February 2013
Only One
Rational
Choice:
Texas Should Participate in
Medicaid Expansion Under the
Affordable Care Act:
Effects on Regions, Local Areas, and Legislative Districts
Provided as a Public Service by
THE PERRYMAN GROUP
510 N. Valley Mills Dr., Suite 300
Waco, TX 76710
ph. 254.751.9595, fax 254.751.7855
[email protected]
www.perrymangroup.com
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the
Affordable Care Act
Contents
Introduction and Overview .................................................................................... 1
Medicaid Expansion Dilemma Facing Texas ..................................................................................... 1
From an Economic Perspective, Texas Should Participate in Medicaid Expansion under the
Affordable Care Act ................................................................................................................................ 1
Effect of Expanding Medicaid under ACA is Clearly Positive for Texas ........................................ 4
Benefits are Spread across All Major Industry Sectors .................................................................... 5
Effects for Regions and Local Areas ....................................................................... 7
Local Areas and Regions Experience Notable Gains with Medicaid Expansion.......................... 7
Conclusion ........................................................................................................... 10
There is Only One Rational Choice for Texas ................................................................................. 10
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act ..................... 10
APPENDICES ......................................................................................................... 11
About The Perryman Group ................................................................................. 12
Methods Used ..................................................................................................... 13
Results by Area .................................................................................................... 17
Results for Economic Planning Regions ..................................................................................... 18
Results for Council of Governments Regions............................................................................. 20
Results for Metropolitan Statistical Areas ................................................................................. 22
Results for Counties ........................................................................................................................ 24
Results for Texas House Districts ................................................................................................ 32
Results for Texas Senate Districts ............................................................................................... 37
Results for US Congressional Districts........................................................................................ 39
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Introduction and Overview
Medicaid Expansion Dilemma Facing Texas



States can decide whether to expand Medicaid coverage under the Affordable Care Act
(ACA or “the Act”), and Texas Governor Rick Perry has indicated that Texas will decline to
expand coverage.
While the Medicaid system and ACA are not perfect, they are key aspects of the current
health care environment in which Texas must function.
In a recent study, The Perryman Group examined the economic effects of expanding
Medicaid coverage in Texas under the ACA and found that the benefits are substantial.
This report provides further detail for regions, metropolitan areas, and counties, as well as
a brief summary of key findings from the prior analysis.1
From an Economic Perspective, Texas Should Participate in Medicaid
Expansion under the Affordable Care Act


Not expanding Medicaid coverage involves significant economic fallout. This significant
economic downside must be weighed against potential savings in direct State outlays. The
health care needs of Texans do not simply go away because individuals do not have
insurance coverage. In fact, they actually compound and become worse over time.
The Perryman Group identified three major sources of economic gains from expanding
Medicaid coverage under the ACA. Total economic benefits were quantified over the first
10 years after implementation (2014-2023). Additional information related to assumptions
and methods used may be found in the box below, with further detail in the statewide
report and Appendices.
o First, health spending expands, generating gains in business activity. The
Perryman Group quantified these likely increases by evaluating the total direct and
spinoff activity on a “gross” and “net” basis; the “net” results account for the fact
that the State portion of the funding will displace other public or private spending
and associated multiplier effects.
o Second, uncompensated care is reduced, freeing up private funds to be used for
other purposes. The cost of uncompensated care is currently borne by local
governments (and, thus, local taxpayers) and privately insured persons (through
higher premiums). Reducing uncompensated care would thus leave more
1
A copy of the October statewide study by The Perryman Group is available on the firm’s website at
www.perrymangroup.com.
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act

resources in the hands of the private sector (both individuals and companies) to be
used in other ways.
o Third, having health insurance increases productivity. When individuals lack
health insurance and their access to care is constrained, empirical evidence
indicates they have worse health care outcomes and, hence, reduced labor force
participation, higher absenteeism. and lower productivity.
When these outcomes and the related multiplier effects are considered, every $1 spent
by the State returns $1.29 in dynamic State government revenue over the first 10 years
of the expansion. In other words, the State actually makes money by participating in the
Medicaid expansion.
NET ECONOMIC IMPACT OF EACH ADDITIONAL DOLLAR OF DIRECT STATE GOVERNMENT EXPENDITURES USED
TO PARTICIPATE IN THE MEDICAID EXPANSION WITHIN THE AFFORDABLE CARE ACT: 2014-2023
Total Expenditures* in Texas
$43.50
Gross State Product*
$21.72
Personal Income* in Texas
$14.34
Retail Sales in Texas
$6.13
Federal Medicaid Funding in Texas
$6.78
Reduced Local Taxes for Uncompensated Care
($1.21)
Reduced Insurance Premiums for Uncompensated Care
($0.30)
Increased Dynamic* State Government Revenue
$1.29
Increased Dynamic* Local Government Revenue
$0.51
Income for Previously Uninsured Population
$1.54
*For definitions of these measures of business activity and terms, as well as an overview of methods
used, see page 3.
SOURCE: The Perryman Group
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Measuring Economic Impacts
Any economic stimulus (such as direct spending, investments, or corporate activity) generates multiplier effects
throughout the economy. In this instance, economic benefits of expanding Medicaid under the ACA include
increased health-related spending, additional private outlays associated with reducing uncompensated care, and
higher productivity stemming from better health outcomes. (These channels of benefits were briefly described
above.) Once the direct stimulus was quantified, the associated multiplier effects were measured.
The Perryman Group’s input-output assessment model (the US Multi-Regional Impact System, which is described
in further detail in the Appendices to this report) was developed by The Perryman Group some 30 years ago and
has been consistently maintained and updated since that time; it has been used in hundreds of analyses for clients
ranging from major corporations to government agencies. The system uses a variety of data (from surveys,
industry information, and other sources) to describe the various goods and services (known as resources or inputs)
required to produce another good/service. This process allows for estimation of the total economic impact
(including multiplier effects) of expanding Medicaid under the ACA. An associated fiscal model allows for
estimation of tax receipts to state and local entities. The submodel used in the current analysis reflects the specific
industrial composition and characteristics of the Texas economy and its various counties and regions.
These total economic effects are quantified for key measures of business activity:




Total expenditures (or total spending) measure the dollars changing hands as a result of the economic
stimulus.
Gross product (or output) is production of goods and services that will come about in each area as a result of
the activity. This measure is parallel to the gross domestic product numbers commonly reported by various
media outlets and is a subset of total expenditures.
Personal income is dollars that end up in the hands of people in the area; the vast majority of this aggregate
derives from the earnings of employees, but payments such as interest and rents are also included.
Job gains are expressed as (1) person-years of employment (one person working for one year) for temporary
projects (such as construction of a facility) or cumulative assessments over time or (2) permanent jobs when
evaluating ongoing annual effects.
Monetary values were quantified on both a current dollar basis (meaning that they allow for medical inflation and
reflect the size of outlays at the time they are expended) and a constant (2012) basis, which eliminates inflationary
effects and allows comparison across various time periods. See the Appendices to this report for additional
information regarding the methods and assumptions used in this analysis.
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Effect of Expanding Medicaid under ACA is Clearly Positive for Texas


During the first 10 years after implementation, The Perryman Group estimates that the
total cumulative gross benefits to the state economy include $270.0 billion (in 2012
dollars) in output (real gross product) and 3,174,640 person-years of employment.
Adjusting for the diversion of State spending, total cumulative net benefits to the state
during the first 10 years after implementation include $255.8 billion (in 2012 dollars) in
output (real gross product) and 3,031,400 person-years of employment.
Total Cumulative Net Impact Over the First Ten Years of Implementation
Associated with Participation in the Medicaid Expansion Portion of the ACA on
Business Activity in Texas
$600
$512.548
Billions of 2012 Dollars
$500
Person-Years of
Employment
$400
3,031,400
$300
$255.838
$200
$168.896
$100
$72.147
$0
Total Expenditures
Gross Product
Personal Income
Retail Sales
Note: Values expressed in constant (2012) dollars to remove the effects of medical inflation and allow year-to-year comparisons from a comparable
base. Amounts are adjusted to reflect the diversion of economic activity required to fund the State portion of the incremental Medicaid funding.
Source: The Perryman Group

These gains rise over time with population growth and aging and the resulting increase in
the need for health care.
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Benefits are Spread across All Major Industry Sectors

Expanding Medicaid under the ACA leads to expansion in business activity in all major
industry groups (as described in the table below).
o Health services would see the largest gains, with a total benefit over the 2014-2023
period of $70.8 billion in output (gross product) and more than 988,400 personyears of employment (approximately 100,000 jobs per year on average).
o Retail trade captures the second-largest component of the gains, with a cumulative
$54.2 billion in output (gross product) and 962,600 person-years of employment
over the first 10 years.
o Every major industry group (including, among others, manufacturing, agriculture,
business services, financial services, mineral extraction, hospitality, and
information) would experience notably increased business activity if Texas
participates in Medicaid expansion under the ACA (see table below).
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TOTAL BENEFITS BY INDUSTRY SECTOR:
2014-2023
THE TOTAL CUMULATIVE NET IMPACT OVER THE FIRST TEN YEARS OF IMPLEMENTATION (HEALTH-RELATED SPENDING,
UNCOMPENSATED CARE REDUCTIONS, AND MORBIDITY AND MORTALITY REDUCTIONS) ASSOCIATED WITH
PARTICIPATION IN THE MEDICAID EXPANSION PORTION OF THE AFFORDABLE CARE ACT (ACA) ON
BUSINESS ACTIVITY IN TEXAS
SECTOR
TOTAL EXPENDITURES
REAL GROSS PRODUCT
PERSONAL INCOME
EMPLOYMENT
(Billions of 2012
Dollars)
(Billions of 2012
Dollars)
(Billions of 2012
Dollars)
(Person-Years)
Agriculture
$9.6
$2.6
$1.7
27,430
Mining
$24.5
$5.5
$2.7
14,550
Construction
$13.2
$6.7
$5.6
78,420
Nondurable
Manufacturing
$60.4
$17.1
$8.9
138,480
Durable
Manufacturing
$19.9
$7.9
$5.2
69,400
Transportation,
Warehousing,
and Utilities
$42.1
$16.1
$9.3
103,860
Information
$12.3
$7.6
$3.3
30,230
Wholesale Trade
$18.6
$12.6
$7.2
80,920
Retail Trade
$72.1
$54.2
$31.5
962,600
Finance,
Insurance, and
Real Estate
$84.4
$23.7
$8.6
87,790
Business Services
$24.5
$15.2
$12.4
151,000
Health Services
$100.5
$70.8
$59.8
988,420
Other Services
$30.5
$15.8
$12.6
298,310
$512.5
$255.8
$168.9
3,031,400
Total
Cumulative
Effect
Source: US Multi-Regional Impact Assessment System, The Perryman Group
Note: Values expressed in constant (2012) dollars to remove the effects of medical inflation and allow year-to-year
comparisons from a comparable base. (Totals may not add due to rounding.) Amounts are adjusted to reflect the
diversion of economic activity required to fund the State portion of the incremental Medicaid funding.
