2020 TX Voter Guide: Health Care Questions for Candidates

What candidates get asked about when they run for office can set the stage for what they care about when they are elected. If we want Texas lawmakers to take action on healthcare coverage in the 2021 legislative session, we must ensure that while they’re on the campaign trail, they get asked questions again and again about healthcare. Every candidate, whether incumbent or challenger, must be on the record with plans to address Texas’ health coverage crisis.

This guide provides sample questions and the background you need to feel confident about asking your healthcare question. There are a number of key healthcare issues that candidates need to address, and one thing is at the heart of many: Texas has a health coverage crisis and our state government must make different policy choices in the future to solve it.

We’ve put together questions and some background material on the issues that state and federal candidates need to address in 2020. As you research the candidates on your ballot, look for their positions on these issues. If you don’t find a satisfactory answer, reach out to the candidate’s campaign, ask questions on social media, or better yet — go to a public campaign event and get your candidates on the record.

The questions in this guide can be used for state House and Senate candidates, as well as for Congressional candidates.

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Key 2020 Election Dates

March Primaries:

• Last Day to Register to Vote in Primaries: February 3, 2020

• Primary Early Voting: February 18 - February 28, 2020

• Primary Election Day: March 3, 2018 

May Runoff:

• Last Day to Register to Vote in Runoff: April 27, 2020

• Runoff Early Voting: May 18 - May 22, 2020

• Runoff Election Day: May 26, 2020 

November General Election:

• Last Day to Register to Vote in General Election: October 5, 2020

• General Election Early Voting: October 19 - October 30, 2020

• General Election Day: November 3, 2020

Questions for Statewide and Texas Legislature Candidates

Expanding Healthcare to All Texans

What to Ask:

What will you do to ensure that everyone in Texas has access to high-quality, affordable health insurance coverage, regardless of their income?

How will you ensure that none of your constituents are left behind and in the coverage gap created by Texas’s refusal to expand Medicaid?

Why It Matters:

Texas has the highest rate and largest number of uninsured people in the country. 17.7% of Texans are uninsured, including 11.2% of Texas children. That translates to 5 million people, or twice the population of the San Antonio metro area. Over 872,000 children lack health insurance. The high rate of uninsured people limits our ability to improve dozens of urgent health problems that our state is grappling with including maternal mortality rates, the lack of access to substance use and opioid treatment services, mental health services, and access to rural healthcare and hospitals.

What Lawmakers Could Do:

Texas lawmakers could expand Medicaid to low-income adults. Texas has consistently rejected Medicaid expansion funding and held only one hearing on Medicaid expansion in the last six years. Expanding Medicaid would bring $6-10 billion a year that Texans pay in federal taxes back to our state. Beyond the obvious benefit of covering more people, expanding Medicaid has proven to be financially wise for the 34 states that have already done so.

How It Would Help:

About 1.5 million now-uninsured Texans are projected to gain coverage if Texas accepted federal funds to cover working poor and near-poor adults. Out of those, over 750,000 Texans currently have no access to health insurance because they make too much money to qualify for our current Medicaid program (A parent with two children can earn no more than $320 per month), but they make too little to qualify for discounted coverage through the Affordable Care Act Marketplace (which starts at $2,300 a month for a family of three). These Texans are in the "coverage gap" and have no affordable health insurance options. People who lack health insurance are not able to get care when they get cancer or get specialists for their chronic health conditions. They miss important health screenings, forego primary care, have serious health conditions that may go untreated until they become critical and risk financial ruin because of health issues. Insuring more Texans makes individuals, families and communities healthier.

What the Legislature Did(n’t) Do in 2019:

During the 86th Legislative session no Medicaid expansion bills received a committee vote. Rep. John Bucy proposed a Medicaid expansion amendment to the state budget that would have directed state leaders to accept billions of dollars in Medicaid funding from the federal government to provide an insurance option to child care teachers, construction workers, and other uninsured low-wage workers.

The House defeated the amendment on a party-line vote, with a handful of Representatives missing the vote. This was the closest vote on Medicaid expansion to date, on a vote of 80-66.

Protecting New Mothers and Babies

What to Ask:

What is your plan to make sure all women have access to affordable healthcare coverage throughout their lives so fewer women die from childbirth-related conditions and more children are born healthy?

