When the window to sign up for health insurance coverage for 2021 closes on Tuesday, many individuals in the Rio Grande Valley will remain uninsured for various reasons including the loss of employment through which they received health benefits or even misconceptions about who is eligible for coverage.

However, one single thing that state legislators could do that would significantly increase health coverage in Texas and the Valley is to expand the Medicaid program, according to Anne Dunkelberg, associate director of left-leaning Every Texan, an Austin-based nonprofit policy research and advocacy organization, formerly named the Center for Public Policy Priorities.

Texas is one of only 12 states in the country that has not expanded the Medicaid program under the Affordable Care Act, or Obamacare.

If Texas were to expand Medicaid, 119,200 people in the Valley would be newly eligible for benefits, according to a study by the Bush School of Government & Public Service at Texas A&M University.

Of those eligible people, 88,400 are likely to enroll for coverage, the study projects.

In the Rio Grande Valley, about 29% of the population is uninsured, according to data from the U.S. Census Bureau, compared to 21% statewide and 9% nationwide.

Because of the economic downturn brought on by the COVID-19, though, the uninsured population in the Valley and statewide is expected to be much larger.

“The latest estimates are (that) we’ve had so many people lose their jobs because of the pandemic and the economic downturn because of the pandemic that probably, by January, we’ll probably be looking at, at least, 2.2 million of our uninsured in Texas,” Dunkelberg said. “And it may turn out to be an even higher number because those estimates were based on where we were in the pandemic around June.”

Dunkelberg explained that through Medicaid expansion, the federal government would pay 90 cents on the dollar for the cost of coverage which would be a lot more than their current match of about 60 cents on the dollar in the regular Medicaid program.

“So we could be getting that money and we’re not,” she said. “It comes from the federal treasury so when you sit down to pay your federal income taxes, we don’t get a discount in Texas because we’re not asking for our money back, and it is billions of dollars a year — the estimates range from $6-10 billion a year that we’re leaving on the table because of that.”

The Texas A&M University study projected the state would receive $5.41 billion more in federal dollars through Medicaid expansion and about 954,000 of Texans would likely enroll out of the 1,274,000 who are estimated to be newly eligible under the program.

The Henry J. Kaiser Family Foundation estimates that 1.5 million uninsured, non-elderly adults in Texas would become eligible for coverage, which they project would jump to 2.2 million by January.

The Kaiser data also shows that about 76% of the eligible individuals are in a family with at least one worker, 57% are Hispanic, and more than half are women.

Since the implementation of the Affordable Care Act in 2014, state Democratic legislators have pushed for Texas to adopt Medicaid expansion without success.

But Dunkelberg said the projected savings to the state and the financial stresses of the pandemic have led Medicaid expansion to be in the conversation among some Republicans.

“One of the things that it has made clear is that the savings to the state budget — which, we had heard this from other states that already did Medicaid expansion — that the savings to the state budget are greater than the cost of that 10% share,” Dunkelberg said.

The state would save about $488 million per year on services it currently fully funds such as inpatient care for people incarcerated, community mental health services, substance abuse treatment centers, the HIV Medication Assistance Program, and the Kidney Health Care Program, according to a report funded by the Episcopal Health Foundation.

Overall, the report projects $110 million in additional annual revenue and a total positive impact of $704 million per year.

“So when you put all that together, the total positive impact is actually greater than the state’s share cost,” Dunkelberg said. “And because of that and because of the fact that we have this revenue downturn because of the COVID economic crisis, you are finding a lot more moderate Republicans talking about the need to consider Medicaid expanding.”

State Rep. Lyle Larson, R-San Antonio, wrote in a Twitter post in October that lawmakers should “seriously consider accessing federal Medicaid funding” during the next legislative session in 2021.

In the lead up to the November elections in which state Rep. Morgan Meyer, R-Dallas, won reelection, he told the Dallas Morning News that while he had supported only a limited Medicaid expansion in the past, he said the pandemic had brought on “unprecedented” circumstances that called for the program’s further expansion.

Other questions remain about the impact of expansion as some physicians worry about the lower reimbursement rates from Medicaid compared to private insurers.

The Texas Public Policy Foundation, a conservative think-tank, has also advocated against expansion, arguing it would cost more than expected.

They also pointed to findings by the Medicaid and CHIP Payment and Access Commission that only about 70% of providers were likely to accept new patients insured by Medicaid, compared to 85% willing to take patients with Medicare, and 90% willing to take those with private insurance.

Despite lingering concerns and continued pushback among conservatives, Dunkelberg said it was significant that it was being talked about.

“Now, that is a long way from a done deal,” she said, “but it is the first time that we’ve seen a number of different Republican lawmakers actually talking about it in public and saying this is going to be part of the discussion.”