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By Sue Owen November 8, 2013

More than a million Texans would become Medicaid-eligible under Obamacare expansion

Visiting Dallas on Nov. 6, 2013, President Barack Obama sought to allay worries about his signature health-care law and assert Texans’ need for more health coverage.

Texas could have helped many immediately, he said, by accepting the law’s offer of federal dollars to help pay for expanding Medicaid, a key Obamacare initiative.

"Across this state, you've got a million people -- because this is a big state -- a million people, citizens, who don’t have health insurance that could get health insurance right away if the state of Texas decided to take advantage of it," Obama said at Temple Emanu-El to volunteers who helped people enroll via the act’s insurance marketplace on

Texas consistently has the nation’s highest percentage of residents without health insurance. The Census Bureau estimated 6.4 million Texans in 2012 had no health coverage. The state Health and Human Services Commission estimated that in January 2013, Texas had about 1 million adults on Medicaid.

Under the health care law, the federal government offered to pay expansion costs during the first three years for states that extended Medicaid to adults earning up to 138 percent of the federal poverty level. Texas Gov. Rick Perry rejected that deal July 19, 2012.

Medicaid is a federal-state insurance program that targets children and low-income families, elderly and disabled people, pregnant women and children in foster care.

Stephanie Goodman, a spokeswoman for the state commission, which administers Medicaid in Texas, told us by email, "We estimate that almost 1.4 million Texans would become eligible for Medicaid if the state opted to expand."

The Urban Institute, a non-partisan research institute in Washington, D.C., reached a slightly larger figure in a July 2012 report that said, "State decisions regarding whether to expand Medicaid under the ACA will directly affect the 15.1 million uninsured adults with incomes below 138 percent of FPL (federal poverty level) who are not currently eligible for Medicaid. Of these newly eligible uninsured adults ... 1.7 million live in Texas." The institute said its estimates were made using data from the Census Bureau’s 2010 American Community Survey.

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In a March 18, 2013, report, the state agency contrasted how Texas’ uninsured population might differ in two different Obamacare scenarios using Current Population Survey census data from March 2012.

"Current state" populations included 19.5 million insured and 6 million uninsured (24 percent uninsured), the report said. The implementation of Obamacare alone, without Medicaid expansion in Texas, would shift that rate to 16 percent uninsured (4.2 million Texans), the agency estimated. Under Obamacare implementation with full Medicaid expansion, 12 percent (3.1 million Texans) would remain uninsured.

Not all the newly eligible adults would be expected to sign up immediately, Goodman said, citing 2012 estimates from the agency that show Medicaid adult enrollment rising by 341,000 in 2014, by 776,000 in 2015 and by just over 1 million in 2016: 

Our ruling

Obama said, "A million people … could get health insurance right away" if Texas expanded Medicaid as encouraged by the Obamacare law. Estimates show some 1.4 million to 1.7 million would be eligible immediately. We rate his statement as True.

TRUE – The statement is accurate and there’s nothing significant missing.

Click here for more on the six PolitiFact ratings and how we select facts to check.

Our Sources

President Barack Obama, "Remarks by the President on the Affordable Care Act," White House press office, Nov. 6, 2013

Email interview with Stephanie Goodman, communications director, Texas Health and Human Services Commission, Nov. 8, 2013

Texas Health and Human Services Commission webpage, "Texas Medicaid Enrollment Statistics," accessed online Nov. 8, 2013

Texas Health and Human Services report, "Presentation to the House Appropriations Committee," March 18, 2013

Texas Health and Human Services Commission spreadsheet, "Impact to Texas Medicaid of ACA Implementation by Levels of Implementation," received March 26, 2013

Urban Institute report, "Opting Out of the Medicaid Expansion Under the ACA: How Many Uninsured Adults Would Not Be Eligible for Medicaid," July 2012

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More than a million Texans would become Medicaid-eligible under Obamacare expansion

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