Texas Democrats outline plans to reintroduce Medicaid expansion in 2023 legislative session


Boram Kim


Texas state legislators led a panel discussion on Democratic health policy leadership at the 2022 North Texas State of Reform Health Policy Conference on September 27th. 


Stay one step ahead. Join our email list for the latest news.



Speaking to an audience of leaders in the health care space in North Texas, Sen. Nathan Johnson (D – Dallas) and Rep. Julie Johnson (D – Carrollton) looked ahead to some of the health care reforms they plan to pursue in next year’s legislative session.

Sen. Johnson filed 2 bills on Medicaid expansion last session and confirmed during the conference that he would introduce the bills again in the next to address the “exorbitantly” high rate of uninsured Texans. 

“The monetary return [due to federal matching contribution] from the relatively small investment we would have to put into [Medicaid expansion] doubles,” Sen. Johnson said. “It comes back double, like $1.95 over 10 years for every dollar we put in plus $1.58 and local spending. That’s $3.43 for each dollar that we put in. When you look at the costs that we are spending right now—because we haven’t extended—that we wouldn’t be spending [if we expanded Medicaid], plus the revenue we get from these little MCO taxes we have in every single policy, it’s about a breakeven.”

Citing economic models observed in 38 states, Sen. Johnson said expanding Medicaid would provide a huge financial benefit to Texas and give people greater dignity, independence, access to work and stable income, and better health.

The senator also pointed to new evidence that showed property and violent crimes fell in states where Medicaid was expanded. 

Rep. Johnson said she was hopeful that the issue would garner more support from her Republican colleagues and help the bill make it to a floor vote next year.

“I was very grateful to the 9 [Republican House members] that did [express support] because they saw the benefit to their community,” Rep. Johnson said. “A lot [of them] represent rural Texas. A lot of them had hospitals close in their districts, and they were like, ‘Electoral consequences be damned. This is what’s right for my community. This is what’s right for Texas, and I’m gonna lead on it.’

I was thrilled when all of them handily won reelection. Obviously they’re supportive. Medicaid expansion was supported by their constituents in their district and I hope to have each one of them sign off on the bill again because we’ll both be following it again.”

Both leaders spoke of the need to address the social determinants of health, compensation rates for health care workers, and interoperability of health information exchange, all of which would require broader legislative funding. 

Texas has lagged behind the rest of the country in health care funding for decades, which has led to the state having the highest uninsured rate in the country, as well as low rates of care quality, health equity, and health care affordability and access. Both leaders view the next session as a reformative one in health care and urged the people in the room to take the lead in advocacy and innovation efforts by pressing legislators to take action. 

“Look at independent care coverage for attendants—$8.15 an hour,” Rep. Johnson said. “That’s inexcusable when you can make twice that flipping a burger. We’re never going to get the workforce we need in this area. Last budget cycle, we debated this ad nauseam. So many families came in heartbroken with just wrenching stories of their need to increase funding … It’s incumbent upon people in the health care space, to educate, to lean, to become health care voters, and for the electorate to let their elected officials know [that] they’re watching on health care, they’re voting on health care, and they demand that we do something.”

As Vice Chair of the Senate Administration Committee, Sen. Johnson said he will be working to take the state’s historic budget surplus and move it into broader health system investments. 

“I think we’re going to see some investments in mental health in particular,” he said. “I also hope we see some investments in the broader health care system. But then the other area … we need help [in] is in figuring out ways to do things better. What is more efficient?

Costs are huge. Something that my team and I have been looking [at] is taking back the health exchange, make it a state-based exchange instead of a DC-based exchange. We could save many hundreds of millions of dollars. Perhaps that money could be invested in the terms of subsidies to help more people purchase private health insurance. Interoperability of health data information systems has been a problem for decades.

There’s a lot of good people working on that. We’re working on that. If we can find more efficient ways to do things, we might have fewer headaches for physicians who are willing to participate in public health. Then I think that’s important.”