If the cost of insuring the poor in Texas is high, several Texas economists see an even higher price in failing to provide that medical care.

The Perryman Group, an economic and financial analyst company based in Waco, published an economic study of Medicaid expansion in February 2013. The findings were striking, as revealed in the report’s title: “Only One Rational Choice: Texas should participate in Medicaid expansion under the Affordable Care Act.”

The study looked at revenues, jobs, and costs of the expansion and found that not expanding Medicaid coverage would cause substantial economic damage. “The needs of Texans do not go away because individuals do not have insurance coverage,” the researchers wrote. “In fact, they compound and become worse over time.”


The study estimated that the Medicaid expansion, in its first 10 years, would have created a net benefit to Texas of more than $255 billion and nearly 300,000 permanent jobs. Those benefits, the economists wrote, would have been spread to every part of the state. Fort Worth and Arlington would have gained $22 billion in revenue and almost 27,000 jobs, for instance.

Burnam: “Turning down Medicaid expansion was the stupidest thing you could do economically.” Robert Hart
Burnam: “Turning down Medicaid expansion was the stupidest thing you could do economically.” Robert Hart

Billy Hamilton, a former deputy state comptroller who now works as a consultant, came to similar conclusions in a report released about the same time.

That study, prepared for Texas Impact and Methodist Healthcare Ministries of South Texas, called Medicaid expansion “smart, affordable, and fair.”

Among the key findings was that, without the expansion, local governments and hospitals are likely to spend more than six times as much on medical care for low-income patients as the state would pay for its share of expanded Medicaid costs.

The consultant predicted that the expansion would provide coverage for as many as 2 million additional people, including up to 878,000 children.

In May of this year, a report by Texas Well and Healthy, a statewide grassroots organization dedicated to healthcare delivery, concluded that expanding Medicaid eligibility would not only reduce insurance premiums that currently “compensate for the high number of uninsured and unhealthy Texans,” but would save Texas employers up to $399 million in ACA penalties for failing to insure their employees. The expansion would provide insurance for 66,000 veterans and their spouses and save as many as 9,000 lives each year, researchers said.

A Houston minister who left her administrative assistant job with Shell Oil to help her daughter start a business is one of those who figures that Texas’ failure to expand Medicaid benefits could have cost her life.

Tina, who asked that her last name not be used, lost her health insurance when she quit the oil business to help her daughter open a child-care center. Neither of them could afford health insurance at that point, and Tina missed several years of annual gynecological exams.

She finally went to the doctor to see about a nagging pain in her left hip. “I tried to ignore it but finally had to go to a family clinic, and they did a Pap smear and discovered the cancer in 2012,” she said. She had an aggressive form of cervical cancer.

Had Tina been insured, “her cancer would have been discovered at a much earlier and more treatable stage,” said Laura Guerra-Cardus of Texas Well and Healthy. “As it is, once the cancer was discovered, Tina was able to get into a state program for breast- and cervical-cancer patients. It’s one of a patchwork of diagnosis-specific healthcare programs that would no longer be needed if we had Medicaid coverage expansion for low-wage Texans.”

The cancer was treated and went into remission, but Tina recently learned that it has returned, this time in her lung and liver. Now, at least, she is eligible for Medicaid, only because she qualifies as disabled. She will be able to get treatment.

“What’s important to remember is that I [originally] got into a program that treats people with breast or cervical cancer,” she said. “If the cancer had first showed up in my lung or liver, I don’t know what I would have done.”

By refusing to expand Medicaid, Guerra-Cardus said, “Perry is going to have a lot more women like Tina who cannot afford even a Pap smear and don’t have a women’s health clinic” close enough to go to where they could get the annual test done free.

“It doesn’t need to be that way,” she said.




  1. So– all 23 states (out of 50) which have declined to expand Medicaid are “Republican run” as in: having Republican governors and legislatures? Nearly half of the states in the country have NOT expanded Medicaid– and this is Rick Perry’s “fault”? None of that is very logical.

    • Governor Perry is only responsible for Texas having turned down the Medicaid expansion. The other governors are responsible for their own states.

      • OK–so you agree that 23 states (quite a few) also have declined to expand Medicaid. Some of these are probably not “Republican” states, and their elected officials have decided that Medicaid expansion is not desirable–just as Perry has. There was an article in the WSJ yesterday about declining Food Stamp use in states, like Texas, which are economically stable and which have enabled people to participate in the work force because of a good local economy, subsequently getting off of the welfare rolls. Most people want to be in an environment where they can be gainfully employed rather than in a declining welfare state. Being on Medicaid or other welfare is not ideal for the taxpayers or the welfare/Medicaid recipients. A good state economy is the most beneficial to all.

