25 TX Groups Urge Cornyn & Cruz to Oppose TX Medicaid Cuts in Trumpcare

Today, 25 Texas organizations sent a letter to Senators John Cornyn and Tex Cruz expressing their concerns about legislation to repeal the Affordable Care Act (ACA).


The letter highlights that the bill includes a “per-capita cap” plan to make deep permanent cuts to Medicaid, which would cut Texas Medicaid funding by an estimated $1.5 billion per year. The letter points out that those cuts would harm the four main groups of Texans who rely on Medicaid for health care: children, pregnant women, seniors, and people with disabilities. The vast majority of Texans enrolled in Medicaid are children.

The letter urges Senators Cornyn and Cruz to take the Medicaid cuts off the table and to fight for Texas’ fair share of health care funding.

The full text of the letter is below:

June 15, 2017

Dear Senators Cornyn and Cruz,

As the U.S. Senate considers legislation to repeal the Affordable Care Act (ACA), we have a number of concerns, including proposals on Essential Health Benefits, pre-existing conditions, and premiums for older and lower-income Americans, as well as concerns about the process in Congress, such as the lack of public hearings.

However, today we write to you express our particular concern about the bill's Medicaid provisions. We urge you to oppose proposals to restructure Medicaid financing and establish permanent Medicaid cuts. We also urge you to fight for Texas’ share of health care funding in any new formulas for distributing federal funds among the states.

According to the CBO, the American Health Care Act (AHCA) passed by the U.S. House of Representatives would lead to 14 million Americans losing Medicaid health coverage by 2026. Many of them would lose that coverage because the bill eliminates the Medicaid expansion funding for low-income, non-elderly adults. (As you know, Texas has not accepted that funding.) Others, including many people in Texas, will either lose their Medicaid coverage or see a reduction in health benefits because the legislation would impose a per-capita cap on funding. The CBO projects that in total, the AHCA would cut federal Medicaid support to the states by $834 billion over the next 10 years, using most of that funding to finance tax cuts targeted primarily at large corporations and the wealthiest Americans.

Here in Texas, the Medicaid per–capita cap plan would take vital health coverage away from children, pregnant women, seniors, and people with disabilities who account for 96 percent of the over 4 million Texans relying on the Medicaid program for their basic medical needs and long-term services.

Texas will lose an average of $1.5 billion per year in federal support for Medicaid from 2019-2028 under the House’s AHCA bill, according to an analysis by the Urban Institute. Unless the Texas Legislature chooses to replace the lost funding, our state legislators will inevitably have to vote to cut Medicaid eligibility and benefits.

Those cuts would hurt some of the most vulnerable Texans. They also would limit the state’s ability to respond to new threats, such as a Zika outbreak, or new opportunities, such as a breakthrough drug to combat Alzheimer’s. Additionally, as the Medicaid cap shifts costs and risks to the states, the loss of federal funding in our state budget could jeopardize other state priorities, such as education.

According to media reports, Senators are considering changes to the bill passed by the House. However, if the Senate does approve a Medicaid cap or similar policy, it would still represent a permanent overhaul of the current program that would lead to coverage being taken away from millions of Texans.

Texas has already seen first hand the damage done by even relatively small cuts to Medicaid. 

In 2015, the state Legislature cut $171 million per year ($75 million per year in state funds) from Medicaid reimbursement rates for physical therapy, speech therapy, and other therapies for children with disabilities. Since that time there has been a major outcry from parents and others as children have lost access to services and community organizations have withdrawn from the state’s Early Childhood Intervention (ECI) program. These state cuts to children’s therapies look small compared to the massive Medicaid cuts that Congress is proposing.

As Congress considers changes to Medicaid, we know that Senators are fighting to maximize funding for their own states, potentially to the detriment of Texas. 

A recent report by Manatt Health, “Capped Federal Medicaid Funding: Implications for Texas,” found that Texas is likely to be disadvantaged if Medicaid funding is distributed to states through a per-capita cap or block grant due the state’s “historically low investments in Medicaid relative to its low-income population, its growing population, its relatively low spending levels for the elderly and its high reliance on supplemental and waiver funding.”

One of the reasons that Texas is at a disadvantage is because state leaders have not accepted $6 to $10 billion per year in federal Medicaid expansion funding. As a temporary strategy to get by without that funding, Texas has relied on local county government tax dollars to fund more than half of Texas Medicaid hospital payments. In fact, the Manatt Health report shows that Texas is relying more heavily on these kinds of supplemental Medicaid payments outside of the state budget than any other state.

The legislation before Congress threatens to lock in this funding inequity in which many other states receive federal funding to cover low-wage adults while Texas continues to over-rely on local tax dollars to finance a patchwork of health care services for low-wage adults. The funding formula in AHCA offsets only a tiny fraction of the losses for Texas and other states without Medicaid expansion. As negotiations continue, Texans expect our Senators to fight to ensure that our state receives its fair share of health care funding and avoids passing the buck to Texas county governments to use local property taxes to pay for our uninsured working poor adults.

We call on you to stand up for Texas children, pregnant women, seniors, and people with disabilities. The decisions that you and other Senators make in the coming weeks will influence the health and well-being of these Texans – and therefore the success of all Texans – for decades to come. We urge you to protect Texans’ health and well-being, oppose the proposed cuts to Medicaid, and ensure that Texas is treated fairly in any negotiations regarding the distribution of health care funding among the states.


Bob Kafka
ADAPT of Texas

Dale Eastman
Chair of Advocacy and Government Relations
Alamo Breast Cancer Foundation

Ann Beeson
Executive Director
Center for Public Policy Priorities

Patrick Bresette
Executive Director
Children's Defense Fund-Texas

Dennis Borel
Executive Director
Coalition of Texans with Disabilities

Christina Buttler 
Navigator Project Manager and Grant Compliance Coordinator
Coastal Bend Center for Independent Living

Kenneth W. Janda
President and CEO
Community Health Choice, Inc.

Iliana Gilman
Chief Executive Officer
El Buen Samaritano Episcopal Mission

Celia Cole
Feeding Texas

George V. Masi, FACHE
President and Chief Executive Officer
Harris Health System

Dr. Janet Realini
Founder and Associate VP
Healthy Futures of Texas

Elaine Wiant
LWV Texas

Shannon Lucas
Regional Director of Advocacy & Government Affairs
March of Dimes

Greg Hansch
Public Policy Director
National Alliance on Mental Illness (NAMI) Texas

Will Francis
Government Relations Director
National Association of Social Workers/Texas Chapter

Patty Ducayet
State Long-term Care Ombudsman
Office of the Texas State Long-term Care Ombudsman

Ronda Rutledge
One Voice Central Texas

Larry S. Robins
President and CEO

Michelle Tremillo
Executive Director

Stephanie Rubin
Texans Care for Children

Dr. Jaime Estrada
Texas Doctors for Social Responsibility

Bee Moorhead
Executive Director
Texas Impact

Laura J. Warren, Executive Director
Linda Litzinger, Policy Specialist
Texas Parent to Parent

Kyle Piccola
Chief Government and Community Relations Officer
The Arc of Texas

Maggie Jo Buchanan
Southern Director
Young Invincibles