logic, if we cancel everyone’s insurance we all live forever.
The clock is ticking. A bill will come out of the House of Representatives and if you make enough money, you might even find it big and beautiful. The rest of us are counting on the Senate to protect the rest of America.
Dave
Picture – Time To Insure – David L Cunix