FORT WORTH, Texas — After the November 3 elections handed Democrats control of the governor’s office, the lieutenant governor’s seat and a majority in the Texas House, health advocates are optimistic that Medicaid expansion may finally become a reality in the Lone Star State.
Political shift creates new opportunity
For years Texas has led the nation with the highest uninsured rate, leaving nearly 4 million residents without affordable coverage in 2024. The recent electoral outcome marks the first time since the Affordable Care Act was enacted in 2010 that a Democratic‑led state government could pursue expanding Medicaid.
What expansion would mean
Under the ACA, states can broaden Medicaid eligibility to adults earning up to 138% of the Federal Poverty Level—about $21,597 for an individual in 2025. The federal government would shoulder 90% of the costs, leaving the state responsible for the remaining 10%.
Expanding coverage could make hundreds of thousands of Texans eligible for health insurance and would alter the operations of county hospitals such as JPS Health Network, which currently must provide low‑cost care to uninsured adults.
Advocates’ renewed focus
“Now, with new state leadership, Medicaid expansion is a tangible reality rather than an ongoing conversation,” said Lynn Cowles, health and food‑justice policy director for Every Texan.
Diana Forester, director of health policy at Texans Care for Children, added that health will be a top priority in the upcoming legislative session.
Work‑requirement hurdle
The One Big Beautiful Bill Act, signed last year, imposes work‑or‑school requirements on Medicaid recipients—80 hours per month of employment, schooling or community service, with limited exceptions. Critics point to Arkansas’s experience, where similar rules led to thousands losing coverage.
John Hawkins, CEO of the Texas Hospital Association, warned that the work‑requirement provisions in HR 1 could make administering an expansion “unworkable” and called for federal action to restore ACA marketplace subsidies and repeal the punitive cuts.
Next steps
Advocates acknowledge the need to amend the One Big Beautiful Bill Act but remain confident that the Democratic majority will prioritize Medicaid expansion alongside other health‑care goals, such as streamlining enrollment for children and pregnant women and clearing a backlog of 238,000 pending applications.
“We are pushing for Medicaid expansion now,” Cowles affirmed, emphasizing that the upcoming legislative session presents a critical window for action.
Original reporting: Texarkana Gazette — read the source article.
