Texas Removes 1.8 Million People From Health Care Plan
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Almost 1.8 million Americans have been disenrolled from Medicaid health coverage in Texas in the last two years, according to data by KFF, a nonprofit health policy research and news organization.
These Americans have lost their health insurance as part of the unwinding process happening nationwide after Medicaid coverage was expanded following the COVID pandemic.
A spokesperson for the Texas Health and Human Services Commission (HHSC) told Newsweek it is "committed to ensuring that those qualified for benefits receive them," and worked closely with the Centers for Medicare & Medicaid Services (CMS) "throughout the public health emergency and the Medicaid unwind process."
"Federal guidance required HHSC to redetermine eligibility for 6 million Medicaid clients over the course of 12 months," they added.
"Redetermining eligibility within federal requirements was a massive undertaking. Throughout the unwind, HHSC met with our federal partners on a regular basis to ensure that we followed federal guidance, and we will continue to collaborate with CMS to provide eligible Texans with benefits."
Why It Matters
The unwinding process has resulted in significant drops in Medicaid enrollment across the U.S. in recent years. While some of those disenrolled from Medicaid may still have had access to other forms of health insurance through their employment, those left without insurance could be in a vulnerable position. Higher rates of uninsured populations in states have been associated with negative impacts on health outcomes and medical costs.
File photo: doctors treat a child in a hospital.
File photo: doctors treat a child in a hospital.
Gerald Herbert/AP
What To Know
During the pandemic, some states expanded Medicaid coverage under the Affordable Care Act (ACA) while some Americans may have being encouraged to enroll for health coverage given the spread of the virus, causing nationwide enrollment levels to increase.
Federal rules then meant states had to keep most Medicaid enrollees on the program even if their eligibility status changed, a requirement which expired in March 2023, allowing states to resume removing individuals from the program.
Medicaid enrollment has since steadily declined, driven by both eligibility losses and procedural disenrollments.
In Texas, there were 5,922,450 covered by Medicaid in March 2023, but by March 2025, that number was 4,164,694, KFF data shows.
This marks a change of almost 1.8 million, a rate of decline faster than in Florida, California and New York.
The number of people with Medicaid coverage is now just lower than February 2020 levels, a difference of 1 percent.
Reasons for Texas' steeper drop in Medicaid enrollment could be because of the fact it, combined with Florida, New York and California, made up a significant proportion of Medicaid enrollment before the unwinding, Timothy McBride, a professor of public health at Washington University in St. Louis, told Newsweek.
All four states together accounted for 36 percent of Medicaid enrollment and subsequently accounted for 31 percent of the drop in the unwinding period between 2020 and 2025, he added.
This is in part because the states have large populations, but also because they have some of lowest percentages of health insurance coverage by employers or private plans, McBride said.
This is due to "higher poverty rates, especially in Florida and Texas, fewer good jobs that offer health insurance, and a higher percentage of nonwhite persons, especially in Florida, Texas, and California," he said.
"If they do not have private coverage they seek Medicaid," he added.
For those that were able to gain health insurance through private coverage once being rolled off Medicaid, there is little concern.
However, those that may remain uninsured as a result of the unwinding process "I am worried about," McBride said.
"The negative outcomes could be delays in seeking needed medical care leading to worse outcomes, lack of prevention, which is especially problematic if they have chronic conditions, bad mental health and financial outcomes, and higher medical debt since they have to pay for more out of pocket," he added.
What People Are Saying
Timothy D. McBride, professor of public health at Washington University in St. Louis, told Newsweek: "Part of the drop is people who maintained Medicaid coverage on paper because they got it at some point during the pandemic but remained there through the PHE. Yet some may have moved along and obtained other coverage, so really were not needing the Medicaid anyway. The group we are concerned about is those who have become uninsured or who lost the coverage for procedural reasons. It appears from some work that maybe 30 percent or so of those who lost coverage may be uninsured. And a lot of people—around that number lost coverage for procedural reasons, many of them children."
Laura Dague, a professor of health policy at Texas A&M University, told Newsweek: "How impactful the decreases in enrollment will be in terms of individual health depend on how aware people were of their ongoing coverage and how often they used it, and there is not much empirical evidence on this topic at the moment. A much bigger issue for Texas in my opinion will be the upcoming projected decreases in Marketplace enrollment due to decreasing subsidies; Texas has had major growth in that market in the last few years as subsidies increased."
What Happens Next
As the unwinding continues, more reductions in enrollment are expected in the state, and across the country. With millions already having lost health coverage, concerns remain about access to care for low-income individuals and families.