Why It Matters:

Texas has a high rate of maternal deaths — deaths of mothers during pregnancy, childbirth, or within a year of giving birth. Also, severe pregnancy complications — like hemorrhage, critically high blood pressure, and seizures — are about 50 times more common than maternal death and can be very damaging to mother and infant. While many complex factors play a role, women can die or experience severe pregnancy complications because they don’t have access to health insurance. Texas has the worst uninsured rate for women of reproductive age, with 25.5% of women lacking insurance. These Texas women lack access to preventive care, chronic disease management, birth control, mental health care, substance use treatment and other services that could help them have healthier pregnancies. Healthcare access throughout a woman's life is critical for healthy moms and healthy babies.

What Lawmakers Could Do:

With few exceptions, under policies established by the state Legislature, low-income Texas women can only apply for Medicaid once they know they are pregnant, and then they lose their insurance two months after delivery. The Texas Maternal Mortality and Morbidity Task Force issued a report last year outlining policy recommendations lawmakers could implement to reduce the number of childbirth-related deaths. The first policy recommendation the Task Force made was to extend healthcare coverage (Medicaid for Pregnant Women) from two months to 12 months following delivery. The Task Force recommended access to health care during the year after pregnancy and between pregnancies to improve the health of women. Because Black women are at much greater risk for maternal mortality and complications regardless of income, education, marital status, or other health factors, the Task Force also recommended additional support to address racial disparities in health care that contribute to a higher likelihood of death for Black mothers. Expanding Medicaid for all eligible Texans would ensure more women of childbearing age have healthcare before they become pregnant.

How It Would Help:

Increasing access to healthcare coverage for all Texas women of reproductive age gives women a fighting chance to survive childbirth, have healthy babies, and be healthier for their kids. Expanding Medicaid and increasing supports for Black women who are at a much higher risk for death would help guarantee that women have access to the critical healthcare they need before, during, and after pregnancy. When women have the regular care they need to manage their health, including chronic conditions, they are healthier when they conceive and when they give birth.

What the Legislature Did(n’t) Do in 2019:

On a vote of 87-43, the Texas House passed HB 744, a bill to extend Medicaid health coverage for low-income women to cover a full 12 months after giving birth. The bill would have implemented the first recommendation included in the 2018 report that the Governor and Legislature commissioned from the Texas Maternal Mortality and Morbidity Task Force. Because the Senate failed to take up the legislation, the state will continue to cut off Medicaid coverage for low-income mothers 60 days after child birth, leaving many Texas mothers uninsured and with limited access to health care during this critical time for their health and their baby’s health. Find out if your representative was among those who voted NOT to expand coverage for new moms.

Keeping Children on Medicaid Covered Without Lapses

What to Ask:

What is your plan to stop the burdensome paperwork requirements that cause eligible children to incorrectly lose Medicaid health coverage?

Why It Matters:

Each year Texas kicks about 50,000 eligible children off Medicaid due to paperwork traps, causing unnecessary lapses in coverage and a lot of stress for parents. Texas has the highest number of uninsured children in the country, and the problem is getting worse. Families with children insured through Medicaid are required to jump through numerous hoops over the course of a year to maintain their child’s eligibility. When they miss the often impossible deadline for additional documentation their children lose coverage. Often parents don’t know their kids have lost coverage until they go to the doctor and find out they were dropped off Medicaid even though they are eligible.

What Lawmakers Could Do:

This problem has a very simple solution: allow children to stay on Medicaid for a full year, like Texas does for children in CHIP insurance.

How It Would Help:

Having insurance continuously throughout the year means kids can get check-ups, therapies and treatment for health conditions, and build a relationship with a health provider that helps provide better care at a lower cost. In 2014, Texas rolled back eligibility rules for Medicaid. Now Texas kids have 6-month continuous coverage followed by month-to-month coverage for the second six months of each year. With the potential for extra paperwork and requests for additional documentation at months 5, 6, 7, and 8, the combined effect of this undue administrative burden is causing tens of thousands of eligible children to lose their Medicaid coverage.

What the Legislature Did(n’t) Do in 2019:

The Children’s Health Coverage Bill would have put an end to the numerous documentation requests families with children on Medicaid experience each year, and at virtually no expense to the state. The House bill moved slowly through the House Human Services Committee and didn’t get a committee vote until late in the session. The bill never got scheduled for a vote in the full House. The companion bill never received a hearing in the Senate Health and Human Services Committee. As a result, about 4,000 children per month will continue to lose their Medicaid health coverage.

Addressing Untreated Mental Illness and Lack of Access to Care

What to Ask:

What will you do to ensure that hundreds of thousands of Texans with mental illness and no access to affordable health insurance get the services they need instead of leaving it to hospital and jails to be urgent care providers?

