Medicaid expansion remains unlikely in Texas

Texas lawmakers remain unlikely to expand Medicaid anytime soon, despite other red states showing new openness to the idea. Driving the news: In the decade-plus since the landmark Affordable Care Act was enacted, 12 states with GOP-led legislatures still have not expanded Medicaid coverage to people living below 138% of the poverty line (or nearly $19,000 annually for one person in 2022). But there's evidence that the political winds are changing in holdout states as leaders court rural voters, assess new financial incentives and confront the bipartisan popularity of extending health care coverage.

In Texas, the state with the highest percentage of uninsured residents per capita, some Republicans have co-sponsored Medicaid expansion bills. That indicates "cracks" in Republican opposition, Luis Figueroa, legislative and policy director at progressive think tank Every Texan, told Axios. Yes, but: Proposals to expand Medicaid did not even get a committee hearing in 2021 — let alone a vote on the Texas House or Senate floor. What they're saying: Based on the history of the state's Republican leadership, there's no reason to think 2023 — the next time the legislature convenes in Austin — will be any different from 2021, David Balat, a former hospital administrator who now runs the health care initiative at the conservative Texas Public Policy Foundation, tells Axios. State Sen. Nathan Johnson, a Dallas Democrat who has led the push for Medicaid expansion, said he doesn't expect to see it pass this session, but noted he was optimistic about last session's shift, where it became "a subject at the forefront of the state."