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Democrats Sidestep GOP Leaders To Expand Medicaid In Texas

SARAH MCCAMMON, HOST:

The Affordable Care Act allows states to expand their Medicaid coverage, but 12 states, including Texas, have not done so. Now, Democrats in Congress have an idea to go around those state leaders and allow local governments to expand Medicaid themselves. The move highlights the often rocky relationship between the federal government, conservative state leadership, and in Texas, their more liberal cities. Texas Public Radio's Paul Flahive has more.

PAUL FLAHIVE, BYLINE: Texas has more than 5.2 million people without health insurance. At more than 18% uninsured, it's double the national average. And people without coverage are less likely to get screened for disease or have an annual checkup, delaying care until it's sometimes too late, says Tommye Austin, chief nurse executive for San Antonio's university health system.

TOMMYE AUSTIN: Cancers that have not been diagnosed, chronic illnesses such as diabetes and other illnesses that you might see someone who has gangrene in their limbs because they have not done the proper care.

FLAHIVE: Despite polls regularly showing expanding Medicaid is popular in Texas, that support doesn't extend to the state's Republican leadership. For a decade, GOP leaders have fought the Affordable Care Act and its Medicaid expansion. Former Texas Governor Rick Perry called Medicaid expansion, quote, "fiscal coercion." He didn't trust the federal government to pay what it said it would. Here he is in a 2013 speech saying it could leave Texas holding the bag.

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RICK PERRY: Nothing stops Washington from changing the rules down the road and increasing the state share, which in the case of Texas, will be up to more than $18 billion over 10 years.

FLAHIVE: A decade later, states pay just 10% of the expanded coverage. But leaders of the Texas GOP haven't budged in their opposition.

LLOYD DOGGETT: Well, thank you all very much for being here.

FLAHIVE: So last month, Democratic members of Congress, led by Texas's Lloyd Doggett, announced legislation to offer Medicaid expansion dollars directly to cities, counties and hospital districts.

DOGGETT: Congress needs to help us overcome state Republican obstruction and provide an alternative pathway to access health care for about 6 million Americans who've been denied access to Medicaid.

FLAHIVE: The bill has more than 40 co-sponsors in the House, but faces an uphill battle. Congressional Dems hope it will be included in a reconciliation bill, avoiding a filibuster in the Senate. Under the plan, local governments could contract directly with the Centers for Medicare and Medicaid Services. San Antonio Mayor Ron Nirenberg knows the process could be cumbersome, but he says he would take the funds, pointing out Texas residents have been paying for benefits they've yet to receive.

RON NIRENBERG: Absolutely. It's already money we are simply sending to other places in the country that should be coming home to do what it's intended to do, and that is provide access to public health.

FLAHIVE: Doggett's office predicts they can enroll about half of the state's eligible population just from Texas's major cities. The other half live in rural Texas.

DOGGETT: The demographics of rural Texas are very challenging. We say older, poorer, sicker.

FLAHIVE: And John Henderson with the Texas Organization of Rural and Community Hospitals says even though Texas leads the nation and rural hospital closures because of politics, small conservative counties wouldn't take the money.

JOHN HENDERSON: Even if it were to pass, I'm not aware of a rural county that would take the help in Texas.

FLAHIVE: So while Doggett's bill could give more than a million Texans health care, it would likely bring the patchwork of coverage and partisan battles over who gets it to the local level. For NPR News, I'm Paul Flahive in San Antonio. Transcript provided by NPR, Copyright NPR.