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Effects for Regions and Local Areas
Local Areas and Regions Experience Notable Gains with Medicaid
Expansion



The Perryman Group examined the potential gains associated with expanding Medicaid
under the ACA for Texas planning regions, Council of Governments regions, Metropolitan
Statistical Areas, and Counties. In addition, the distribution of these effects by Texas
House, Texas Senate, and Congressional district was quantified.
All Texas House districts see substantial benefits over the 2014-2023 period, with the
effects ranging from more than $430 million in gross product and 5,500 person-years of
employment in some rural districts to $3.2 billion and almost 40,000 jobs in urban areas
with a notable presence of health care facilities. The distribution in the larger Texas
Senate districts spans from $4.2 billion to $14.7 billion in output and 52,500 to 164,500
persons-years of employment. Congressional districts are between $4.0 billion and $12.5
billion in output and from 46,200 to more than 140,000 job-years. Simply stated, each
legislative district has a sizable stake in Medicaid expansion.
Benefits are generally distributed with population, and regional health care centers see
additional gains. The following maps indicate results for Council of Governments Regions
and Metropolitan Statistical Areas.
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Only One Rational Choice:
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BENEFITS BY COUNCIL OF GOVERNMENTS REGION
TOTAL CUMULATIVE NET IMPACT OVER THE FIRST TEN
YEARS OF PARTICIPATION IN THE MEDICAID EXPANSION
PORTION OF THE ACA ON BUSINESS ACTIVITY
GROSS
EMPLOYMENT
PRODUCT
(Billions of
2012
Dollars)
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(Person-Years)
Panhandle
South Plains
North Texas
North Central Texas
North East Texas
East Texas
West Central Texas
Upper Rio Grande
Permian Basin
Concho Valley
Heart of Texas
Capital
Brazos Valley
Deep East Texas
South East Texas
Gulf Coast
Golden Crescent
Alamo
South Texas
Coastal Bend
Lower Rio Grande
Valley
Texoma
Central Texas
Middle Rio Grande
$3.6
$4.3
$1.9
$79.5
$2.5
$8.6
$2.7
$6.6
$2.6
$1.5
$2.9
$16.1
$2.2
$2.3
$3.8
$64.8
$1.6
$23.4
$1.8
$5.9
44,319
53,735
23,634
922,820
32,622
106,353
33,641
78,816
32,180
18,497
35,629
195,545
28,125
29,237
48,112
728,291
19,391
286,206
23,201
71,441
$10.7
135,922
$1.6
$4.1
$0.9
20,411
52,040
11,333
Border Region
$19.9
249,204
$255.8
TOTAL STATE
Source: The Perryman Group
3,031,403
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Only One Rational Choice:
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BENEFITS BY METROPOLITAN STATISTICAL AREA
TOTAL CUMULATIVE NET IMPACT OVER THE FIRST TEN YEARS
OF PARTICIPATION IN THE MEDICAID EXPANSION PORTION OF
THE ACA ON BUSINESS ACTIVITY
GROSS
EMPLOYMENT
PRODUCT
(Billions of
2012
Dollars)
Abilene
Amarillo
Austin-Round Rock-San
Marcos
Beaumont-Port Arthur
Brownsville-Harlingen
College Station-Bryan
Corpus Christi
Dallas-Plano-Irving MD*
Fort Worth-Arlington MD*
El Paso
Houston-Sugar LandBaytown
Killeen-Temple-Fort Hood
Laredo
Longview
Lubbock
McAllen-Edinburg-Mission
Midland
Odessa
San Angelo
San Antonio-New Braunfels
Sherman-Denison
Texarkana
Tyler
Victoria
Waco
Wichita Falls
Rural Areas
TOTAL STATE
(Person-Years)
$2.0
$3.1
23,973
38,633
$15.5
188,426
$3.8
$3.7
$1.9
$5.1
$56.5
$22.1
$6.5
48,112
46,930
23,577
60,887
645,734
266,580
77,596
$64.1
718,567
$3.9
$1.5
$2.4
$4.0
$6.9
$1.0
$1.1
$1.4
$22.5
$1.3
$1.4
$4.3
$1.3
$2.4
$1.6
49,795
18,713
29,866
48,959
88,297
12,209
13,513
17,027
274,316
16,414
17,950
51,885
15,610
29,296
20,016
$14.8
188,521
$255.8
3,031,403
*Metropolitan Division
Source: The Perryman Group
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Conclusion
There is Only One Rational Choice for Texas



Neither the Affordable Care Act nor the Medicaid program is perfect, and there are many
opportunities to provide needed health services in a more efficient and cost effective
manner.
However, the economic benefits of improving access to care far more than outweigh the
costs. The Perryman Group found that for every dollar the State spends for Medicaid
expansion under the ACA, $1.29 is returned in dynamic State government revenue. Over
the first 10 years of implementation, economic gains (even when fully adjusted for the
diversion of State funding for other purposes) include an estimated $255.8 billion (2012
dollars) in output (real gross product) and 3,031,400 person-years of employment (an
average of over 300,000 per year). These gains are spread across industries and
throughout the state, with thousands of jobs at stake in every legislative district.
Expanding Medicaid coverage is an investment that improves the quality of life of many
Texans, while simultaneously enhancing the economy and providing a positive return to
the State government on the dollars expended.
Texas Should Participate in Medicaid Expansion Under the Affordable Care
Act


Given the available options, expanding Medicaid coverage is the only rational choice.
Such an expansion would improve the lives of some of the most vulnerable Texans, while
providing notable resources at all levels of government and bringing an economic
stimulus to a spectrum of industries and communities both large and small.
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APPENDICES
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About The Perryman Group
•
The Perryman Group (TPG) is an economic research and analysis firm based in Waco, Texas. The
firm has more than 30 years of experience in assessing the economic impact of corporate
expansions, regulatory changes, real estate developments, public policy initiatives, and myriad
other factors affecting business activity. TPG has conducted hundreds of impact analyses for
local areas, regions, and states throughout the U.S. Impact studies have been performed for
hundreds of clients including many of the largest corporations in the world, governmental
entities at all levels, educational institutions, major health care systems, utilities, and economic
development organizations.
•
Dr. M. Ray Perryman, founder and President of the firm, developed the US Multi-Regional
Impact Assessment System (used in this study) in the early 1980s and has consistently
maintained, expanded, and updated it since that time. The model has been used in hundreds of
diverse applications and has an excellent reputation for reliability. Dr. Perryman has been asked
to testify before the State legislature, Congress, and other major legislative and regulatory
bodies on more than one hundred occasions, including invited testimony related to publicsector funding for health insurance.
•
The firm has conducted numerous investigations related to health care including previous
studies of health care funding. The Perryman Group has also measured the comprehensive cost
of cancer (including treatment as well as lost productivity and premature mortality) on multiple
occasions. The firm is also engaged in the ongoing evaluation of the economic effects of the
Cancer Prevention and Research Institute of Texas (CPRIT). In addition, the firm measured
economic aspects of obesity including associated morbidity, mortality, and productivity. The
Perryman Group has performed assessments of scores of major medical facilities, teaching
institutions, and research programs. Representative clients include The Methodist Hospital,
Parkland (on multiple occasions), Scott & White, M. D. Anderson (including a comprehensive
assessment of the benefits of its research and superior outcomes), Citizens Medical Center, the
University of Kansas Cancer Center (including an investigation of the benefits of achieving the
status of a Comprehensive Cancer Center), the Menninger Clinic, the University of Texas Medical
Branch, Baylor College of Medicine, Texas Tech University Health Science Center, Texas Health
Resources, the University of Texas Health Science Center at San Antonio, Texas A&M University
School of Medicine, the Texas Institute for Genomic Medicine, and others. As noted, TPG has
developed numerous public policy studies related to health care issues. Representative efforts
include analyses of Medicaid and Children’s Health Insurance Program (CHIP) funding, wellness
initiatives, more extensive use of Advanced Practice Registered Nurses, and mental health
programs. Moreover, a major study developed using the relevant model was recently published
in The Journal of Medical Economics.
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Methods Used
•
The basic modeling technique employed in this study is known as dynamic input-output analysis.
This methodology essentially uses extensive survey data, industry information, and a variety of
corroborative source materials to create a matrix describing the various goods and services
(known as resources or inputs) required to produce one unit (a dollar’s worth) of output for a
given sector. Once the base information is compiled, it can be mathematically simulated to
generate evaluations of the magnitude of successive rounds of activity involved in the overall
production process.
•
There are two essential steps in conducting an input-output analysis once the system is
operational. The first major endeavor is to accurately define the levels of direct activity to be
evaluated. In the case of a prospective evaluation, it is necessary to first calculate reasonable
estimates of the direct activity.
•
In this instance, the Texas Health and Human Services Commission prepared information
describing the effects of the Affordable Care Act. These measures include likely enrollment
increases and costs to the state of expanding Medicaid coverage. This information was used as
a starting point for assessing the economic benefits of extending Medicaid coverage to these
individuals. After verifying their reasonableness, TPG used the recent HHSC projections for
enrollment growth, health costs, administration fees, and other factors under both elements of
the Medicaid expansion under the Affordable Care Act. The incremental health spending was
allocated among various categories of providers based on current and projected usage patterns
(all economic projections required for this analysis are obtained from the most recent
simulations of the Texas Econometric Model, which was developed and is maintained by The
Perryman Group).
•
It was assumed that the offsetting funds necessary to provide the State contribution are
withdrawn from the economy based on current spending and production patterns across more
than 500 industrial categories based on current information from the Bureau of Economic
Analysis of the US Department of Commerce.
•
To quantify potential reductions in the value of uncompensated care, TPG used extensive
research by the Institute of Medicine to estimate the reduction in uncompensated care (which is
essentially funded by increased local taxes and higher private-sector insurance premiums)
associated with each additional person obtaining insurance coverage. All information was
updated from the original analysis to reflect current medical costs in Texas. This analysis was
then combined with HHSC estimates regarding incremental insured individuals and incremental
costs to determine the additional direct benefits (cost reductions) within the state economy.
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Only One Rational Choice:
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This amount was then assumed to be available within the private or public sector for alternative
uses based on the current composition of business activity.
