While Rick Perry Holds Medicaid Funds Hostage, Texas Counties Consider Setting Up Their Own Expansions

More than 25 percent of Texans — about 6.2 million residents in the Lone Star state — are uninsured. The Affordable Care Act’s expansion of the Medicaid program would give Texas federal funds to help address that coverage gap, but Gov. Rick Perry (R-TX) has pledged to reject the Medicaid expansion, playing politics with the health of millions of his constituents who struggle to afford insurance.

County officials, however, won’t stand by as their governor refuses to take steps to improve Texas’ health care system, which is ranked as the worst in the nation. Frustrated with Perry’s authority to block funds that could positively impact county budgets as well as low-income Texans, they are discussing the possibility of circumventing the governor to set up their own Medicaid expansions in the the state’s largest counties:

George Hernandez Jr., CEO of University Health System in San Antonio, came up with the idea of the alternative, county-run Medicaid expansion, and said he has been discussing it with other officials in his county, Bexar. “They are all willing,” he said. He added that he has also been talking up the proposal with officials in other big counties, such as those including Houston and Dallas, and is optimistic they’ll support the idea. […]

The county-led effort would require the consent of both the White House and the Texas legislature. Federal officials would have to waive requirements that states apply the same eligibility standards statewide.

Whatever the plan’s fate, it shows that frustrated local officials don’t necessarily want to give the governor the last word on whether to accept millions of federal health aid that could ease local burdens.

Texas’ Medicaid program is one of the most restrictive in the nation, requiring a family of three to bring in an annual income of less than $5,000 to qualify for assistance — far less than the federal poverty line. In order to compensate, Texas’ biggest counties currently offer free or low-cost health care for uninsured residences whose incomes far surpass the Medicaid cut-off, but those programs are costly. Local officials say that expanding Medicaid would shift some of the costs to federal government, take some burden off strained county budgets, and provide for local tax cuts. Hospital officials also warn that Texas’ existing county programs should not operate as a complete substitute for Medicaid, pointing out that patients’ quality of care would be better under Medicaid than in the stop-gap programs in the counties, which are often stretched too thin.


Perry has remained largely oblivious to his state’s insurance coverage issues, even going so far as to claim that “everyone in America has access to health care.” Unfortunately for Perry, that is especially untrue for Texans. Nevertheless, Perry continues to align himself with the other Republican governors who are committed to turning down Medicaid expansion in their states at the expense of their uninsured residents.