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For the first time since the Affordable Care Act went into effect in 2010, the number of Americans without health insurance has gone up — and once again Texas leads the nation. Isn't it time that changed?

The Census Bureau says 27.5 million Americans (8.5% of the U.S. population) didn't have health insurance in 2018, compared with 25.6 million (7.9 in 2017).

In Texas alone, more than 5 million (17.7 were uninsured last year), compared with 4.8 million (17.3%) in 2017.

Having an uninsured rate that's more than double the nation's is embarrassing but it hasn't stirred the state's elected leaders to action. They have blithely ignored polls that show most Texans not only care about the uninsured problem, they want Medicaid expanded to help solve it.

That could happen under the Affordable Care Act, which would fund up to 90% of the cost to add more Texans to Medicaid's rolls. Unfortunately, Gov. Greg Abbott and Republican leaders in the Legislature have decided it's more important politically for them to reject any part of Obamacare — initially to thwart President Barack Obama's signature achievement and now to walk in lockstep with President Donald Trump.

"Medicaid expansion would be the biggest contributor to reducing the number of uninsured," said Elena Marks, president of the Episcopal Health Foundation. "There's this false narrative that Medicaid is a broken program. Actually, Medicaid is a really good program, and most of its cost is borne by the federal government."

Marks told the editorial board that, ironically, the unemployment rate's drop to record levels nationally may have pushed more Americans into the ranks of the uninsured. "Many of the people who have finally found jobs no longer qualify for Medicaid and earn too much to qualify for subsidies to buy health insurance on the ACA exchanges," she said.

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That description fits about 625,000 of the 1.2 million Texans who would become eligible for Medicaid if it were expanded here. Many of them have more than one job but still can't afford to both put food on the table and buy health insurance.

It's irresponsible to let politics get in the way of helping families trying their best to get by. It's unconscionable to be so obstinate when children's health is at stake. Texas' uninsured includes more than 833,000 children — also the highest in the nation. Second-place Florida is far behind, with 321,000 uninsured children.

It's clear that Trump's misguided war against the ACA has endangered public health. Many of the nation's uninsured are in the age 19-25 cohort that was expected to forgo coverage after Republicans voided the ACA's tax penalty for not having insurance. Trump dealt the ACA another blow when he drastically cut funding for Obamacare outreach efforts intended to educate people about the program and help new applicants sign up.

Some Republicans claim they have opposed Medicaid expansion because federal funding might be reduced or eliminated later. By that logic, Abbott shouldn't have accepted $25 billion from the Trump administration to cover the hospital bills of indigent patients who don't qualify for Medicaid under Texas' current rules. That money will run out in 2021.

It's time for Texas' elected leaders to stop playing political games and make decisions in the best interest of Texans. They can do that by joining the 37 states that have already claimed a share of the billions of dollars in federal funds available to expand Medicaid. That money includes taxes paid by Texans. Why shouldn't they get some of it back?

-- Houston Chronicle

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