•
The annual value of the reduction in morbidity and mortality associated with higher insurance
rates on an annual basis is based on estimates by the Institute of Medicine as part of a major
research initiative, and has been fully updated to current price levels and relative income levels
in Texas based on appropriate cost indices from the US Department of Labor and income data
from the US Department of Commerce. The totals have also been adjusted to include only the
portion of the value that reflects earned income and to eliminate various non-pecuniary,
quality-of-life factors. While such considerations are obviously beneficial and important to the
future of the state, they do not result in any net governmental revenue and, thus, are not
appropriate to consider in an analysis focused on an economic and fiscal assessment.
•
The second major phase of the analysis is the simulation of the input-output system to measure
overall economic effects of these direct changes in health care spending and outcomes. The
present study was conducted within the context of the US Multi-Regional Impact Assessment
System (USMRIAS) which was developed and is maintained by The Perryman Group. This model
has been used in hundreds of diverse applications across the country and has an excellent
reputation for accuracy and credibility. The system used in the current simulations reflects the
unique industrial structure and characteristics of the Texas economy, as well as its various
counties and regions.
•
The USMRIAS is somewhat similar in format to the Input-Output Model of the United States and
the Regional Input-Output Modeling System, both of which are maintained by the US
Department of Commerce. The model developed by TPG, however, incorporates several
important enhancements and refinements. Specifically, the expanded system includes (1)
comprehensive 500-sector coverage for any county, multi-county, or urban region; (2)
calculation of both total expenditures and value-added by industry and region; (3) direct
estimation of expenditures for multiple basic input choices (expenditures, output, income, or
employment); (4) extensive parameter localization; (5) price adjustments for real and nominal
assessments by sectors and areas; (6) measurement of the induced impacts associated with
payrolls and consumer spending; (7) embedded modules to estimate multi-sectoral direct
spending effects; (8) estimation of retail spending activity by consumers; and (9) comprehensive
linkage and integration capabilities with a wide variety of econometric, real estate,
occupational, and fiscal impact models. Moreover, the model uses specific local taxing patterns
to estimate the fiscal effects of activity on a detailed sectoral basis. The models used for the
present investigation have been thoroughly tested for reasonableness and historical reliability.
•
The impact assessment (input-output) process essentially estimates the amounts of all types of
goods and services required to produce one unit (a dollar’s worth) of a specific type of output.
For purposes of illustrating the nature of the system, it is useful to think of inputs and outputs in
dollar (rather than physical) terms. As an example, the construction of a new building will
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Only One Rational Choice:
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require specific dollar amounts of lumber, glass, concrete, hand tools, architectural services,
interior design services, paint, plumbing, and numerous other elements. Each of these suppliers
must, in turn, purchase additional dollar amounts of inputs. This process continues through
multiple rounds of production, thus generating subsequent increments to business activity. The
initial process of building the facility is known as the direct effect. The ensuing transactions in
the output chain constitute the indirect effect.
•
Another pattern that arises in response to any direct economic activity comes from the payroll
dollars received by employees at each stage of the production cycle. As workers are
compensated, they use some of their income for taxes, savings, and purchases from external
markets. A substantial portion, however, is spent locally on food, clothing, health care services,
utilities, housing, recreation, and other items. Typical purchasing patterns in the relevant areas
are obtained from the ACCRA Cost of Living Index, a privately compiled inter-regional measure
which has been widely used for several decades, and the Consumer Expenditure Survey of the US
Department of Labor. These initial outlays by area residents generate further secondary activity
as local providers acquire inputs to meet this consumer demand. These consumer spending
impacts are known as the induced effect. The USMRIAS is designed to provide realistic, yet
conservative, estimates of these phenomena.
•
Sources for information used in this process include the Bureau of the Census, the Bureau of
Labor Statistics, the Regional Economic Information System of the US Department of Commerce,
and other public and private sources. The pricing data are compiled from the US Department of
Labor and the US Department of Commerce. The verification and testing procedures make use
of extensive public and private sources.
•
Impacts were measured both in terms of (1) current dollars, reflecting the actual amounts as
they are expended over the 10-year timeframe, and (2) constant 2012 dollars to eliminate the
effects of inflation and allow comparisons across years on a comparable basis.
•
The USMRIAS generates estimates of the effect on several measures of business activity. The
most comprehensive measure of economic activity used in this study is Total Expenditures. This
measure incorporates every dollar that changes hands in any transaction. For example, suppose
a farmer sells wheat to a miller for $0.50; the miller then sells flour to a baker for $0.75; the
baker, in turn, sells bread to a customer for $1.25. The Total Expenditures recorded in this
instance would be $2.50, that is, $0.50 + $0.75 + $1.25. This measure is quite broad, but is
useful in that (1) it reflects the overall interplay of all industries in the economy, and (2) some
key fiscal variables such as sales taxes are linked to aggregate spending.
•
A second measure of business activity frequently employed in this analysis is that of Gross
Product. This indicator represents the regional equivalent of Gross Domestic Product, the most
commonly reported statistic regarding national economic performance. In other words, the
Gross Product of Arkansas is the amount of US output that is produced in that state; it is defined
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as the value of all final goods produced in a given region for a specific period of time. Stated
differently, it captures the amount of value-added (gross area product) over intermediate goods
and services at each stage of the production process, that is, it eliminates the double counting in
the Total Expenditures concept. Using the example above, the Gross Product is $1.25 (the value
of the bread) rather than $2.50. Alternatively, it may be viewed as the sum of the value-added
by the farmer, $0.50; the miller, $0.25 ($0.75 - $0.50); and the baker, $0.50 ($1.25 - $0.75). The
total value-added is, therefore, $1.25, which is equivalent to the final value of the bread. In
many industries, the primary component of value-added is the wage and salary payments to
employees.
•
The third gauge of economic activity used in this evaluation is Personal Income. As the name
implies, Personal Income is simply the income received by individuals, whether in the form of
wages, salaries, interest, dividends, proprietors’ profits, or other sources. It may thus be viewed
as the segment of overall impacts which flows directly to the citizenry.
•
The fourth measure, Retail Sales, represents the component of Total Expenditures which occurs
in retail outlets (general merchandise stores, automobile dealers and service stations, building
materials stores, food stores, drugstores, restaurants, and so forth). Retail Sales is a commonly
used measure of consumer activity.
•
The final aggregates used are Permanent Jobs and Person-Years of Employment. The PersonYears of Employment measure reveals the full-time equivalent jobs generated by an activity. It
should be noted that, unlike the dollar values described above, Permanent Jobs is a “stock”
rather than a “flow.” In other words, if an area produces $1 million in output in 2010 and $1
million in 2011, it is appropriate to say that $2 million was achieved in the 2010-2011 period. If
the same area has 100 people working in 2010 and 100 in 2011, it only has 100 Permanent Jobs.
When a flow of jobs is measured, such as in a construction project or a cumulative assessment
over multiple years, it is appropriate to measure employment in Person-Years (a person working
for a year). This concept is distinct from Permanent Jobs, which anticipates that the relevant
positions will be maintained on a continuing basis.
•
Because any expenditure of State funds is an economic stimulus, The Perryman Group also
calculated these economic benefits on a “net” basis by adjusting for the diversion of State funds
that would have otherwise been spent for various other goods or services.
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Results by Area
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Results for Economic Planning Regions
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and Mortality
Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014 -2023:
Comptroller's Economic Region Results
Economic Region
Total
Expenditures
(2012 Dollars)
Gross
Product
(2012 Dollars)
Personal
Income
(2012 Dollars)
Retail
Sales
(2012 Dollars)
Employment
(PersonYears)
High Plains
Northwest Texas
Metroplex
Upper East Texas
Southeast Texas
Gulf Coast
Capital
Central Texas
Alamo
South Texas
West Texas
Upper Rio Grande
$15,107,935,708
$8,780,529,394
$162,762,355,630
$21,521,593,209
$11,498,955,921
$139,311,530,764
$30,075,905,897
$17,297,870,540
$48,322,544,177
$36,713,246,565
$8,219,376,765
$12,935,958,453
$7,946,171,300
$4,594,013,722
$81,043,958,923
$11,155,319,381
$6,077,217,481
$64,848,288,245
$16,051,907,321
$9,168,844,164
$25,020,175,910
$19,213,336,763
$4,149,768,310
$6,569,287,716
$5,308,347,403
$3,078,856,247
$52,908,818,923
$7,492,565,454
$4,150,937,155
$42,437,818,602
$10,687,440,372
$6,171,814,735
$16,676,885,108
$12,931,000,705
$2,745,829,285
$4,305,813,538
$2,476,644,206
$1,479,026,139
$22,312,875,096
$3,532,209,611
$2,022,580,389
$15,715,493,962
$4,902,873,473
$2,916,483,000
$7,458,933,596
$6,098,645,270
$1,343,369,593
$1,888,093,011
98,054
57,274
943,232
138,975
77,348
728,291
195,545
115,794
305,597
241,799
50,677
78,816
TOTAL STATE IMPACT
$512,547,803,023
$255,838,289,237
$168,896,127,527
$72,147,227,347
3,031,403
NOTE: Allocations reflect best available evidence regarding incidence and industrial structure and com position of each area.
SOURCE: US Multi-Regional Im pact Assessm ent System , The Perrym an Group
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Results for Council of Governments Regions
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014-2023:
Council of Governments (COG) Region Results
COG
Panhandle
South Plains
North Texas
North Central Texas
North East Texas
East Texas
West Central Texas
Upper Rio Grande
Permian Basin
Concho Valley
Heart of Texas
Capital
Brazos Valley
Deep East Texas
South East Texas
Gulf Coast
Golden Crescent
Alamo
South Texas
Coastal Bend
Lower Rio Grande Valley
Texoma
Central Texas
Middle Rio Grande
Border Region
TOTAL STATE IMPACT
Total
Expenditures
(2012 Dollars)
Gross
Product
(2012 Dollars)
Personal
Income
(2012 Dollars)
Retail
Sales
(2012 Dollars)
Employment
(PersonYears)
$6,981,513,893
$8,126,421,814
$3,474,401,231
$159,822,515,478
$4,738,664,042
$16,782,929,167
$5,306,128,162
$12,935,958,453
$5,218,548,675
$3,000,828,090
$5,636,157,342
$30,075,905,897
$4,330,105,753
$4,212,636,888
$7,286,319,033
$139,311,530,764
$3,110,309,483
$45,212,234,694
$3,335,549,995
$12,066,635,670
$19,738,206,976
$2,939,840,151
$7,331,607,446
$1,572,853,924
$3,610,299,248
$4,335,872,051
$1,868,151,246
$79,463,235,866
$2,544,716,178
$8,610,603,203
$2,725,862,476
$6,569,287,716
$2,647,199,955
$1,502,568,356
$2,872,379,116
$16,051,907,321
$2,239,780,392
$2,265,289,613
$3,811,927,868
$64,848,288,245
$1,572,477,063
$23,447,698,848
$1,798,245,266
$5,882,214,667
$10,662,996,016
$1,580,723,057
$4,056,684,656
$869,880,814
$2,405,751,925
$2,902,595,477
$1,263,594,695
$51,834,022,074
$1,735,890,795
$5,756,674,659
$1,815,261,552
$4,305,813,538
$1,759,065,025
$986,764,260
$1,906,350,279
$10,687,440,372
$1,499,989,632
$1,544,991,695
$2,605,945,460
$42,437,818,602
$1,059,734,225
$15,617,150,884
$1,218,805,634
$3,919,694,383
$7,200,029,922
$1,074,796,849
$2,765,474,824
$592,470,765
$1,139,750,868
$1,336,893,338
$623,830,447
$21,777,053,390
$856,255,371
$2,675,954,240
$855,195,692
$1,888,093,011
$872,444,907
$470,924,686
$882,019,167
$4,902,873,473
$712,917,322
$766,017,914
$1,256,562,475
$15,715,493,962
$502,661,153
$6,956,272,443
$630,801,858
$1,815,284,537
$3,356,712,849
$535,821,707
$1,321,546,510
$295,846,026
44,319
53,735
23,634
922,820
32,622
106,353
33,641
78,816
32,180
18,497
35,629
195,545
28,125
29,237
48,112
728,291
19,391
286,206
23,103
71,441
135,922
20,411
52,040
11,333
$37,586,866,868
$19,902,804,617
$13,318,697,286
$6,172,425,194
249,204
$512,547,803,023 $255,838,289,237 $168,896,127,527
$72,147,227,347
3,031,403
NOTE: Allocations reflect best available evidence regarding incidence and industrial structure and com position of each area.