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MEHMET OZ: Well, the president's letter on Thursday for most favored nation pricing is a good example of that, and he's been working on this tirelessly since the first administration. And just to put this in context for many of the viewers, about two thirds of bankruptcies in America are caused by health care expenses. About a third of people when they go to the pharmacy, they leave empty handed. They can't afford the medication. So the President has said, Enough global freeloading. We've been covering much of the development costs for new drugs to cure cancer, deal with lots of other illnesses that are life threatening. It is in time for the American public to understand that we should not be paying three times more for the exact same medication in the same box, made in the same factories. The president's saying, equalize it out. Let's use a model that's worked, for example, for external threats, that's what NATO did. Everyone has to pay a little more. We'll pay extra too, but we won't pay a lot more than everybody else, so they actually have to raise their contributions, in this case, to an internal threat, which is illness. We'll pay a little less than America that way more Americans can afford these medications, and it's a fair system for the entire globe. MARGARET BRENNAN: So this was declared in these letters that were sent out to 17 pharmaceutical companies this past week, and it calls for extending that to Medicaid drug prices. Is that intended to offset what will be, you know, cuts to Medicaid? And do you know, you know, if the companies are actually going to follow through on this, like, how do you actually strong arm them into doing it? DR. OZ: Well just get the numbers correct. We're putting 200 billion more dollars into Medicaid. So we're actually investing— MARGARET BRENNAN: —by the time when costs are going up, so. DR. OZ: Costs are going up, but there's been a 50 percent increase in the cost of Medicaid over the last five years. So I'm trying to save this beautiful program, this noble effort, to help folks giving them a hand up. And as you probably gather, if Medicaid isn't able to take care of the people for whom it was designed, the young children, the dawn of their life, those are the twilight of their life, the seniors and those who are disabled living in the shadows, as Hubert Humphrey said, then we're not satisfying the fundamental obligation of a moral government. And this President has said over and over that he believes that it is the wise thing and the noble thing to help those who are vulnerable and every great society does that, we're going to as well. So we're going to invest in Medicaid as is required, but we want an appropriate return on that investment. One thing that Medicaid patients should not face are drug prices they can't afford. MARGARET BRENNAN: Right, how do you enforce this? Pharmaceutical companies— DR. OZ: Well, the pharmaceutical companies, if you sit them down quietly, Margaret, and we've done that, and say you went into this business at some point, because you cared about people. I know there's many out there shaking their heads, but that is actually the truth. People go into health care, whether they're pharmaceutical companies or insurance companies or the PBMs or anybody in the space. Even at the CMS, the most impressive thing to me in my new task, and the President has appointed me to, is the remarkable quality of people within the organization, just unbelievably talented. They went into this job because they care about health care and about people. Somewhere along the lines, people forget. They put numbers ahead of patients. And when that happens, then you start running into problems. We went to the pharmaceutical companies and we said, you appreciate this is not a fair system. We should not be paying more in America, three times more, for your products than you charge in Europe. They get the joke. They understand the reality of this problem. They are engaging with us. We're in the middle of those negotiations. The President has a unique power to convene. We've done it with dealing with prior authorization, this heinous process where patients feel like they're trying to get care from a doctor. Everything's being done except all of a sudden the arm of insurance comes in and stops the whole process for unknown reasons for weeks, sometimes months. The insurance companies, representing 80 percent of the American public, got together and they said, because we pushed them, we're going to deal with this. We can do the same, I believe, with the pharmaceutical industry, with most favored nation pricing. MARGARET BRENNAN: Let me ask you about the changes that are coming because of this new law to Medicaid, which is jointly administered between the feds and the states. There are major reduction- reductions to federal health care spending here, one of the changes are these work requirements. It's about 20 hours a week, volunteer or work to qualify for health care. What is the guidance you are giving to states on how to implement this? Because in this economy, things are more complicated. Uber driver, independent contractor, how do they show they work their 20 hours a week? DR. OZ: Last weekend, I was at the National Governors Association with Secretary Kennedy, who has been a big advocate of work as well. Every Democratic president and Republican president has said that the foundation of a healthy welfare system of a social system of support is work. MARGARET BRENNAN: Right, but I'm asking how you actually implement that and register it so that people who are working do qualify, and they don't get caught up in paperwork because they didn't file something on time. DR. OZ: As long as we're okay that people should work and would want to work, and it's not just work, it's community engagement. They can go get educated, right? They can take care of family members. They can contribute in other ways, but work is a great way of doing and get you out of poverty if you can find jobs and elevate yourself. There have been efforts to do this in the past, but they haven't been able to achieve what we can achieve, because we have technologies