        • Yes, and Rick Perry has turned down 200,000 to 300,000 upper middle class jobs–enough to end unemployment in Texas, by refusing Medicaid expansion.

          • I am not even going to ask you to verify your numbers, I will ask you this, though, where is the money for those “jobs” coming from? Government jobs, paid with Government money, paid for by the people. Pretty soon everyone will be employed by the Government to enforce the Governments agenda, and those who actually contribute to the economy will be taxed to Death or Switzerland. New Utopia.

          • Perry has not “turned down” any viable jobs. Texas and other conservative well run states lead the nation in job creation.

        • Actually, the 20 states which have refused expanding Medicaid, and two of the three which are undecided, either have a Republican governor or Republican legislature. So yes, this is a partisan issue.
          Aas for foodstamps: in 1971, a college kid could get $200 a month in about 20 minutes. Here in Texas in 2014, a family making something like $20 grand a year for four people–essentially homeless people–make too much to qualify. Texas has never welcomed poor people.

          • In 1971 college tuition was 1/10th of what it is today.Part of education”inflation” has more to do with govt. policies and tenure policies gone wrong then anything else combined with lax immigration policies. You need to have a basic history and economics tutorial,Mr. Gorman. Perhaps a basic math course also. For the record, in 1971 very few college students or grad students needed to be on food stamps, because life was more affordable–something which would be nice to see today or in the future when govt is reined in.

          • What exactly do you see in today’s world that gives you any hope that government will ever be “reigned in”?

          • Economically there is usually a “tipping point” where a turn around is possible because the status quo is intolerable.

  2. First I must admit I have not finished the story because I got mad and had to put it down for a minute but I want to mention (in case this story does not) that the issue of affordable healthcare extends beyond the “poor” and unemployed/uninsured. I work and make a decent amount of money and I have a pretty good insurance policy. I pay a pretty hefty premium every month and with only a few minor health issues, I still can not afford to go to all the doctors I am supposed to see or pay for the diagnostic and preventative medical care I need. I have had to borrow money to cover my share. I know everything in this article about our governor is true and failure to expand Medicaid is a huge problem but the entire system is out of control. From where I am sitting it sure does fell like that as a country we simply do not care about providing quality healthcare to anyone but the wealthy. I recently paid twice as much for an MRI because I chose to run it through it through insurance so it could go against my deductible. What kind of scam is that and who is running this circus anyway?

    • To Stacy: The increases in insurance premiums and subsequent increase in deductibles has nothing to do with Gov. Perry or Medicaid expansion (which you probably would not qualify for -because you seem to be a hard worker- even if it was expanded–no offense). The insurance companies were 100% behind the PPACA legislation passed by the Obama administration and Democrat controlled Senate and Congress in 2010. To my knowledge no Republican voted for this cumbersome piece of legislation . Your premiums are high due to the mandates for coverage which are not applicable to much of the population. The fact is employers soon may not be able to subsidize your coverage–which will leave you further on your own. Meanwhile insurance companies are making more money than ever at your expense. As far as your MRI is concerned, most insurance companies have significantly reduced payment to outpatient facilities and non hospital physicians to a degree which makes it difficult for most physicians to stay in business. If you received an MRI in a hospital-the AHA has effective lobbyists, as do the health insurers- or in a hospital owned/affiliated outpatient or “mini ER” facility you will have to pay hospital prices which are 3-10X higher than ordinary unaffiliated outpatient facilities. The accreditation standards of cheaper outpatient facilities are equal to and frequently better than those at the hospital. Also many physicians direct patients to more expensive hospitals,surgery centers or imaging facilities where the primary care physician or surgeon has a part ownership. The referring doctor has an ethical obligation to disclose ownership or other financial ties to such facilities and this should be posted on the wall of the physician’s office. You should always ask, however. None of this,however has anything to do with Medicaid expansion in Texas or elsewhere.

    • I realize the two are not directly related and because of that, perhaps I should not have posted on this thread. I am just very frustrated. America claims to be the greatest nation in the world but we can not get this health care issue and many other equally

  3. Important issues handled in a suitable manner. I would love to blame Perry and while he is definitely part of the problem, it goes much deeper. Frankly I am embarrassed to be part of a nation where profit seems the only motivation for anything.

    • There are many people in this country who have sacrificed so that their fellow citizens could have a better life. Profit is not the ONLY motivation for anyone I know.

      • When Baggers & Repugs are mentioned, Mother Therrisa immediately comes to mind. Good point skeptic. You’re a real piece of work skeptic…you know that? I’m praying for you.

        • Oh goody –the FWW TROLL has come back to life with its personal contributions to humanity which are less than ZERO. Pray for yourself– Benny.

          • Why don’t you get a decent job and amount to something reader? What do you eat? Pull yourself up by your bootstraps. Where is the Startle-Gram hang out now, the bus station?