SOURCE: US Multi-Regional Im pact Assessm ent System , The Perrym an Group
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Results for Metropolitan Statistical Areas
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and Mortality
Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014 -2023:
Metropolitan Statistical Area (MSA) and Rural Texas Results
MSA
Abilene
Amarillo
Austin-Round Rock-San Marcos
Beaumont-Port Arthur
Brownville-Harlingen
College Station-Bryan
Corpus Christi
Dallas-Plano-Irving MD*
Fort Worth-Arlington MD*
El Paso
Houston-Sugar Land-Baytown
Killeen-Temple-Fort Hood
Laredo
Longview
Lubbock
McAllen-Edinburg-Mission
Midland
Odessa
San Angelo
San Antonio-New Braunfels
Sherman-Denison
Texarkana
Tyler
Victoria
Waco
Wichita Falls
Rural Area
TOTAL STATE IMPACT
Total
Expenditures
(2012 Dollars)
Gross
Product
(2012 Dollars)
Personal
Income
(2012 Dollars)
Retail
Sales
(2012 Dollars)
Employment
(PersonYears)
$3,910,301,323
$6,020,076,548
$28,938,075,353
$7,286,319,033
$6,994,645,710
$3,657,507,939
$10,526,987,666
$114,589,851,489
$43,654,109,110
$12,763,649,577
$137,881,879,617
$7,008,975,574
$2,760,527,554
$4,510,590,873
$7,409,491,791
$12,649,073,915
$2,029,792,543
$2,139,959,944
$2,775,398,474
$43,388,721,329
$2,309,561,495
$2,559,334,872
$8,526,613,726
$2,555,574,314
$4,689,751,134
$2,914,637,179
$1,976,256,421
$3,147,686,638
$15,473,485,705
$3,811,927,868
$3,703,574,010
$1,882,921,959
$5,059,610,095
$56,502,705,975
$22,138,278,040
$6,474,023,802
$64,094,990,245
$3,883,592,638
$1,474,248,816
$2,389,998,933
$3,962,097,389
$6,906,111,807
$1,030,669,412
$1,093,411,566
$1,385,364,669
$22,506,261,451
$1,261,159,476
$1,404,106,926
$4,263,748,866
$1,276,862,430
$2,378,414,744
$1,580,581,915
$1,309,581,148
$2,103,923,561
$10,305,200,642
$2,605,945,460
$2,479,034,811
$1,258,674,320
$3,361,650,444
$36,610,478,722
$14,666,737,829
$4,241,899,123
$41,927,312,445
$2,647,712,324
$993,940,625
$1,621,669,730
$2,654,408,553
$4,685,278,918
$673,950,283
$739,312,219
$908,770,701
$14,987,027,858
$861,713,475
$959,572,599
$2,808,014,593
$858,867,402
$1,571,514,730
$1,071,926,612
$588,798,496
$967,623,097
$4,715,520,141
$1,256,562,475
$1,162,247,798
$590,913,201
$1,529,894,136
$15,059,751,194
$6,445,907,342
$1,853,214,126
$15,451,176,401
$1,258,179,838
$503,821,786
$752,163,568
$1,193,789,473
$2,174,400,544
$338,343,282
$350,212,392
$428,378,107
$6,644,802,189
$425,044,691
$459,732,088
$1,301,541,204
$403,992,759
$713,740,707
$521,261,125
23,973
38,633
188,426
48,112
46,930
23,577
60,887
645,734
266,580
77,596
718,567
49,795
18,713
29,866
48,959
88,297
12,209
13,513
17,027
274,316
16,414
17,950
51,885
15,610
29,296
20,016
$28,096,394,940
$14,776,197,442
$9,982,008,401
$5,056,215,188
188,521
$512,547,803,023 $255,838,289,237 $168,896,127,527
$72,147,227,347
3,031,403
*Metropolitan Division
NOTE: Allocations reflect best available evidence regarding incidence and industrial structure and com position of each area.
SOURCE: US Multi-Regional Im pact Assessm ent System , The Perrym an Group
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Results for Counties
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014 -2023:
County Results
County
Anderson
Andrews
Angelina
Aransas
Archer
Armstrong
Atascosa
Austin
Bailey
Bandera
Bastrop
Baylor
Bee
Bell
Bexar
Blanco
Borden
Bosque
Bowie
Brazoria
Brazos
Brewster
Briscoe
Brooks
Brown
Burleson
Burnet
Caldwell
Calhoun
Callahan
Cameron
Camp
Carson
Cass
Castro
Chambers
Cherokee
Childress
Clay
Cochran
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Total
Expenditures
(2012 Dollars)
$831,854,138
$62,397,356
$1,890,672,737
$160,427,545
$22,274,585
$13,889,004
$462,874,266
$285,921,664
$26,418,955
$97,902,353
$341,315,706
$72,379,648
$285,093,499
$6,624,979,169
$39,957,851,399
$63,053,236
$1,728,181
$127,597,698
$2,559,334,872
$2,255,714,653
$3,495,519,066
$106,609,556
$2,928,350
$42,913,262
$555,418,368
$76,601,726
$572,152,919
$315,340,551
$103,724,546
$42,874,662
$6,994,645,710
$115,484,248
$27,496,611
$201,059,692
$33,231,570
$121,141,523
$418,307,207
$48,590,912
$113,809,906
$10,674,611
Gross
Product
(2012 Dollars)
$462,030,943
$30,872,489
$1,007,290,997
$74,455,336
$11,107,832
$7,183,471
$229,429,005
$135,836,940
$13,553,105
$48,243,830
$172,017,465
$39,269,278
$152,630,453
$3,678,883,128
$20,768,698,805
$31,616,561
$792,156
$67,837,447
$1,404,106,926
$1,105,245,690
$1,797,932,721
$60,862,148
$1,357,313
$23,564,438
$314,851,212
$39,927,068
$289,198,306
$160,823,230
$43,286,873
$20,966,553
$3,703,574,010
$60,632,965
$10,759,317
$106,325,967
$15,930,694
$48,595,169
$227,135,965
$25,286,124
$58,185,850
$5,154,107
Personal
Income
(2012 Dollars)
$315,532,757
$19,639,676
$683,217,054
$47,502,662
$7,134,907
$4,959,782
$153,636,036
$86,643,940
$8,531,806
$31,514,132
$112,685,412
$26,650,225
$104,390,560
$2,509,556,191
$13,835,569,235
$20,697,386
$469,181
$46,369,571
$959,572,599
$733,171,858
$1,201,698,070
$41,412,141
$832,449
$16,433,268
$216,116,173
$26,523,473
$190,199,031
$109,747,006
$27,801,463
$13,824,980
$2,479,034,811
$41,852,173
$6,370,872
$72,394,089
$10,000,652
$29,958,599
$157,106,535
$17,182,130
$39,426,202
$3,284,475
Retail
Sales
(2012 Dollars)
$148,321,589
$11,342,656
$332,612,880
$27,584,227
$4,330,706
$1,700,089
$71,151,130
$42,426,833
$5,715,517
$17,977,301
$61,475,132
$12,942,540
$53,022,690
$1,187,053,854
$6,054,367,394
$10,757,723
$282,510
$19,102,831
$459,732,088
$397,602,066
$557,400,903
$19,973,906
$589,263
$8,768,716
$111,711,863
$15,952,624
$95,564,440
$52,492,539
$15,241,455
$7,248,428
$1,162,247,798
$17,908,233
$2,536,346
$40,029,619
$6,817,905
$15,628,521
$72,475,939
$8,989,770
$18,571,800
$1,715,050
Employment
(PersonYears)
5,848
359
12,881
901
137
87
2,783
1,526
163
605
2,152
493
1,981
47,129
252,433
392
8
846
17,950
13,799
22,480
774
16
316
4,199
507
3,554
2,046
514
258
46,930
772
111
1,381
200
541
2,938
329
719
61
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Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014-2023:
County Results
County
Coke
Coleman
Collin
Collingsworth
Colorado
Comal
Comanche
Concho
Cooke
Coryell
Cottle
Crane
Crockett
Crosby
Culberson
Dallam
Dallas
Dawson
Deaf Smith
Delta
Denton
DeWitt
Dickens
Dimmit
Donley
Duval
Eastland
Ector
Edwards
El Paso
Ellis
Erath
Falls
Fannin
Fayette
Fisher
Floyd
Foard
Fort Bend
Franklin
26 | P a g e
Total
Expenditures
(2012 Dollars)
$8,528,873
$58,145,043
$15,052,842,978
$31,749,325
$261,818,710
$1,435,336,580
$88,814,728
$11,304,645
$390,102,238
$241,331,389
$6,879,579
$22,230,994
$8,712,523
$32,562,411
$14,877,600
$36,111,845
$87,633,318,975
$49,662,053
$62,259,765
$53,956,844
$8,204,018,358
$184,841,326
$5,725,857
$52,543,848
$20,470,966
$49,475,173
$199,914,486
$2,139,959,944
$3,982,547
$12,763,649,577
$1,029,081,383
$418,280,977
$114,734,261
$240,176,418
$331,749,350
$17,005,197
$20,949,035
$6,709,349
$6,753,915,899
$221,493,026
Gross
Product
(2012 Dollars)
$4,033,745
$30,503,120
$7,808,689,927
