One afternoon in April 2021, state Sen. Nathan Johnson sprinted through the Texas Capitol building, determined to reach the House chamber in time to see history made. For one of the few times since the Affordable Care Act was passed in 2010, the full Texas House was going to vote on a proposal to expand Medicaid, the program that provides health care to America’s poorest.
An ongoing series on the 11 states that refuse to expand Medicaid. Read other project stories.
Eighteen percent of Texans don’t have health insurance—the highest rate in the nation—and Johnson had already filed five pieces of legislation that session to use Medicaid expansion to get as many as 1.2 million of those people insured.
To him, the approach made sense. The federal government would pick up 90% of the cost. Research showed that by rejecting Medicaid expansion, Texas was turning its back on more than $5 billion in federal money every year.
All of Johnson’s bills were likely dead that session, doomed by opposition from Republicans whose hostility toward the Affordable Care Act goes back to 2013, when then-Gov. Rick Perry called it a “criminal act.” But as he ran to the House chamber that day, Johnson clung to a faint hope that this new effort would succeed. Nine Republicans had recently signed onto a House version of his last expansion bill, suggesting that cracks were forming in the GOP front.
If Republicans were looking for a way to expand Medicaid on their own terms, this bare-bones amendment to a House budget bill could be it.