Why It Matters:

In a given year about one million Texas adults face mental illness or a substance use disorder without the benefit of health insurance. Just as people shouldn’t have to go without treatment for a heart condition or diabetes, they should not have to go without treatment for mental illness. As a result of the structural lack of services (not enough providers or affordable services for people who are uninsured), county jails and emergency rooms have become the leading providers of mental health treatment in Texas. The largest provider of mental healthcare in Texas is the Harris County jail system. When Texans can get better mental health treatment in jail than they can outside it, something in our healthcare system has to change.

What Lawmakers Could Do:

The U.S. Department of Health and Human Services reports that if Texas accepted Medicaid expansion funding approximately 400,000 of the one million uninsured Texas adults with mental illness or substance use disorders would be covered by health insurance and become eligible to receive treatment. It would also reduce the pressure on our hospital and jail systems.

How it Would Help:

Medicaid expansion in Texas would bring $6-10 billion in federal taxes paid by Texans back to the state each year, meaning that as many as 1.3 million uninsured Texans could get insured. Getting insured is the first step for most Texans to be able to get treatment. Just as people leave other health conditions untreated until they reach a crisis level, they also go without mental health treatment when they have no health insurance.

Protecting Healthcare for Vulnerable Texans

What to Ask:

Will you support fully funding Medicaid, CHIP and other health programs that serve children, women, seniors, and people with disabilities?

Why It Matters:

One of the most important responsibilities of the state Legislature is to fully fund critical health programs. Those programs include Medicaid (for people with disabilities and low-income children, pregnant women, and seniors); CHIP (for uninsured children in families earning too much to quality for Medicaid but too little to purchase insurance); women’s health programs (including health screenings and family planning); and substance use recovery programs (including those that help keep families safely together while serving pregnant women and other parents in need).

What Lawmakers Can Do:

In recent sessions, the Texas Legislature continued its practice of underfunding Medicaid and other health programs, putting pressure on the next Legislature to backfill the program or cut services. In 2011 the Legislature cut funding to the Family Planning Program, which served women who don’t have health insurance or Medicaid. Those cuts led to thousands fewer women getting care. While numbers have rebounded somewhat, the program is still underfunded and inadequate to serve all women in need. Rather than funding piecemeal programs to address the lack of comprehensive health coverage, lawmakers could expand Medicaid, which would cover many of the people receiving care through special programs, while also creating savings in the state budget.

How It Would Help:

Fully funding Medicaid, CHIP and women’s health programs would ensure that Texas’s vulnerable populations - women, children, seniors and people with disabilities - would be able to get the care they need.

Protecting People with Pre-Existing Conditions

What to Ask:

How will you ensure that Texans with pre-existing conditions don’t face discrimination in buying and using health insurance?

Will you support legislation that prevents health insurance companies from discriminating against people with preexisting conditions in any way?

Why It Matters:

With the start of the Affordable Care Act (ACA), insurance companies could no longer raise rates or deny coverage to people with pre-existing conditions. Approximately one-quarter of Texans have a pre-existing condition. In the bad old days, even a moderate case of eczema could cause an insurer to deny coverage, exclude the condition, or raise rates. The ACA banned discrimination based on pre-existing conditions. Despite Congress’ failure to repeal the ACA, threats to pre-existing condition coverage persist, including a federal lawsuit filed by the Texas Attorney General that could end pre-existing coverage protections.

What Lawmakers Can Do:

Elected leaders can reject attempts to weaken current standards for coverage of pre-existing conditions and make commitments to uphold them when necessary.

How it Would Help:

The outcome of the federal lawsuit is uncertain, and appeals could take many years. The pre-existing condition protection of the ACA is one of its most popular features. Millions of Texans could lose their coverage or be subject to much higher rates if the lawsuit succeeds. Texas lawmakers can protect their constituents by asking the Attorney General to drop his lawsuit and by passing legislation to make pre-existing condition protections part of state law.

Questions for Congressional Candidates

Ensuring Everyone Has Access to Affordable High-Quality Health Care

What to Ask:

What will you do to stop the administration from undermining health coverage and increasing healthcare costs for middle-class families?

What will you do to help ensure everyone in our country has access to high-quality health and healthcare regardless of their race, income, health status, or geographic location?