$17,244,346
$138,439,972
$741,723,856
$47,946,776
$6,250,821
$190,842,458
$127,985,801
$3,873,397
$12,094,140
$4,417,485
$18,008,834
$8,659,422
$19,119,705
$42,658,192,057
$23,981,897
$30,501,543
$29,177,766
$4,120,058,275
$97,202,736
$3,000,278
$27,987,616
$11,914,863
$25,245,369
$99,905,704
$1,093,411,566
$1,963,560
$6,474,023,802
$504,671,958
$233,705,721
$63,295,548
$128,721,123
$170,984,851
$9,478,281
$10,163,606
$3,909,831
$3,126,433,512
$113,813,668
Personal
Income
(2012 Dollars)
$2,591,283
$20,570,879
$5,193,319,085
$11,470,202
$94,122,781
$493,330,188
$32,698,094
$4,411,633
$125,371,392
$86,208,107
$2,625,117
$8,428,795
$2,799,918
$12,502,949
$5,798,948
$12,038,378
$27,421,735,465
$14,733,435
$19,536,131
$20,368,133
$2,713,935,078
$66,267,738
$1,962,872
$19,369,001
$8,310,936
$17,313,619
$66,695,272
$739,312,219
$1,183,474
$4,241,899,123
$327,811,605
$161,500,579
$43,481,499
$87,711,981
$113,965,827
$6,460,806
$6,552,309
$2,777,359
$2,014,462,760
$77,113,269
Retail
Sales
(2012 Dollars)
$1,626,708
$10,125,376
$2,505,380,251
$6,834,420
$47,289,487
$238,642,589
$15,053,898
$1,912,548
$69,585,020
$44,587,020
$1,282,281
$3,401,559
$2,222,538
$4,340,723
$4,284,875
$6,485,945
$10,705,567,769
$10,096,935
$9,364,233
$6,373,542
$1,198,887,903
$31,886,698
$1,205,348
$10,512,936
$4,599,087
$7,168,581
$37,174,918
$350,212,392
$831,623
$1,853,214,126
$178,291,004
$82,355,297
$19,326,126
$41,191,995
$51,532,922
$3,322,612
$2,951,856
$1,147,874
$1,004,284,328
$37,950,733
Employment
(Permanent
Jobs)
49
382
95,387
216
1,812
9,389
603
82
2,354
1,664
48
151
57
224
120
227
476,939
287
360
353
49,193
1,247
37
373
163
315
1,287
13,513
23
77,596
6,222
3,108
802
1,644
2,097
123
119
52
36,496
1,442
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014-2023:
County Results
County
Freestone
Frio
Gaines
Galveston
Garza
Gillespie
Glasscock
Goliad
Gonzales
Gray
Grayson
Gregg
Grimes
Guadalupe
Hale
Hall
Hamilton
Hansford
Hardeman
Hardin
Harris
Harrison
Hartley
Haskell
Hays
Hemphill
Henderson
Hidalgo
Hill
Hockley
Hood
Hopkins
Houston
Howard
Hudspeth
Hunt
Hutchinson
Irion
Jack
Jackson
27 | P a g e
Total
Expenditures
(2012 Dollars)
$130,653,034
$138,417,072
$47,807,462
$3,266,370,898
$24,803,269
$546,529,257
$1,811,003
$25,979,982
$120,871,747
$276,688,882
$2,309,561,495
$3,889,084,420
$122,201,699
$663,604,451
$288,529,094
$20,484,658
$73,573,023
$16,107,727
$13,071,847
$687,163,488
$117,613,832,940
$699,050,065
$9,941,912
$69,913,807
$1,491,306,779
$18,901,996
$774,538,566
$12,649,073,915
$296,050,854
$171,142,060
$402,657,797
$243,740,842
$218,097,844
$601,521,087
$6,686,666
$721,787,468
$137,767,184
$22,266,479
$57,438,086
$53,963,621
Gross
Product
(2012 Dollars)
$65,760,445
$68,814,571
$21,650,222
$1,632,173,650
$11,588,623
$281,716,025
$765,396
$13,889,376
$63,788,103
$135,033,024
$1,261,159,476
$2,080,060,223
$62,824,469
$335,777,778
$160,000,992
$10,631,055
$39,082,954
$6,347,142
$7,289,008
$350,935,636
$54,344,593,840
$335,485,908
$4,902,179
$37,161,652
$792,888,914
$8,542,377
$392,484,946
$6,906,111,807
$149,880,249
$87,820,174
$204,313,852
$129,503,062
$111,437,783
$301,745,538
$3,456,044
$385,414,633
$62,963,494
$8,796,646
$27,446,044
$26,858,215
Personal
Income
(2012 Dollars)
$43,174,646
$45,657,407
$13,314,862
$1,090,657,733
$7,304,580
$189,919,575
$450,008
$9,555,212
$43,716,509
$91,285,473
$861,713,475
$1,414,482,147
$42,429,423
$219,857,517
$108,990,396
$6,934,143
$26,747,848
$3,695,703
$4,862,951
$232,021,156
$35,502,211,788
$226,611,231
$3,192,375
$25,768,015
$530,648,546
$5,436,622
$261,583,273
$4,685,278,918
$100,017,939
$59,363,992
$137,629,584
$86,202,259
$75,430,721
$202,721,690
$2,047,161
$259,273,268
$40,061,307
$5,062,329
$17,590,715
$17,286,621
Retail
Sales
(2012 Dollars)
$26,138,134
$22,097,884
$8,279,556
$515,719,263
$5,052,299
$92,412,774
$194,373
$5,766,693
$20,828,231
$46,021,727
$425,044,691
$648,808,637
$22,878,285
$130,492,589
$61,332,217
$3,696,958
$13,914,272
$2,080,650
$3,219,632
$128,620,281
$12,393,740,745
$97,227,301
$1,708,580
$11,610,010
$257,063,421
$2,759,441
$124,835,401
$2,174,400,544
$51,331,827
$31,775,259
$68,551,266
$51,012,381
$29,029,855
$98,408,011
$2,219,262
$141,474,625
$30,390,388
$3,551,439
$11,614,053
$10,973,663
Employment
(Permanent
Jobs)
830
843
247
20,114
141
3,581
8
186
816
1,685
16,414
26,033
804
4,296
2,124
130
509
65
99
4,384
601,574
4,042
62
471
9,964
97
4,893
88,297
1,936
1,134
2,581
1,667
1,321
3,744
46
4,984
785
93
337
334
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014-2023:
County Results
County
Jasper
Jeff Davis
Jefferson
Jim Hogg
Jim Wells
Johnson
Jones
Karnes
Kaufman
Kendall
Kenedy
Kent
Kerr
Kimble
King
Kinney
Kleberg
Knox
La Salle
Lamar
Lamb
Lampasas
Lavaca
Lee
Leon
Liberty
Limestone
Lipscomb
Live Oak
Llano
Loving
Lubbock
Lynn
Madison
Marion
Martin
Mason
Matagorda
Maverick
McCulloch
28 | P a g e
Total
Expenditures
(2012 Dollars)
$372,658,168
$24,128,573
$6,061,731,206
$58,618,120
$691,704,042
$1,304,720,423
$84,389,824
$86,647,426
$741,040,460
$412,622,933
$2,376,012
$7,989,358
$1,051,919,609
$21,430,904
$412,701
$9,004,303
$385,245,253
$22,066,730
$25,783,899
$949,813,635
$53,089,878
$142,665,016
$195,058,476
$93,712,410
$35,380,520
$782,158,567
$277,370,361
$6,003,547
$48,659,439
$77,162,629
$37,594
$7,376,929,380
$12,513,266
$87,952,171
$79,607,373
$34,230,664
$25,462,743
$264,377,546
$609,328,999
$89,453,159
Gross
Product
(2012 Dollars)
$203,058,150
$12,680,165
$3,181,346,516
$29,512,740
$382,572,025
$687,408,139
$43,743,302
$41,181,119
$383,919,178
$199,292,517
$1,046,598
$3,577,679
$549,725,682
$9,785,052
$206,867
$4,315,081
$197,535,087
$11,633,746
$14,120,655
$501,168,436
$26,113,572
$76,723,709
$107,765,579
$46,535,674
$18,816,163
$411,422,135
$147,190,682
$2,628,631
$23,558,065
$40,086,223
$11,587
$3,944,088,555
$6,180,731
$47,362,068
$41,848,419
$16,916,703
$12,893,621
$123,129,662
$326,488,163
$48,350,375
Personal
Income
(2012 Dollars)
$139,346,707
$8,593,500
$2,183,766,386
$18,529,683
$260,387,661
$466,575,361
$29,569,910
$27,198,625
$259,393,029
$130,862,689
$654,916
$2,165,502
$367,347,419
$6,098,201
$127,483
$2,713,965
$133,207,913
$7,889,524
$9,684,775
$342,449,627
$17,104,859
$51,948,026
$73,595,955
$30,578,910
$11,877,850
$280,759,002
$101,791,893
$1,592,813
$15,480,734
$26,798,575
$7,051
$2,641,905,604
$3,910,224
$32,064,533
$28,493,131
$11,405,808
$8,533,415
$80,429,995
$220,507,123
$33,032,461
Retail
Sales
(2012 Dollars)
$70,870,746
$4,407,607
$1,027,138,101
$13,823,794
$132,419,520
$221,744,794
$13,291,691
$13,329,379
$126,355,356
$69,996,829
$633,694
$1,422,387
$183,630,216
$3,800,701
$59,084
$1,569,716
$65,212,406
$3,207,533
$5,344,013
$170,013,799
$9,194,769
$26,538,964
$34,979,802
$16,180,129
$8,801,419
$131,455,468
$52,379,543
$832,326
$9,410,198
$13,318,118
$3,513
$1,189,448,749
$1,537,478
$17,651,091
$14,744,821
$4,882,281
$4,189,919
$50,980,504
$113,550,317
$16,477,388
Employment
(Permanent
Jobs)
2,654
162
40,138
368
4,919
8,750
