Expert: Perry’s Decisions to Decline Medicaid Expansion, Create State-Based Insurance Exchange Shoot Texans in the Foot Twice

A Texas Tech University expert in social work can help decipher these two decisions and how they will impact Texans across the state.


The current Texas State Legislature may decide to address two issues related to the Patient Protection and Affordable Care Act of 2010 (ACA or Obamacare, as it is commonly known).

One is the decision of Gov. Rick Perry to decline to accept Medicaid expansion as offered through the ACA. The other is his refusal to set up a state-based insurance exchange, also as outlined in the ACA.

While these two issues are frequently linked in the press, they are in fact two separate issues. A Texas Tech University expert in social work can help decipher these two decisions and how they will impact Texans across the state.


Helen Morrow, associate professor of social work, Texas Tech University, (806) 787-2023 or

Talking Points

  • By refusing to accept Medicaid expansion through the ACA, it would raise the allowable income amount for families applying for Medicaid. Millions of currently uninsured Texans would then be eligible for the Medicaid program.
  • This is especially true for women who lack health insurance. Many Texas women could especially benefit from the expansion.
  • However, this will not happen due to the governor’s refusal to accept this program. Texans will be unable to take advantage of the Medicaid expansion because governor does not want additional federal intervention.
  • Ironically, the second decision by the governor seems to have the reverse effect. By refusing to establish a state-based insurance exchange for those who have no current insurance coverage and who do not qualify for Medicaid,  by default, these people will now be allowed to participate in an insurance exchange to be created and managed by the federal government.


  • “If the intent of the governor is to retain as much control as possible at the state level, it seems that he would choose to support the creation of a state-based insurance exchange. These two decisions – no Medicaid expansion and no insurance exchange – seem at odds with each other from the perspective of state power as opposed to federal control.”
  • “Opponents of the Medicaid Expansion applaud the governor’s decision. They point to the additional state funds that will not be spent over the next 10 years as the state’s portion of the cost of expansion would eventually increase to 10 percent. According to an Urban Institute Analysis, Texas will save an estimated $9.6 trillion during that time frame. On the other hand, it will forego more than $77 trillion in federal funds that could have been expended for Texas Medicaid recipients.”
  • “Since the federal insurance exchanges are yet to be devised, it remains to be seen whether those who do not qualify for Medicaid will fare better under most state-run exchanges or under the new federal exchange program. Texans will know soon whether their legislature will decide either of these issues is worth their discussion and debate.”