Texas Coverage Gap Project

Hospitals & doctors

Coverage helps hospitals get paid for care they already provide. It does not create doctors.

Less uncompensated care Association

In expansion states, hospitals' uncompensated-care costs fell by about $2.8 million per hospital per year (roughly 30%), relative to non-expansion states.1

Limits: Operating margins did not change significantly in that study.

Lower closure risk Association

Expansion was associated with better hospital finances and a lower likelihood of closure, especially in rural markets.2

Limits: Observational, and closures are rare events. We have not verified the exact odds ratios in the full text, so we don't quote them.

Fewer Texas doctors take new Medicaid patients Official data

Between 2014 and 2017, 65.1% of Texas physicians who accepted any new patients accepted new Medicaid patients, compared with 74.0% nationally.3 A 2016 Texas Medical Association survey found that 41% of Texas physicians accepted all new Medicaid patients.4

Limits: Both figures are dated, and we found no newer Texas-specific public data.

2025 federal law and Texas hospital financing Official data

Federal guidance treats any state that expands in the future as an expansion state. Its provider-tax limits would phase down and its state-directed hospital payments would be capped at 100% of Medicare rates, compared with 110% for non-expansion states.5 Texas relies heavily on these tools.

Limits: This is the strongest Texas-specific objection to expansion. No public analysis yet nets these losses against new coverage revenue for Texas hospitals.

Sources for this page

  1. Blavin, JAMA 2016;316(14):1475-83, doi:10.1001/jama.2016.14765; Dranove, Garthwaite, Ody, Health Affairs 2016, doi:10.1377/hlthaff.2015.1344 (2016). https://jamanetwork.com/journals/jama/fullarticle/2565750 [evidence R2]
  2. Lindrooth, Perraillon, Hardy, Tung, Health Affairs 37(1):111-20, doi:10.1377/hlthaff.2017.0976 (2018-01-08). https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0976 [evidence R1]
  3. MACPAC, 'Physician Acceptance of New Medicaid Patients: Findings from the NEHRS' (June 2021) (2021-06). https://macpac.gov/wp-content/uploads/2021/06/Physician-Acceptance-of-New-Medicaid-Patients-Findings-from-the-National-Electronic-Health-Records-Survey.pdf [evidence R4]
  4. Texas Medical Association physician surveys (2012, 2016), as reported by PolitiFact (2017-04-07); TMA page texmed.org/Template.aspx?id=43908 returned 404 on 2026-10-24 (2016 survey). https://www.politifact.com/factchecks/2017/apr/07/donna-campbell/donna-campbell-says-due-low-rates-70-percent-physi/ [evidence R3]
  5. CMS Dear State Medicaid Director letter on OBBBA sections 71115/71117 (2025-11-14). https://www.medicaid.gov/medicaid/downloads/providertax_dcl_11142025.pdf [evidence L7]

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