Gov. Greg Abbott and other top leaders are talking about trimming the state’s budget, including in health care and education.

Meanwhile, the state’s main doctor group, the Texas Medical Association, is asking Abbott  – again – to accept federal Medicaid expansion. 

That’s the governmental insurance plan for low-income communities, paid for almost entirely by the federal government. And some legislators and others say that could painlessly solve the state’s budget problems.

The TMA letter pointed out that Texas is one of just 14 states to have turned down Medicaid expansion – which is paid for almost entirely with federal money. 

It would cover more than 1 million people, currently locked out from accessing those benefits because they make too much money.

Currently, a person has to be 18 or younger, a senior over 65 or disabled, and make less than the federal poverty line to qualify for the state’s Medicaid program.

That line is $12,760 for one person, $26,200 for a family of four.

The TMA group says people who could qualify for Medicaid expansion are essential workers – in grocery stores, restaurants and shipping warehouses – at higher risk of virus exposure. 

If they get sick, it hurts them, but also the state’s economy, trying to recover from a downturn without a healthy workforce.

The TMA notes that Texas is first in the nation in people without health insurance.

That number was 18 percent before the COVID-19 pandemic, and now about 29 percent.

The TMA letter, backed by 32 other organizations representing physicians, dentists, and child welfare groups, said expanding Medicaid would help many uninsured Texans cover costs associated with COVID-19 should they get sick.

“To truly defeat COVID-19, Texas must let loose every authority at its disposal,” said the groups’ Sept. 1 letter.

Some members of the Texas Legislature are also weighing in, noting that Abbott, Lt. Gov. Dan Patrick, and House Speaker Dennis Bonnen, all Republicans, may be suggesting the state tighten its spending belt when it will undercut vital needs, and cost more in the long run.

Respected Austin State Rep. Donna Howard, a moderate-progressive Democrat and longtime member of the House Appropriations Committee, has been calling for Texas to accept Medicaid expansion ever since the opportunity became available.

A House member since 2006, Howard outlined some of her thoughts about the budget situation in a Sunday (Sept. 6) column in the Austin American-Statesman.She warned about continuing talk of belt-tightening from state leaders, “despite the fact that there aren’t many notches left in our very lean budget.

“The pandemic has forced 3.2 million Texans to file for unemployment relief; at least 659,000 have lost their health insurance; and our oil and gas industry has taken hits from both the pandemic and a global price war,” Howard continued.

She pointed out State Comptroller Glen Hegar had revised his revenue estimate from a $2.9 billion surplus for the coming legislative biennium to a $4.6 billion budget deficit. Definitely a problem.

Howard said, however, that proposed budget cuts are a problem of their own.

They include, for starters, cuts in child support payment operations and child abuse prevention services, services for children with disabilities; women’s health services.

Plus, career and technology summer school programs; student mental health services, food pantries, and after-school tutoring; and student success initiatives in higher education.

Plus, graduate medical education (residencies); food bank supplies; home-delivered meals for seniors and Texans with disabilities.

But, rather than seeing the budget gap as a huge problem, Howard counseled considering it a creative opportunity to re-prioritize Texas spending – and readily available revenue sources, especially 

“It’s clear that we cannot tighten our belts out of this deficit,” Howard said. “If Republicans tightened the state’s belt any more, they’d squeeze the life out of Texans.

“The reality is, we don’t have a spending problem; we have a revenue problem,” she said.

The state’s budget, when adjusted for population increase and inflation, has stayed relatively flat over the past decade, Howard said.

But instead of greeting the predicted shortfall by “paring away at our already-lean budget,” she said the state should explore its revenue options.

Accepting Medicaid expansion alone “would return Texas taxpayer dollars to our state to the tune of $10 billion per year,” Howard said.

“And, of course, there’s the almost-$9 Billion Economic Stabilization Fund (known as the Rainy Day Fund), which could be used to help keep us afloat,” she added.

It was former Republican Gov. Rick Perry who refused to accept Medicaid expansion for Texas in 2013, while he was still trying to run for president. When Abbott became governor in 2015, he continued to refuse the expansion. 

He could solve, or certainly substantially relieve, Texas’ budget problems with a flick of his pen.


Contact McNeely at  

Mobile -- 512/751-3540.

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