544
498
4,928
2,472
16
39
6,968
117
2
52
2,501
140
189
6,475
315
1,002
1,385
571
237
5,157
1,918
29
295
505
0
48,735
68
624
548
201
159
1,546
4,268
618
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014-2023:
County Results
County
McLennan
McMullen
Medina
Menard
Midland
Milam
Mills
Mitchell
Montague
Montgomery
Moore
Morris
Motley
Nacogdoches
Navarro
Newton
Nolan
Nueces
Ochiltree
Oldham
Orange
Palo Pinto
Panola
Parker
Parmer
Pecos
Polk
Potter
Presidio
Rains
Randall
Reagan
Real
Red River
Reeves
Refugio
Roberts
Robertson
Rockwall
Runnels
29 | P a g e
Total
Expenditures
(2012 Dollars)
$4,689,751,134
$1,082,597
$173,039,458
$4,760,747
$2,029,792,543
$167,802,829
$43,861,282
$51,968,259
$128,206,555
$6,533,197,421
$104,563,041
$61,505,384
$8,215,655
$905,883,082
$590,488,691
$31,928,425
$114,873,080
$9,981,238,399
$44,367,300
$17,159,543
$537,424,339
$163,547,800
$197,422,698
$904,989,229
$22,319,890
$88,844,139
$314,371,310
$5,198,702,795
$20,006,480
$23,741,493
$779,988,138
$11,743,012
$28,596,577
$116,279,928
$52,776,619
$33,098,729
$941,064
$85,387,147
$1,153,805,023
$76,093,174
Gross
Product
(2012 Dollars)
$2,378,414,744
$461,280
$86,863,058
$2,432,297
$1,030,669,412
$86,458,685
$26,899,734
$27,949,755
$64,781,973
$3,166,283,665
$44,908,974
$28,763,715
$3,994,736
$498,583,057
$306,455,386
$19,976,066
$60,118,337
$4,796,530,757
$20,001,742
$9,209,464
$279,645,716
$78,595,265
$100,345,960
$434,261,710
$9,880,490
$44,021,242
$166,479,095
$2,722,208,912
$9,606,135
$10,858,096
$407,534,939
$5,834,924
$13,859,981
$60,111,729
$26,341,318
$15,991,257
$393,084
$45,062,170
$612,582,180
$35,011,664
Personal
Income
(2012 Dollars)
$1,571,514,730
$274,316
$57,105,186
$1,530,894
$673,950,283
$58,443,976
$18,802,078
$18,996,883
$43,251,154
$2,111,414,095
$28,085,248
$19,328,420
$2,552,403
$344,742,368
$207,653,185
$13,964,599
$39,574,116
$3,186,298,008
$12,611,756
$6,039,324
$190,157,917
$50,709,896
$67,973,428
$277,697,167
$6,415,443
$28,905,002
$111,185,310
$1,823,972,378
$6,062,667
$6,584,340
$268,620,528
$3,534,389
$9,141,396
$40,687,204
$17,131,816
$9,900,951
$232,839
$30,452,777
$414,643,059
$22,527,227
Retail
Sales
(2012 Dollars)
$713,740,707
$147,385
$29,763,494
$1,085,909
$338,343,282
$32,087,268
$9,601,865
$9,502,354
$21,473,272
$901,535,338
$16,138,224
$7,727,953
$1,395,751
$174,289,108
$92,749,258
$8,706,146
$20,824,026
$1,434,322,372
$7,330,932
$5,437,627
$100,804,094
$27,604,396
$33,249,183
$155,549,801
$1,974,476
$17,332,560
$61,049,442
$829,168,127
$3,993,236
$5,006,070
$134,218,534
$2,859,570
$4,607,572
$18,687,232
$11,786,366
$8,607,210
$226,705
$17,559,674
$197,420,744
$11,724,876
Employment
(Permanent
Jobs)
29,296
5
1,092
30
12,209
1,110
359
353
820
37,835
514
343
48
6,675
3,858
270
743
57,568
230
136
3,590
960
1,252
5,290
111
559
2,091
33,415
118
129
5,020
69
169
760
342
206
5
590
7,729
421
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014-2023:
County Results
County
Rusk
Sabine
San Augustine
San Jacinto
San Patricio
San Saba
Schleicher
Scurry
Shackelford
Shelby
Sherman
Smith
Somervell
Starr
Stephens
Sterling
Stonewall
Sutton
Swisher
Tarrant
Taylor
Terrell
Terry
Throckmorton
Titus
Tom Green
Travis
Trinity
Tyler
Upshur
Upton
Uvalde
Val Verde
Van Zandt
Victoria
Walker
Waller
Ward
Washington
Webb
30 | P a g e
Total
Expenditures
(2012 Dollars)
$401,331,213
$53,445,374
$89,019,073
$45,096,323
$385,321,722
$37,394,738
$15,562,953
$69,183,846
$10,896,474
$138,877,354
$4,987,471
$8,526,613,726
$57,536,458
$452,942,694
$42,516,636
$2,866,786
$3,295,806
$25,603,270
$17,213,679
$40,876,070,088
$3,783,036,836
$4,297,520
$63,679,283
$7,731,850
$331,479,820
$2,753,131,996
$23,841,593,261
$66,925,935
$85,661,262
$220,175,240
$11,027,539
$241,461,103
$549,473,619
$281,283,957
$2,425,869,785
$567,900,566
$224,529,730
$52,597,888
$427,063,423
$2,760,527,554
Gross
Product
(2012 Dollars)
$197,581,693
$28,312,730
$45,353,564
$23,148,739
$188,624,002
$20,650,645
$8,240,843
$37,139,496
$5,401,213
$77,873,976
$2,129,472
$4,263,748,866
$28,359,393
$260,709,324
$23,160,946
$1,621,701
$1,853,343
$13,342,822
$8,079,690
$20,726,270,667
$1,911,546,566
$2,394,805
$31,246,189
$3,913,131
$171,744,909
$1,376,568,023
$12,765,301,369
$37,434,002
$46,341,455
$112,357,017
$5,541,532
$129,737,974
$319,637,478
$160,638,304
$1,219,686,180
$312,538,504
$101,256,906
$26,944,906
$227,855,733
$1,474,248,816
Personal
Income
(2012 Dollars)
$133,226,705
$19,747,220
$30,714,790
$15,377,474
$127,849,774
$13,768,599
$5,784,328
$23,524,213
$3,529,203
$54,349,821
$1,287,610
$2,808,014,593
$19,680,413
$183,434,439
$15,388,909
$1,077,509
$1,259,226
$8,599,528
$5,068,665
$13,732,482,445
$1,266,186,258
$1,577,427
$19,210,019
$2,516,361
$117,775,194
$903,708,372
$8,493,693,797
$25,464,864
$31,450,768
$73,960,878
$3,607,603
$87,860,716
$219,144,251
$110,545,673
$821,510,727
$213,004,517
$62,655,195
$17,531,549
$154,943,507
$993,940,625
Retail
Sales
(2012 Dollars)
$62,914,681
$10,153,505
$13,953,590
$8,544,833
$67,987,538
$7,763,267
$1,707,485
$16,347,493
$2,029,616
$27,420,257
$728,828
$1,301,541,204
$6,508,178
$99,639,756
$10,155,944
$827,454
$769,560
$5,836,359
$2,835,234
$5,957,403,909
$568,258,377
$971,449
$14,480,797
$1,414,728
$64,728,025
$424,826,667
$3,796,898,512
$13,109,153
$16,278,399
$40,440,251
$1,790,917
$41,908,587
$105,669,065
$55,888,709
$382,984,610
$106,621,383
$40,239,005
$11,319,312
$72,673,326
$503,821,786
Employment
(Permanent
Jobs)
2,446
374
565
294
2,418
268
101
465
68
1,031
24
51,885
352
3,576
302
22
25
168
96
248,933
23,171
30
381
47
2,251
16,934
154,413
486
594
1,387
65
1,661
4,147
2,112
14,910
4,059
1,232
342
2,883
18,713
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas 2014 -2023:
County Results
County
Wharton
Wheeler
Wichita
Wilbarger
Willacy
Williamson
Wilson
Winkler
Wise
Wood
Yoakum
Young
Zapata
Zavala
TOTAL STATE IMPACT
Total
Expenditures
(2012 Dollars)
$380,650,649
$28,646,719
$2,778,552,689
$101,234,150
$94,487,351
$2,948,519,056
$185,489,889
$17,826,087
$568,329,369
$324,434,823
$30,776,359
$173,844,837
$63,461,626
$52,679,030
Gross
Product
(2012 Dollars)
$202,338,601
$15,607,203
$1,511,288,233
$51,965,119
$53,310,198
$1,582,454,726
$96,232,601
$9,045,046
$290,337,524
$165,393,898
$14,751,683
$89,034,681
$33,774,386
$31,770,305
Personal
Income
(2012 Dollars)
Retail
Sales
(2012 Dollars)
Employment
(Permanent
Jobs)
$138,326,338
$10,518,166
$1,025,365,502
$35,265,075
$35,716,193
$1,058,425,881
$65,152,873
$5,878,622
$189,982,856
$110,707,797
$9,291,507
$58,645,487
$22,900,887
$22,866,063
$67,971,020
$6,285,052
$498,358,618
$17,633,042
$20,064,508
$547,590,536
$32,410,862
$3,797,234
$111,208,838
$52,592,221
$6,688,439
$33,256,629
$13,516,522
$11,852,198
2,600
206
19,159
661
694
19,850
1,246
112
3,608
2,068
183
1,109
445
451
$512,547,803,023 $255,838,289,237 $168,896,127,527
$72,147,227,347
3,031,403
NOTE: Allocations reflect best available evidence regarding incidence and industrial structure and com position of each area.
