Economy & program integrity

Jobs estimates are models, not observations Projection

A Michigan study projected about 30,000 additional jobs a year from that state's expansion.¹

Limits: These are model results that assume federal dollars are new money to the state. We found no observed, Texas-specific jobs study.

Little crowd-out of employer coverage Strong design

Expansion did not measurably reduce employer-sponsored coverage.²

Limits: Evidence comes from the early years of expansion. Texans at 100–138% of poverty who now buy subsidized Marketplace plans would shift to Medicaid. That is by design, but it is a real shift.

Improper payments are mostly paperwork Official data

Medicaid's improper payment rate was 6.12% in fiscal 2025. About 77% of that was insufficient documentation, and CMS says the rate is not a measure of fraud.³

Limits: Eligibility errors do occur, and federal law now penalizes states with high error rates.

Paperwork can push eligible people off Official data

During the 2023–24 Medicaid unwinding, Texas disenrolled more than half of the people it reviewed, most for procedural reasons.⁴ Expansion adults would now face renewals every six months.⁵

Limits: How Texas designs renewals (for example, automatic data checks) would matter a great deal.

Federal policy is in flux Official data

Enhanced Marketplace premium tax credits expired at the end of 2025 and had not been restored as of October 2026.⁶