Supporters of sweeping tax and spending legislation sent to President Donald Trump say changes to Medicaid, food aid, and other programs will encourage personal responsibility and stop system abuse.
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In Texas, Medicaid covers a third of all children, half of all pregnant women, the elderly in long-term care, and the disabled. Critics say new requirements in the bill will disrupt lives, while supporters argue it will prevent people from scamming the system.
The bill introduces work requirements for many adults ages 19 through 64 to enroll and remain on Medicaid. Beneficiaries would need to work, attend school, or perform at least 80 hours of community service a month. This change will heavily impact the 40 states that expanded Medicaid. Since Texas did not expand Medicaid in 2014, it is in a unique position.
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Ann Barnes, president and CEO of the Episcopal Health Foundation, said there’s a possibility Texas may not be as hard hit as other states but is already behind in insurance coverage.
“I don’t think that we will be as hard hit, but we are already behind many other cities and states in the country. Fewer people in Texas have insurance. In fact, we rank number one in the uninsured rate. So we’re already behind the ball,” Barnes said.
She added that if Medicaid funding is reduced, Texas will face tough decisions. The state may have to choose which populations remain eligible—children, elderly, pregnant women, or the disabled—or reduce services and reimbursements to the point that care is minimal.
“These are things that are really concerning to me. I do think that the effect on Texas is maybe less dramatic than it will be on some other states, especially those that expanded Medicaid,” Barnes said.
Most people covered by Medicaid already meet the work requirements or qualify for an exception. However, advocates worry that even those who meet the requirements could lose coverage because eligibility will be reassessed regularly by 2027. They fear paperwork could get in the way.
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Community clinics, which rely on Medicaid for up to 70 percent of their revenue, expect to feel the impact.
Barnes also warned that cuts could lead to job losses, with an estimated 100,000 health-related jobs at risk in Texas. Fewer staff and services could overwhelm emergency rooms, affecting everyone, including those with private insurance.
We will share more details on how these changes will affect Texans and local clinics on Monday morning during KPRC 2 News at 6 a.m.
