Texas Democrats’ Huge Win Could Help a Million People Gain Health Insurance

A long-standing coverage gap

The Supreme Court ruled in 2012 that states could choose whether to expand. Texas is among 10 states that have not done so, and it is the largest. KFF estimates 1.1 million Texans would qualify, including 605,000 with no other insurance options without expansion.

Democrats open a path

Gov.-elect Gina Hinojosa pledged to pursue Medicaid expansion, presenting it as a way to help children. Texas Impact executive director Bee Moorhead said expansion bills were expected to be filed on November 9, the first day of early bill filing.

Senate remains a hurdle

Republicans retain control of the Texas Senate, so expansion is not assured. Democrats’ House position would let them press for a more serious debate, while some observers hope the election results could encourage compromise.

Hospitals, which have long backed expansion, could add pressure. Campaign concerns about potential Trump-approved Medicaid cuts and rural hospital closures may also shape discussions, but hospital leaders are not declaring victory.

Support, but no guarantee

Lynn Cowles of Every Texan called expansion a short-term lifesaver and a long-term money-saver, and said the group was ready to work with the new state cohort and committee chairs in January. John Henderson of the Texas Organization of Rural & Community Hospitals said the political climate and priorities would change, but ambitious policies still faced obstacles. A 2020 poll found 69 percent of Texas voters supported expansion.