Medicaid’s Background:
For decades, Medicaid was a partnership between the federal government and the states. Washington paid between 50% and 83% of the costs (poorer states received more), and states had flexibility to shape their programs. This support kept rural hospitals open and helped families and seniors get care.
The Affordable Care Act (2010):
The ACA offered states the chance to expand Medicaid. For the first three years (2014–2016), the federal government paid 100% of costs for new enrollees. After that, the match phased down:
• 2017: 95% federal / 5% state
• 2018: 94% federal / 6% state
• 2019: 93% federal / 7% state
• 2020 and beyond: 90% federal / 10% state (permanent floor)
Texas Refused Expansion:
Unlike most states, Texas never expanded Medicaid. That means low-income working adults without disabilities or dependent children got nothing. They fell into the “coverage gap” — too poor to buy private insurance, but not eligible for Medicaid. Texas left billions in federal money on the table, money that could have gone to rural hospitals, clinics, and families in TX-10.
Then July 2025 Hit — Trump’s “One Big Beautiful Bill”:
On July 4, 2025, Washington passed the so-called “One Big Beautiful Bill.” It made the Medicaid crisis even worse:
• Massive cuts: Up to $1.2 trillion over 10 years, about a 15% reduction overall.
• Work requirements: Adults 19–64 must prove 80 hours of work or community service each month to keep coverage.
• New costs: Co-pays up to $35, stricter eligibility checks, and waiting periods for green card holders.
• Rural hospitals left short: The bill created a $50 billion Rural Hospital Fund, but experts agree it doesn’t come close to covering the losses. Analysts estimate as many as 10 million people could lose Medicaid coverage nationwide.
👉 Bottom line: Rural Texas was already hurt when Austin refused Medicaid expansion. Now, with Washington’s “big, beautiful bill,” the squeeze is worse than ever. Our families are left carrying the burden, our hospitals are at risk, and our seniors stand to lose the most.
Current FICA breakdown: Employees pay FICA tax = 7.65% (6.2% toward Social Security + 1.45% toward Medicare), and employers match with another 7.65%.
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