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March 6, 2013: News, Research and Events from the James A. Baker III Institute for Public Policy
Baker Institute Update: Why Texas should expand Medicaid; Syria: Then and Now
In this edition
Why Texas should expand Medicaid: The numbers tell the story

As the Texas Legislature and Gov. Rick Perry consider whether to accept the billions of dollars available to the state to expand Medicaid coverage in Texas, Baker Institute health policy scholar Elena M. Marks asserts that decision-makers should look at the hard numbers and not let rhetoric get in the way of covering 1.5 million uninsured Texans.

In "Should Texas Expand Medicaid?" Marks summarizes the key facts and figures at play in this debate. "A trove of data has been produced by state agencies, think tanks and researchers that builds a persuasive case for expansion," she writes in the Baker Institute Blog. "Hospitals, counties, chambers of commerce and advocacy groups have been urging the state to seize this opportunity because of the health and economic benefits."

Consider the following figures:

People
  • 5  — The number of Americans who die every hour due to lack of health insurance
  • 1st — Texas' ranking for the percentage of residents without health insurance
  • 6 million — The number of Texans without health insurance
  • 1.5 million — The number of Texans who would gain insurance under the Medicaid expansion
  • $26,951 — Maximum annual income for a family of three to qualify for Medicaid expansion

Costs
  • $100 billion — Federal dollars available to Texas for Medicaid expansion, 2014-23
  • $15 billion — State dollars needed for Medicaid expansion, 2014-23
  • $101.4 billion — Amount of money available to the state for general-purpose spending in the budget under development for 2014 and 2015
  • $1.2 billion — Amount of state revenue required for Medicaid expansion for 2014 and 2015
  • 87 cents — The amount of each Medicaid expansion dollar paid for with federal, as opposed to state, funds
  • $1.29 — The amount of money returned to state coffers for every $1.00 Texas spends on Medicaid expansion, 2014-23
  • $1.8 billion — Additional tax revenues received by Texas on account of Medicaid expansion, 2014-17
  • $1.5 billion — Local taxes paid to five largest Texas hospital districts to pay for care to low-income and uninsured residents, 2011
  • $2.5 billion —  Additional tax revenues received by local governments, including hospital districts, on account of Medicaid expansion, 2014-17
  • 300 percent —  The increase in cost when non-emergency care is provided in hospital emergency rooms instead of offices or clinics
  • $3.1 billion — Losses absorbed by Texas hospitals for charity care to low-income patients, including emergency room care, 2011
  • $1,017  — Estimated additional annual insurance premium per family to cover the costs of the uninsured, 2008

Texas Economy
  • $90.2 billion — Benefit to Texas economy due to increased productivity resulting from better health, in 2012 dollars, 2014-23
  • $23.2 billion — Benefit to Texas economy in output through redeployment of local government and private funds used for uncompensated care, in 2012 dollars, 2014-23
  • $67.9 billion — Value of economic activity in Texas as Medicaid expansion dollars are spent in the health care sector and recirculated through the economy, 2014-17
  • 231,000  — Number of jobs likely to be created because of Medicaid expansion by 2016
  • $50,818 — The average salary for the jobs likely to be created because of the Medicaid expansion, 2014-17

"Virtually every group — from those in the health care industry, to faith groups, counties and local political leaders — have weighed in in favor of Medicaid expansion," says Marks. "Texas can get a good plan if we can get away from 'just say no.'"

Marks is chair of the board of directors of Community Health Choice, a nonprofit organization serving more than 200,000 members. An attorney with a master's degree in public health, she served as Houston Mayor Bill White's director of health and environmental policy from 2004 through 2009.
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Syria: Then and now

After nearly two years of armed fighting, bloodshed and civilian suffering, there is no clear end in sight to the violence in Syria. Baker Institute founding director Edward P. Djerejian, former ambassador to Syria, continues to share his insights with the national and international media, most recently appearing on BBC-5 Live radio to discuss the U.S. decision to supply non-military aid to the Syrian government's opposition.

Why not give opposition forces the arms and weapons they are calling for, Djerejian was asked. "The opposition has not formed a truly coherent organization where you can readily identify who the parties are, and what their political leanings are," the ambassador said. "There's a great reluctance in Washington to get involved in a situation where all of the sudden one realizes that military assistance, for example, is going into the hands of radicals. Remember, there's a background here — the background is Afghanistan, where we armed the mujahedeen that morphed into Al Qaeda. As the opposition becomes more coherent, and as the United States does its own due diligence in vetting and identifying parties that we can support, then I think we are going to begin to see more assistance, and probably military assistance."

With much of the country now in rubble, Baker Institute Middle East research associate Dina Shahrokhi remembers "The Syria I Knew" in an essay for Syria Deeply, a single-issue news website covering the civil war. "When I first lived in Damascus, I felt safer than I did back home in the U.S.," writes Shahrokhi, who spent three years in the city as a student and United Nations worker. "I would take taxis right and left, opting for a cheap micro bus every now and then ... I would spend nights strolling the old city, dining with local friends at 10 p.m., dancing to cheesy Arabic pop until the sun rose ... When I returned to live in Damascus last year, the Syria I knew had changed — but not completely." [back to top]


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