San Antonio’s health‑care community is laying out a clear agenda for the 2027 legislative session, seeking bipartisan support for Medicaid expansion, increased funding for community health workers and the restoration of safety‑net protections that were cut during the second Trump administration.
Medicaid expansion seen as a tipping point
Texas remains the most populous state that has not adopted Medicaid expansion under the Affordable Care Act. Gov.-elect Gina Hinojosa has placed the issue at the top of her agenda, noting that roughly 1.1 million uninsured Texans could gain coverage if the program is broadened.
In Bexar County, 18 % of residents under age 65 lack health insurance, according to the U.S. Census Bureau. Dr. Lyssa Ochoa, founder of the SAVE Clinic on the South Side, described how delayed care due to lack of insurance leads to severe complications, including amputations for diabetic patients.
“Many of my patients present very late because they don’t have a primary‑care doctor,” Ochoa said. “They may have foot wounds that aren’t healing, and they don’t get seen until it’s too late.” Even insured patients sometimes skip specialist visits because copays are unaffordable.
Local leaders back expansion
Alan Kramer, chief financial officer of Methodist Healthcare Ministries, a nonprofit serving 74 counties in South and Central Texas, said his organization has long advocated for Medicaid expansion, affordable care and clean water. “Expanding Medicaid would have a significant impact on individuals in San Antonio and would allow them to access health care they’ve never had before,” Kramer said.
Methodist Healthcare Ministries also co‑owns the region’s largest hospital system, Methodist Healthcare System, in partnership with HCA Healthcare. The nonprofit plans to grow its policy and advocacy team, adding lobbyists in Austin and Washington, D.C., to capitalize on the new political landscape.
Hospital association’s cautious support
John Hawkins, CEO of the Texas Hospital Association, which represents more than 500 hospitals, expressed support for expansion but warned that provisions in H.R. 1 – the “One Big Beautiful Bill” crafted by the Trump administration – could create work‑requirement hurdles and financing challenges for new expansion states.
“We support more coverage, without unintended consequences,” Hawkins said. “Options need to be studied and understood before finalizing an expansion strategy.” He also urged the Legislature to remove enrollment barriers in the existing Medicaid program and to leverage existing coverage expansions for mental health, women’s health and rural health.
Backlog and federal attention
Delays in processing Medicaid applications have surged, with a backlog of over 200,000 pending cases as of August. U.S. Rep. Joaquin Castro (D‑San Antonio) and fellow Democrats have asked HHS Secretary Robert F. Kennedy Jr. and Texas Health and Human Services Commissioner Stephanie Muth to investigate the bottleneck.
Community health workers and SNAP reforms
Methodist Healthcare Ministries and other local providers are also lobbying for better reimbursement for promotoras – community health workers who connect residents to care. Kramer noted that current Medicare and Medicaid rules provide limited support for these essential workers.
Ochoa echoed the need for paid community health navigators, saying they are key to closing the health‑care gap on the South Side.
Additionally, the nonprofit wants Congress to revisit recent changes to SNAP under H.R. 1, which tightened eligibility and enrollment. Texas saw a 20 % drop in SNAP enrollment from September 2025 to September 2026, according to the Texas Tribune.
Optimism for a receptive Congress
“We’re optimistic about the change in politics,” Kramer said of the upcoming midterms, adding that more ears in Austin and D.C. are now willing to hear their message.
San Antonio’s health leaders remain hopeful that a combination of state action, supportive federal legislation and targeted community‑based programs will finally bring expanded coverage to the millions of Texans still waiting for health‑care access.
Original reporting: San Antonio Report — read the source article.