SOURCE: US Multi-Regional Im pact Assessm ent System , The Perrym an Group
31 | P a g e
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Results for Texas House Districts
32 | P a g e
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas:
Results by Texas House District
House District
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
33 | P a g e
Total
Expenditures
(2012 Dollars)
$3,846,921,460
$1,246,812,268
$1,962,360,244
$1,383,907,471
$2,903,033,063
$6,480,226,432
$4,109,259,660
$1,849,046,716
$1,369,462,556
$1,160,752,939
$1,725,521,501
$2,443,700,160
$1,700,415,047
$2,936,236,016
$2,397,683,453
$2,397,683,453
$957,887,841
$1,395,155,456
$1,491,782,653
$1,388,629,940
$2,719,647,573
$3,879,507,972
$1,558,344,718
$1,829,167,703
$1,256,891,993
$1,837,065,125
$1,837,065,125
$1,837,065,125
$1,263,200,205
$2,933,941,913
$1,239,212,813
$4,890,806,815
$2,960,146,180
$5,090,431,583
$2,808,171,232
$2,757,498,113
$2,937,751,198
$2,867,804,741
$2,757,498,113
$2,757,498,113
Gross
Product
(2012 Dollars)
$2,079,200,759
$675,555,999
$943,488,360
$709,681,684
$1,460,693,311
$3,240,449,138
$2,192,417,241
$984,127,023
$690,192,960
$571,394,399
$923,300,714
$1,256,742,059
$883,634,611
$1,510,263,486
$1,162,026,105
$1,162,026,105
$484,345,592
$747,109,379
$786,790,401
$723,797,030
$1,424,930,462
$2,036,061,770
$766,751,575
$914,017,244
$609,437,766
$850,389,915
$850,389,915
$850,389,915
$618,937,587
$1,464,511,759
$660,957,674
$2,350,300,071
$1,549,624,971
$2,446,230,686
$1,513,589,893
$1,505,532,374
$1,555,501,084
$1,518,465,344
$1,505,532,374
$1,505,532,374
Personal
Income
(2012 Dollars)
$1,419,822,700
$456,021,200
$624,291,344
$476,507,146
$970,171,425
$2,134,091,090
$1,488,443,025
$666,378,527
$469,568,920
$372,280,761
$635,075,608
$839,452,279
$592,224,906
$1,009,426,379
$774,888,973
$774,888,973
$323,926,462
$509,140,992
$527,968,540
$481,496,701
$976,313,816
$1,397,610,487
$509,848,002
$610,768,330
$403,025,612
$547,933,871
$547,933,871
$547,933,871
$410,576,241
$982,538,753
$451,157,980
$1,561,286,024
$1,037,841,350
$1,625,011,984
$1,021,151,619
$1,021,390,804
$1,041,194,621
$1,016,404,273
$1,021,390,804
$1,021,390,804
Retail
Sales
(2012 Dollars)
$686,383,852
$248,375,715
$280,047,405
$229,968,738
$460,332,391
$989,171,315
$689,248,888
$318,540,808
$222,824,686
$199,513,022
$309,679,729
$392,571,699
$287,733,278
$468,216,759
$330,863,469
$330,863,469
$164,305,410
$246,621,684
$285,525,014
$248,121,626
$470,573,810
$657,368,384
$242,544,997
$288,802,787
$225,925,413
$273,165,337
$273,165,337
$273,165,337
$222,657,157
$472,070,894
$236,151,775
$702,817,962
$498,066,375
$731,504,410
$475,905,395
$474,019,319
$488,144,075
$476,521,597
$474,019,319
$474,019,319
Employment
(PersonYears)
26,628
8,764
11,296
8,990
18,015
39,432
27,419
12,472
8,628
7,054
12,059
15,696
11,013
18,883
13,885
13,885
6,083
9,509
9,994
9,031
18,039
25,688
9,391
11,264
7,617
9,927
9,927
9,927
7,727
17,964
8,557
28,208
19,175
29,360
19,280
19,249
19,711
19,241
19,249
19,249
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of he Affordable Care Act (ACA) on Business Activity in Texas:
Results by Texas House District
House District
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
34 | P a g e
Total
Expenditures
(2008 Dollars)
$2,757,498,113
$1,766,737,634
$1,747,364,515
$849,094,340
$1,554,360,015
$3,886,179,702
$4,053,070,854
$4,053,070,854
$3,910,021,295
$3,886,179,702
$4,053,070,854
$1,149,922,432
$1,534,136,313
$3,322,655,017
$3,444,989,168
$3,282,825,794
$2,388,048,282
$1,432,318,121
$1,050,245,754
$1,475,971,266
$1,473,318,598
$2,603,694,757
$2,051,004,590
$2,051,004,590
$2,051,004,590
$3,311,625,455
$3,311,625,455
$1,198,853,852
$3,015,792,907
$3,311,625,455
$3,982,299,740
$3,489,267,054
$2,394,488,770
$1,486,071,670
$2,552,729,915
$2,552,729,915
$2,552,729,915
$2,552,729,915
$2,552,729,915
$1,542,352,598
Gross
Product
(2008 Dollars)
$1,505,532,374
$943,519,242
$921,361,566
$432,010,379
$824,505,476
$2,080,744,123
$2,170,101,233
$2,170,101,233
$2,093,509,425
$2,080,744,123
$2,170,101,233
$617,157,343
$791,854,456
$1,842,587,611
$1,913,019,226
$1,664,890,320
$1,267,694,577
$755,245,587
$572,981,400
$777,697,865
$724,599,234
$1,419,058,365
$1,030,014,569
$1,030,014,569
$1,030,014,569
$1,717,911,784
$1,717,911,784
$606,948,440
$1,635,394,770
$1,717,911,784
$2,015,408,205
$1,740,628,458
$1,222,732,399
$818,473,588
$1,294,804,760
$1,294,804,760
$1,294,804,760
$1,294,804,760
$1,294,804,760
$822,814,425
Personal
Income
(2008 Dollars)
$1,021,390,804
$636,122,000
$625,835,909
$285,010,391
$551,345,932
$1,384,472,089
$1,443,927,946
$1,443,927,946
$1,392,965,783
$1,384,472,089
$1,443,927,946
$412,786,094
$526,436,468
$1,256,534,997
$1,304,969,219
$1,100,060,311
$858,769,812
$512,944,932
$392,438,179
$524,464,895
$467,680,023
$969,793,590
$678,483,769
$678,483,769
$678,483,769
$1,142,530,199
$1,142,530,199
$402,889,037
$1,109,243,720
$1,142,530,199
$1,335,330,284
$1,146,084,440
$814,112,452
$553,901,051
$848,379,825
$848,379,825
$848,379,825
$848,379,825
$848,379,825
$556,472,700
Retail
Sales
(2008 Dollars)
$474,019,319
$322,445,943
$318,642,154
$162,903,451
$267,821,144
$618,894,458
$645,472,747
$645,472,747
$622,691,356
$618,894,458
$645,472,747
$213,560,309
$268,971,236
$596,324,814
$617,268,004
$499,618,495
$415,157,988
$240,847,625
$196,261,186
$274,601,809
$266,758,639
$472,610,228
$299,721,976
$299,721,976
$299,721,976
$551,183,655
$551,183,655
$217,414,489
$538,559,071
$551,183,655
$602,374,094
$545,931,647
$401,052,193
$285,761,872
$370,642,825
$370,642,825
$370,642,825
$370,642,825
$370,642,825
$281,263,970
Employment
(Permanent
Jobs)
19,249
11,976
11,819
5,542
10,356
25,169
26,250
26,250
25,324
25,169
26,250
7,742
9,994
23,624
24,507
20,507
16,114
9,597
7,479
10,038
8,897
18,410
12,298
12,298
12,298
20,985
20,985
7,583
20,700
20,985
24,458
21,421
15,442
10,619
15,519
15,519
15,519
15,519
15,519
10,510
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of he Affordable Care Act (ACA) on Business Activity in Texas:
Results by Texas House District
House District
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
35 | P a g e
Total
Expenditures
(2008 Dollars)
$2,272,781,275
$2,146,943,794
$3,197,652,049
$4,426,157,628
$1,677,334,796
$927,781,092
$5,473,517,103
$1,031,375,041
$3,311,625,455
$3,719,722,378
$3,719,722,378
$3,719,722,378
$3,719,722,378
$3,719,722,378
$3,719,722,378
$3,719,722,378
$3,719,722,378
$3,719,722,378
$3,719,722,378
$6,221,965,647
$3,678,846,308
$6,221,965,647
$6,221,965,647
$6,221,965,647
$6,221,965,647
$2,051,004,590
$6,221,965,647
$6,221,965,647
$6,221,965,647
$6,221,965,647
$6,353,415,626
$6,221,965,647
$6,353,415,626
$6,353,415,626
$6,353,415,626
$3,995,785,140
$3,995,785,140
$3,995,785,140
$3,995,785,140
$3,995,785,140
Gross
Product
(2008 Dollars)
$1,160,274,007
$1,089,203,684
$1,702,593,970
$2,366,453,133
$804,460,582
$481,148,320
$2,842,970,169
$524,805,664
$1,717,911,784
$1,886,090,631
$1,886,090,631
$1,886,090,631
$1,886,090,631
$1,886,090,631
$1,886,090,631
$1,886,090,631
$1,886,090,631
$1,886,090,631
$1,886,090,631
$3,028,731,636
$1,865,364,360
$3,028,731,636
$3,028,731,636
$3,028,731,636
$3,028,731,636
$1,030,014,569
$3,028,731,636
$3,028,731,636
$3,028,731,636
$3,028,731,636
$3,092,718,924
$3,028,731,636
$3,092,718,924
$3,092,718,924
$3,092,718,924
$2,076,869,880
$2,076,869,880
$2,076,869,880
$2,076,869,880
$2,076,869,880
Personal
Income
(2008 Dollars)
$782,362,065
$712,125,923
$1,136,187,623
$1,585,143,363
$526,274,107
$315,842,179
$1,899,777,416
$350,594,725
$1,142,530,199
$1,249,655,902
$1,249,655,902
$1,249,655,902
$1,249,655,902
$1,249,655,902
$1,249,655,902
$1,249,655,902
$1,249,655,902
$1,249,655,902
$1,249,655,902
$1,946,943,218
$1,235,923,420
$1,946,943,218
$1,946,943,218
$1,946,943,218
$1,946,943,218
$678,483,769
$1,946,943,218
$1,946,943,218
$1,946,943,218
$1,946,943,218
$1,988,075,821
$1,946,943,218
$1,988,075,821
$1,988,075,821
$1,988,075,821
$1,383,556,923
$1,383,556,923
$1,383,556,923
$1,383,556,923
$1,383,556,923
Retail
Sales
(2008 Dollars)
$376,671,594
$358,514,975
$526,209,687
$713,669,250
$263,732,999
$159,189,395
$878,961,913
$192,214,611
$551,183,655
$542,123,756
$542,123,756
$542,123,756
$542,123,756
$542,123,756
$542,123,756
$542,123,756
$542,123,756
$542,123,756
$542,123,756
$760,095,312
$536,166,352
$760,095,312
$760,095,312
$760,095,312
$760,095,312
$299,721,976
$760,095,312
$760,095,312
$760,095,312
$760,095,312
$776,153,663
$760,095,312
$776,153,663
$776,153,663
$776,153,663
$605,436,739
$605,436,739
$605,436,739
$605,436,739
$605,436,739
Employment
(Permanent
Jobs)
14,327
12,914
21,017
29,241
9,649
5,915
34,850
6,653
20,985
22,653
22,653
22,653
22,653
22,653
22,653
22,653
22,653
22,653
22,653
33,863
22,404
33,863
33,863
33,863
33,863
12,298
33,863
33,863
33,863
33,863
34,578
33,863
34,578
34,578
34,578
25,243
25,243
25,243
25,243
25,243
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
(continued)
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of he Affordable Care Act (ACA) on Business Activity in Texas:
Results by Texas House District
House District
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
TOTAL
Total
Expenditures
(2008 Dollars)
Gross
Product
(2008 Dollars)
Personal
Income
(2008 Dollars)
Retail
Sales
(2008 Dollars)
Employment
(Permanent
Jobs)
$3,995,785,140
$3,995,785,140
$3,995,785,140
$3,995,785,140
$3,995,785,140
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$1,149,922,432
$4,822,167,151
$4,822,167,151
$4,822,167,151
$4,822,167,151
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,939,780,983
$4,822,167,151
$4,822,167,151
$4,822,167,151
$4,822,167,151
$2,076,869,880
$2,076,869,880
$2,076,869,880
$2,076,869,880
$2,076,869,880
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$617,157,343
$2,228,128,347
$2,228,128,347
$2,228,128,347
$2,228,128,347
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,282,472,941
$2,228,128,347
$2,228,128,347
$2,228,128,347
$2,228,128,347
$1,383,556,923
$1,383,556,923
$1,383,556,923
$1,383,556,923
$1,383,556,923
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$412,786,094
$1,455,590,683
$1,455,590,683
$1,455,590,683
$1,455,590,683
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,491,092,895
$1,455,590,683
$1,455,590,683
$1,455,590,683
$1,455,590,683
$605,436,739
$605,436,739
$605,436,739
$605,436,739
$605,436,739
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$213,560,309
$508,143,371
$508,143,371
$508,143,371
$508,143,371
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$520,537,111
$508,143,371
$508,143,371
$508,143,371
$508,143,371
25,243
25,243
25,243
25,243
25,243
25,266
25,266
25,266
25,266
25,266
25,266
25,266
25,266
25,266
25,266
7,742
24,665
24,665
24,665
24,665
25,266
25,266
25,266
25,266
25,266
25,266
24,665
24,665
24,665
24,665
$512,547,803,023
$255,838,289,237
$168,896,127,527
$72,147,227,347
3,031,403
NOTE: Allocations reflect best available evidence regarding incidence and industrial structure and com position of each area.