Why It Matters:

Our country has made historic gains in reducing the uninsured population thanks to the Affordable Care Act — but the work isn't done. Because of both sabotage attempts by the administration and parts of the ACA that have never been fixed (e.g. family glitch), the ACA is not working as well as it could be and prices, especially for middle-class consumers, are not being adequately controlled. We need a commitment to universal coverage — everyone should have access to good coverage that is affordable for them.

There are big racial and income disparities in access to insurance and healthcare, too. Poor outcomes disproportionately affect communities of color, those with low incomes, people with disabilities, and those living in distressed geographic areas.

What Lawmakers Can Do:

Lawmakers can undo some of the sabotage Congress and the Trump administration have enacted in their zeal to repeal the Affordable Care Act without having any real plan to replace it. They can also fix parts of the ACA that have created problems for consumers, such as the "family glitch" that makes insurance unaffordable for some families when one spouse has job-based insurance and the other does not. Lawmakers can help keep the insurance market stable and drives down premiums — especially for the middle class — by restoring funding for consumer outreach and assistance with enrollment, limiting the sales of short-term junk insurance plans with skimpy coverage, and reinstating the individual requirement to have health insurance.

Why It Matters:

More than 20 million people who were previously uninsured have gotten health insurance because of the Affordable Care Act. We can’t afford to backtrack on that progress. In Texas 17.7% of the population is uninsured — and the rate is going the wrong direction, having risen for the last two years. Further cuts to the ACA, and further repeal attempts, will cause that number to keep climbing if lawmakers don’t take action.

Protections for People with Pre-Existing Conditions

What to Ask:

Will you commit to opposing legislation that would have the effect of harming people with preexisting conditions?

If court decisions or administrative action allow health insurers to discriminate against people with preexisting conditions, will you support legislation to reinstate all current protections?

Why It Matters:

With the start of the Affordable Care Act (ACA), insurance companies could no longer raise rates or deny coverage to people with pre-existing conditions. Approximately one-quarter of Texans have a pre-existing condition. In the bad old days, even a moderate case of eczema could cause an insurer to deny coverage, exclude the condition, or raise rates. The ACA banned discrimination based on pre-existing conditions. Congress persists in its threats to repeal the ACA, and a pending federal lawsuit filed by the Texas Attorney General could end pre-existing coverage protections.

What Lawmakers Can Do:

Members of Congress must resist any further calls to repeal the Affordable Care Act, or to repeal portions of the ACA. Over the last two years the Trump administration has chipped away at ACA protections and introduced policies that undermine pre-existing condition coverage, such as by allowing short-term junk insurance. Congress should be on guard for these attempts, and consider legislation to make sure all insurance plans offer the comprehensive coverage people have come to expect from their health insurance.

How it Would Help:

The pre-existing condition protection of the ACA is one of its most popular features. More than 130 million people nationwide have pre-existing conditions, and today they can afford health insurance that may have been out of reach in the past. People like having health insurance and the peace of mind that comes with it. No one wants to go back to a time when discriminatory and capricious insurance practices were common.

Protecting Medicaid

What to Ask:

What will you do to protect Medicaid and ensure that children, people with disabilities, and seniors continue to have coverage?

Will you commit to protecting Medicaid, rejecting legislation that slashes funding for or restructures this vital healthcare safety net?

Why It Matters:

Medicaid provides healthcare coverage for nearly four million vulnerable Texans, including children, pregnant women, seniors and people living with a disability. Two-thirds of Medicaid recipients are children. Medicaid covers more than 50% of all births, provides healthcare to more than two out of every five Texas children, covers long-term care and supports for millions of seniors, and pays for 60% of all nursing home care. Most adults who live in nursing homes or who live with a disability will use Medicaid at some point. Medicaid is a very important part of our healthcare system, and it’s constantly under threat.

What Lawmakers Can Do:

Despite growing more slowly per-capita than Medicare or private insurance, Medicaid was on the chopping block in 2017 when Congressional leaders attempted to gut the program as part of the Affordable Care Act repeal effort. Lawmakers must protect Medicaid, even as some members of Congress and the administration call for massive cuts to healthcare and other programs to pay for the ballooning deficits created by the tax cuts for the wealthy and corporations passed in 2017.

How it Would Help:

Ensuring a strong Medicaid program in our community protects the most vulnerable among us and provides a safety net for all of us. Through Medicaid, two out of every five Texas children are able to get the healthcare they need. Seniors, pregnant women and people living with disabilities are protected. Medicaid is there for all of us. It helps keep our urban and rural hospitals open and is there for all of us should we attain a disability or have a child born with a disability. Medicaid provides funding for special education and healthcare services for schools.