now. And we've invested already, as soon as the bill was signed, began pilots to try to demonstrate that we can actually do this correctly. We have pilots now in Louisiana and in Arizona, in both cases, within seven minutes, you can click on where you're working. You mentioned Uber, you're an Uber driver. You click that button on your phone. It just takes you to your payroll provider. Let's say it's ADP. We then ask your permission, can we connect with this payroll provider to demonstrate what you've actually been able to work and earn over the past month? This also, by the way, confirms your eligibility. But there's a bigger benefit here. Once you do that, you're in, you're done. However, what if we take one step further, Margaret? What if we go beyond just proving that you tried the work to actually say, You know what, you didn't work enough, but we can actually help you by connecting you through an employment office? MARGARET BRENNAN: So you're still figuring out the technology, but isn't there an end-of-December deadline for a lot of these things to be figured out? And how do you make sure that people don't get kicked off? Because in the state of Georgia, which already had work requirements, they have really struggled to make this work. DR. OZ: Well, a couple of things. It's not the end of December, it's end of December a year from now, and Georgia is apples and oranges. Georgia had a program only for people under the poverty level, and for those people, if they wanted, they could elect to come into a system to help them get jobs. There have been 50,000 reduction in head count of uninsured people in the overall program in the last five years. Overall, Georgia, 2 million less uninsured people. So Georgia is using a lot of tactics, and they're going in the right direction. I would argue that if you have confidence in the American people and their desire to take to offer to try to get a job, if we challenge you to that. And remember, if you're an able-bodied person on Medicaid, you're spending 6.1 hours watching television or leisure time, so you don't want that— MARGARET BRENNAN: —Well, KFF Health Policy found 92 percent of adult Medicaid recipients already are working. Or they have the carve out because they have to have caregivers, or they have to do other things. DR. OZ: They're fine. All they have to do is there'll be a simple app. If you've already carved out, that's super simple. If you're supposed to be if you're able-bodied and supposed to be working, we want to help connect you to the job market and get you into work. We have twice as many jobs available in America as people who seem to want them. The foundation of work is not just about fulfilling eligibility. The goal of health care insurance is to catalyze action in the right direction, to get you healthier, to give you agency over your future, so you recognize you matter, and you should have a job, therefore to go out and change the world. MARGARET BRENNAN: So there's a drug addiction problem in this country. How are those changes going to impact people who are on Medicaid in states like Kentucky, in states like West Virginia? DR. OZ: In many instances, there are carve outs for folks who have substance use disorder problems. There are programs-- MARGARET BRENNAN: —How do they prove that? ADMINISTRATOR OZ: Well, they can— MARGARET BRENNAN: Is this in the app? DR. OZ: Yes, it will be in the app. The app, again, this is being developed by the United States Digital Service, led by Amy Gleason, who is a wonderful technologist. She and I were with the President and Secretary Kennedy and the head of the czar for AI in this country on Wednesday, talking about overall how we're going to change the use of health technology in America. We've got to get into 2025 with health technology, as is true in every other sector. If you're watching the show right now, you could also be streaming media. You could take an Uber somewhere, the rideshare. You could do an Airbnb. Technology should make the system more efficient. We should have confidence that it will also allow us to do what we all agree is possible. If the whole challenge to a work requirement is that you don't have confidence in our ability to accomplish it, that's a separate question, because I do have confidence in the American people, and we have confidence we can pull this off. Look at the passport system, Margaret. Right now, you can go and get a passport in two weeks without having to go to the post office, send pictures, and all that's gone. It's fixable. Let's use technology. MARGARET BRENNAN: I'm still confused on how someone who is in the throes of substance abuse is going to use an app to say, I'm in the throes of substance abuse every week, to file on online— DR. OZ: —When they go in to get their help for their substance abuse treatment, assuming they're going for help on that, they can also get enrolled in, in those requirements, can be fulfilled. We want to talk to them in as many ways as possible. It's not going to happen just because we put an app out there, you, you have social workers and other folk elements who care a lot about this population, who are coming together, but they have to have some mechanism to report back. That just has not been done well. MARGARET BRENNAN: Well, and this is incredibly detailed, and that's why we wanted to have you on. I have so many more questions for you on rural hospitals and some of the other criticisms. I have to leave it there for now. But thank you, Dr. Oz-- DR. OZ: Can I give you 30 seconds on rural hospitals, because this is important. You have 7 percent of Medicaid money going to rural hospitals. We're putting 50 billion dollars the president wants us to, Congress wants to— MARGARET BRENNAN: There are a lot questions on how you're going to duel that out, and whether you have already made promises. Do you have any specifics for us? DR. OZ: Yes. Wait, wait, it's going to be, they'll get the applications in early September. The money is designed to help you with workforce development, right sizing the system and using technology to provide things like telehealth that can change the world. Imagine if we can change the way we think about the delivery of health and make it more about getting people healthy so they can thrive and flourish and be fully present in their own lives and as Americans. MARGARET BRENNAN: Dr Oz, we'll leave it there. We'll be back in a moment. Black swimmers teach others amid history of aquatic segregation How safe is our Social Security safety net? In Gaza, hunger forces impossible choices as Hamas releases propaganda video of hostage Solve the daily Crossword
