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Items of Comparison
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California
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Texas
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Context and importance of the problem to expand or not expand Medicaid
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Adopted a Medicaid expansion program called Medi-Cal in2014 through the Affordable Care Act (ACA). The state’s uninsured number stood at 17.2 percent in 2013, prompting the adoption of the Medicaid expansion program to cover more low-income individuals.
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Texas opted out because of the state’s opposition to outreach and enrollment for the many Texans who are eligible for coverage under the ACA. Texas has maintained a highly restrictive Medicaid eligibility policy for low-income adults in Texas as compared to their counterparts in California.
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Critique of policy options
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The move to expand Medicaid was right because it has played a vital role in decreasing the state’s uninsured rate. As a result of the expansion policy, Medi-Cal enrollment grew by more than 5.6 million people since its adoption.
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The decision not to adopt the Medicaid expansion program has left many low-income Texans who are eligible under the ACA without insurance coverage. Had it accepted the policy, approximately a million uninsured Texans would be eligible for Medicaid under the expansion.
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Stakeholders
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California state government, including the governor, Federal government, and state hospitals’ leaders, California’s Legislators.
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Healthcare Leaders, Texas’ legislators, including attorney general.
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Potential or actual effects of this decision or action
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Since the adoption of the policy, approximately 3.4 million were eligible due to the ACA’s expansion of Medicaid, which took effect in 2014. Medi-Cal enrollment has grown significantly since 2014. Besides, undocumented immigrant children gained access to the Medi-Cal program.
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Texas’ refusal to accept Medicaid under the ACA could potentially kill more than 738 low-income individuals annually because they cannot afford healthcare services due to lack of insurance coverage. Besides, the decision not to expand Medicaid also impacted the capability of low-income adults to pay for and access care.
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Financial considerations
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The expansion of Medi-Cal has not been cheap. It is noted that 38 percent of California taxes are utilized to fund Medi-Cal, and Medicaid spending in California accounts for 27 percent of the state’s expense, as opposed to an average of 17 percent nationwide.
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Texas would have received $10 million annually had it accepted the policy option to expand Medicaid under the ACA. Besides, this amount would also come from the taxpayers’ money as opposed to the leaders’ claim that it is free money and cannot accept it.
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References or sources consulted or recommended
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Norris, L. (2020). California and the ACA’s Medicaid expansion: eligibility, enrollment and benefits. Retrieved 6 March 2020, from https://www.healthinsurance.org/california-medicaid/
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Christi Caller, C. (2019). How many people die because Texas refuses Medicaid expansion? Who's to blame?. Retrieved 6 March 2020, from https://www.caller.com/story/opinion/2019/08/07/why-does-texas-allow-730-people-year-die-needlessly-medicaid-expansion-greg-abbott-michigan-study/1932174001/
Sommers, B. (2016). Medicaid Expansion in Texas: What's at Stake? | Commonwealth Fund. Retrieved 6 March 2020, from https://www.commonwealthfund.org/publications/issue-briefs/2016/apr/medicaid-expansion-texas-whats-stake
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