Texas is waiting for the Supreme Court’s ruling on the Affordable Care Act with bated breath, because Texas politicians have been dragging their feet in passing legislation compatible with the Affordable Care Act. The state is fundamentally unprepared if the Supreme Court decides to uphold the ACA.  Due to our huge poor population and the individual mandate, millions of people in Texas would be added to Medicaid. Even though the feds will be paying for almost all of this new population, Texas still hasn't dealt with funding our current Medicaid numbers.

The Texas government has prepared for the Supreme Court overturning the Affordable Care Act by passing SB7, in which Texas would receive federal money formerly meant for Medicare and Medicaid, that can be used however the state decides - but that's not guarantee that Texans will get the health care they need. Additionally, SB7 made Texas a member of an interstate compact, in which several states would create a commission that would advise the states on health care issues. This interstate compact, known as the Health Care Compact, must first be approved by Congress in order to go forward. With the health care compact, federal programs within Texas could be easily dismantled and replaced with untested state programs, thus taking away programs that Texans have come to depend on. 

Right now, the majority of people on Medicaid in Texas are poor children, the disabled, the elderly and low income pregnant women. Unlike other states, Texas has only done the bare minimum to comply with the federal Medicaid standards. Due to the ACA’s expansion of Medicaid eligibility many low income adults without children will have the opportunity to enroll in Medicaid. Texas is already lagging in its number of primary care doctors, many of whom do not take Medicaid due to the low payments that Medicaid pays out to doctors. Even as Texas worries on how to provide adequate general care to potentially millions of new Medicaid patients, Texas has to confront the issue of its population growing faster than it can produce doctors. State cuts in medical residency programs only exacerbate the potential lack of doctors. Texas' only current solution, the health care compact (which assumes that the Affordable Care Act will be overturned), would create unproven statewide programs that could worsen care for Medicaid patients and possibly all Texans. 

Texas' politicians have spent so much time on creating legislation in case that the Supreme Court does not uphold the Affordable Care Act, that it is completely unprepared for when the Supreme Court does uphold the ACA. In their highly politicized efforts to avoid showing any support for the ACA and their eagerness to create legislation against the ACA, Texas politicians have risked the healthcare system in Texas. If the Supreme Court upholds the ACA, hopefully state politicians will move beyond their partisan posturing in order to pass laws for the benefit of Texans.