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The following is the transcript of an interview with Democratic New Mexico Gov. Michelle Lujan Grisham that aired on "Face the Nation with Margaret Brennan" on Aug. 3, 2025. _______________________________________________________________________________________________________________________ MARGARET BRENNAN: We turn now to New Mexico's Democratic Governor Michelle Lujan Grisham. She joins us from Santa Fe. Governor, two out of five New Mexicans are on Medicaid. You've got a lot of rural hospitals. Have you figured out how to implement everything Dr. Oz just laid out? GOV. LUJAN GRISHAM: Absolutely not. There is no real way to implement this. It's more paperwork for everyone. It's more paperwork for federal government, for state governments, for county governments, for local hospitals, for independent providers. And you know what Americans really hate, Margaret? When you go to your primary care physician and you spend 20 minutes sitting at a chair, not even on the exam table, while they are inputting data into a computer. So this doesn't make any sense. We should be a society and a country that is connecting people to healthcare providers. I think the one thing that Dr. Oz represents that's a fair representation, is we should be healthier as Americans. All right. We need to be moving out of poverty. We need drug prices- we should talk about that, to come down. So go after insurance companies. Do manufacturing here. Make sure we can negotiate fair prices. Let states do that, because I guarantee you, we'll do a better job than the federal government. And lastly, get people early, easy access today, more than half, or about half, our small businesses don't even offer health care coverage. So you can get a job. but now what? MARGARET BRENNAN: Yeah, well, you said, though- in your state, because as a governor, you're going to have to figure this out. You have reserve cash from some oil and gas revenues, as I understand it, that have been put aside. Doesn't that show it is possible for the federal government to shift more responsibility back to the states? That's the argument conservatives are making. GOV. LUJAN GRISHAM: They are and it's temporary. There is no way any state, including this one—which, frankly, I am really proud of, we are in really good financial shape that takes planning and effort. You know, our job projections continue to be met and exceed, unlike the federal jobs report, which is going in the opposite direction. So I don't know where all these jobs are going to be in this anemic economy. I mean, it's so bad. The last time it was this bad, I was in college, and let me tell you, that was a very long time ago. And so yes, temporarily we can do that. But you can't do it over the long haul. The lost minimally to New Mexico over less than a decade is between 12 and $13 billion dollars and when, not if, rural hospitals and local providers close their doors. I can do this better than any other state. The last governor completely canceled behavioral health. Six years later, we are still reeling from trying to rebuild. We put a billion dollars into behavioral health just this last legislative session. It is not so easy to rebuild something out of nothing. MARGARET BRENNAN: Well, the $50 billion Rural Health Care Fund under this Republican law is supposed to give people the— your—states like yours, the ability to come and say, we need this extra cash. Are you going to have to ask for that? GOV. LUJAN GRISHAM: I'm going to ask for every dollar the federal government has put aside anywhere that benefits a New Mexican. So you got 50 billion. That's $1 billion for each state, if it was even. Do you know how much money it would take to shore up rural hospitals? More than a billion. And to put that in perspective—let me do this, it's a billion just for behavioral health, it's a billion plus just to keep people's coverage, it's another billion for prescription drugs, it's a billion dollars for rural provider delivery investments, and that's only 50 hospitals. You have hundreds of hospitals. Hundreds. 400 rural hospitals across America that will shutter. So that's the number at it is. We are- how do we pick these rural hospitals? And if you pick a Southeastern rural hospital in New Mexico, what about the rural hospital in western New Mexico. Economies fail. People have to move away. You don't have any OBGYN care. That whole area collapses, and they are reducing rural health care delivery by about 134 billion. So the 50 billion is just to make someone somewhere feel like they recognize that this is a disaster. $900 billion out of Medicaid is catastrophic, straight up. MARGARET BRENNAN: Governor, we ran through a lot of material here. I have more questions for you, but very quickly—can you tell me—you deployed the National Guard to counter unrest in New Mexico. How is that different from what the president did in California? GOV. LUJAN GRISHAM: Well, they're not policing. They're doing the back end work so that trained community policing, and members of that training, right—those local police officers, they're on the streets. What we have in this country is a shortage of police officers. What I have in New Mexico is a partnership. So they're doing all of the—they answer all of the emergency calls. They handle all the traffic clearance when we've got a crash. And it is working, we're beginning to see more productive fentanyl drug dealing high end arrests than we did without the guard. And I'm really proud of that work. This is about partnering and leveraging, not about indiscriminately going after individuals who have not committed serious crimes. MARGARET BRENNAN: Thank you for your time today. 'Face the Nation' will be right back.
