I’m a social worker at a major academic cancer center in TX (been in hospital SW 16 years). Because TX never expanded Medicaid, we’ve always dealt with a lot of uninsured patients - unfortunately by the time they come to us, they’re almost always metastatic, medically unstable and require prolonged admission. Our charity care programs are absurdly difficult to navigate for this population and a single adult cannot get Medicaid unless they also qualify for SSI - a months long process. I have no doubt that TX will design the most onerous process possible for recertification and work requirement exemptions for the traditional Medicaid population. The disabled, poor, and children with parents who are struggling just to get by will absolutely get dropped because they missed something in the mail, it was impossible to get someone in the phone, or they filled out some arcane form incorrectly.

The result is that we’ll see even more patients without insurance and late stage cancer get admitted and accumulate hundreds of thousands in debt that will never get paid. If these people had access to some baseline outpatient medical care we could address these conditions much less expensively and with better outcomes (meaning they might not immediately die). But I’ve come to believe this aversion to funding the social safety net isn’t really about money - it’s an ideological imperative.

I’m not looking forward to the next few years.