The Texas Medical Association, along with 32 other organizations representing physicians, dentists and child welfare groups, called on Gov. Greg Abbott — again — to expand Medicaid to help fight the COVID-19 crisis.

Expanding the government health insurance for low-income families would make it easier for people to seek medical care and help cover the costs if they get sick from the virus, Medicaid expansion advocates said in a letter to Gov. Greg Abbott.

"To truly defeat COVID-19, Texas must let loose every authority at its disposal," the groups wrote in a letter dated Tuesday.

Texas is one of 14 states that have not expanded Medicaid. Advocates said that locks out more than 1 million people from accessing those benefits because they make too much.

To qualify for the state's Medicaid program, a person has to be 18 or younger, a senior over 65, pregnant or disabled. Their earnings must not exceed the federal poverty line. Approximately 4 million residents are enrolled.

If Texas expands Medicaid, the federal government would bear 90 percent of the cost, while the state would pay 10 percent.

COVID-19 has pushed groups to renew the call, as more than 3 million Texans have filed for unemployment benefits, and an estimated 659,000 adults have lost health care coverage through their employers, according to data from Families USA, a consumer health advocacy nonprofit.

Texas had the highest rate of uninsured residents at 18 percent before COVID-19, according to recent Census estimates. Now, as many as 29 percent, or nearly one in three residents are without coverage.

The people who could qualify for Medicaid under a possible expansion are essential workers in grocery stores, restaurants and warehouses, where they are at higher risk of exposure.

A sick workforce means a slower economic recovery, said Dr. Diana Fite, president of the Texas Medical Association.

“Suddenly, we’ve got a lot of Texans losing their jobs and insurance, or making less money,” Fite said. “On top of that, if they get sick and have COVID, they’re going to be very ill and using quite a bit of health care resources.”

Overloading the system

Health policy experts against the expansion of Medicaid, however, said the Medicaid system has flaws that need to be fixed before more people are put on those plans.

David Balat, a senior health policy expert at the conservative-learning Texas Public Policy Foundation, said Medicaid expansion is not the solution because many people on the program face difficulties finding doctors who take the government insurance.

Putting someone on Medicaid without guaranteeing more doctors would be “irresponsible,” he said.

“We must stop conflating health insurance with health care,” Balat said. “People need care. And insurance is a financial vehicle that is helping nobody but the middlemen.”

Some doctors don’t participate in Medicaid for financial reasons, said Katie Mitten, a health policy researcher at Texans Care for Children, a children’s advocacy group.

“The Legislature tends to set low payment rates for Medicaid, which discourages some doctors and other health care providers from participating in the program,” she said. But, she added, the program is still helpful for families who rely on it as their source of health care.

Advocates said expanding Medicaid and bumping up reimbursement rates could also help struggling hospitals and doctors bounce back from a dip in revenue as patients worried about contracting COVID-19 avoid doctors’ offices and elective procedures.

“In the new practice environment,” the letter said, “physicians, hospitals and providers cannot easily absorb more uninsured patients as they struggle to stay afloat themselves.”

Will it pass?

For Medicaid expansion to happen soon, Abbott and state lawmakers would have to pass legislation during the next session of the Texas Legislature, which meets again in January 2021.

But it’s an uphill battle, health care advocates said. The state legislature has declined to do so in the past.

Fite, the Texas Medical Association president, said she’ll take anything — even a temporary two-year expansion to help alleviate the costs of care during the COVID-19 pandemic.

“Part of me thinks that yes, it will definitely happen because it’s so much more necessary now with less of the population working,” Fite said. “But then again, that’s wishful thinking.”

This story was updated to correct how Medicaid expansion would be funded in Texas after 2020.