In cases in w hich a county w as part of m ore than one district, allocations are based on the percentage of the population
residing in a district. This convention is adopted because of a lack of subcounty data sufficient for allocation purposes. In
som e instances, this approach w ill result in districts w hich reflect the sam e proportion of a large urban county reporting
identical results. Allocations reflect district m aps as currently defined.
SOURCE: US Multi-Regional Im pact Assessm ent System , The Perrym an Group
36 | P a g e
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Results for Texas Senate Districts
37 | P a g e
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas:
Results by Texas Senate District
Senate District
Total
Expenditures
(2012 Dollars)
Gross
Product
(2012 Dollars)
Personal
Income
(2012 Dollars)
Retail
Sales
(2012 Dollars)
Employment
(PersonYears)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
$18,894,170,162
$18,357,196,732
$9,158,730,832
$15,362,501,208
$7,918,686,450
$23,522,766,588
$23,522,766,588
$17,176,582,480
$21,784,862,538
$18,802,992,241
$13,023,118,605
$12,940,745,751
$21,277,595,621
$17,984,094,720
$22,346,628,259
$30,233,495,047
$18,150,322,912
$10,235,630,468
$14,161,160,599
$17,952,506,189
$9,179,578,038
$10,656,422,201
$30,233,495,047
$14,099,837,827
$14,347,402,557
$18,580,400,901
$12,789,365,370
$13,407,674,218
$12,829,348,897
$11,681,547,334
$11,936,176,646
$9,743,490,300
$9,092,706,991
$4,832,224,667
$7,599,605,188
$4,166,400,633
$10,868,918,768
$10,868,918,768
$8,770,296,041
$10,886,169,312
$9,534,084,507
$6,182,593,009
$6,528,588,969
$9,832,603,320
$9,618,340,478
$10,325,472,830
$14,717,076,260
$8,407,882,087
$4,972,592,728
$7,397,237,864
$9,160,246,760
$4,873,930,921
$5,426,950,250
$14,717,076,260
$7,570,924,806
$7,470,507,262
$9,657,444,944
$6,856,032,853
$7,005,526,755
$6,508,425,568
$6,122,460,163
$6,123,559,977
$6,534,642,484
$5,906,416,771
$3,277,750,308
$5,105,514,038
$2,793,363,565
$7,100,442,358
$7,100,442,358
$5,785,407,996
$7,137,000,223
$6,316,941,925
$4,070,794,563
$4,312,438,481
$6,418,123,929
$6,398,018,822
$6,745,420,240
$9,460,498,736
$5,487,198,892
$3,279,299,655
$4,940,253,281
$6,148,717,730
$3,274,490,367
$3,607,358,010
$9,460,498,736
$5,107,161,285
$4,972,569,370
$6,433,539,694
$4,616,430,979
$4,665,877,375
$4,264,401,398
$4,098,756,158
$4,076,357,801
$3,068,295,980
$2,444,669,943
$1,598,745,632
$2,195,056,428
$1,389,108,236
$2,478,748,149
$2,478,748,149
$2,664,851,602
$2,989,018,428
$2,740,405,798
$1,652,469,348
$1,888,687,546
$2,297,749,949
$2,871,180,031
$2,354,810,742
$3,693,420,880
$2,055,813,922
$1,574,478,392
$2,220,144,863
$2,822,319,700
$1,594,924,374
$1,669,216,186
$3,693,420,880
$2,424,759,793
$2,255,477,818
$2,815,280,838
$2,161,406,634
$2,186,983,491
$1,868,119,106
$2,038,571,104
$1,960,343,403
121,035
104,625
61,343
91,465
52,502
120,315
120,315
104,926
127,562
114,509
71,545
78,170
109,202
116,418
114,299
164,544
94,161
59,747
90,774
113,440
61,015
67,090
164,544
95,536
91,531
117,381
87,226
86,663
78,043
76,686
74,792
TOTAL
$512,547,803,023
$255,838,289,237
$168,896,127,527
$72,147,227,347
3,031,403
NOTE: Allocations reflect best available evidence regarding incidence and industrial structure and com position of each area.
In cases in w hich a county w as part of m ore than one district, allocations are based on the percentage of the population
residing in a district. This convention is adopted because of a lack of subcounty data sufficient for allocation purposes. In
som e instances, this approach w ill result in districts w hich reflect the sam e proportion of a large urban county reporting
identical results. Allocations reflect district m aps as currently defined.
SOURCE: US Multi-Regional Im pact Assessm ent System , The Perrym an Group
38 | P a g e
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
Results for US Congressional Districts
39 | P a g e
www.perrymangroup.com
Copyright 2013
Only One Rational Choice:
Texas Should Participate in Medicaid Expansion Under the Affordable Care Act
The Cumulative Net Impact Over the First Ten Years of Implementation
(Health-Related Spending, Uncompensated Care Reductions, and Morbidity and
Mortality Reductions) Associated with Participation in the Medicaid Expansion
Portion of the Affordable Care Act (ACA) on Business Activity in Texas:
Results by US Congressional District in Texas
US
Congressional
District in Texas
Total
Expenditures
(2012 Dollars)
Gross
Product
(2012 Dollars)
Personal
Income
(2012 Dollars)
Retail
Sales
(2012 Dollars)
Employment
(PersonYears)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
$16,982,939,299
$19,994,351,600
$13,397,030,250
$10,287,390,626
$15,516,838,575
$13,064,869,698
$19,994,351,600
$10,008,154,632
$18,154,415,586
$14,577,807,313
$9,313,097,232
$13,798,219,411
$11,008,312,028
$10,433,402,284
$9,583,515,105
$11,104,375,132
$12,188,690,945
$19,994,351,600
$13,162,451,594
$16,382,719,074
$13,847,877,993
$8,568,128,056
$10,385,109,748
$19,473,630,909
$9,831,593,815
$10,167,054,163
$14,247,486,347
$9,661,082,643
$19,994,351,600
$25,764,195,779
$8,844,750,516
$24,914,699,978
$20,911,451,163
$10,596,016,715
$14,051,476,300
$12,341,613,717
$8,732,317,330
$9,238,580,953
$6,949,734,035
$5,513,893,908
$7,700,900,441
$6,614,483,130
$9,238,580,953
$4,855,635,735
$8,389,851,516
$7,233,252,993
$4,758,833,656
$6,972,637,251
$5,754,555,683
$5,355,090,554
$5,196,597,694
$5,632,400,707
$6,309,848,296
$9,238,580,953
$6,883,028,499
$8,515,166,510
$7,246,502,053
$3,995,392,313
$5,426,136,559
$9,616,892,880
$5,240,552,333
$5,120,408,214
$6,936,363,871
$5,132,125,423
$9,238,580,953
$12,541,508,465
$4,856,660,710
$12,156,866,019
$10,336,720,235
$5,648,750,129
$7,386,837,355
$5,874,020,928
$5,848,076,191
$6,035,376,004
$4,622,053,986
$3,746,861,182
$5,011,843,066
$4,380,559,875
$6,035,376,004
$3,230,099,780
$5,473,925,340
$4,769,145,888
$3,163,581,648
$4,608,860,039
$3,850,764,702
$3,633,678,330
$3,516,795,409
$3,690,452,237
$4,198,263,928
$6,035,376,004
$4,591,080,535
$5,672,583,386
$4,825,996,466
$2,594,808,954
$3,616,412,328
$6,250,381,206
$3,509,236,391
$3,378,586,446
$4,622,995,036
$3,457,040,578
$6,035,376,004
$8,061,990,227
$3,291,930,891
$7,825,154,663
$6,722,431,984
$3,799,618,099
$4,920,393,721
$3,869,021,001
$2,734,691,868
$2,106,935,927
$2,229,788,423
$1,852,219,337
$2,059,263,659
$1,939,113,357
$2,106,935,927
$1,350,853,335
$1,986,194,786
$1,956,799,880
$1,554,941,658
$2,045,716,460
$1,866,032,694
$1,737,682,376
$1,664,386,979
$1,612,296,289
$1,938,681,611
$2,106,935,927
$2,123,769,908
$2,482,290,632
$2,199,540,082
$1,203,865,114
$1,649,234,758
$2,547,332,546
$1,623,273,185
$1,482,374,840
$2,146,658,966
$1,633,376,956
$2,106,935,927
$3,147,436,924
$1,604,068,467
$3,083,648,384
$2,737,741,908
$1,803,882,847
$2,197,413,056
$1,524,912,356
108,399
102,267
84,894
70,568
88,773
79,781
102,267
57,551
93,344
84,379
58,764
83,866
71,362
67,014
66,407
67,508
77,934
102,267
84,788
103,497
88,804
46,441
66,745
110,462
64,778
61,222
84,116
64,422
102,267
140,220
61,795
136,404
118,838
71,863
89,985
67,407
TOTAL
$512,547,803,023
$255,838,289,237
$168,896,127,527
$72,147,227,347
3,031,403
NOTE: Allocations reflect best available evidence regarding incidence and industrial structure and com position of each area.
In cases in w hich a county w as part of m ore than one district, allocations are based on the percentage of the population
residing in a district. This convention is adopted because of a lack of subcounty data sufficient for allocation purposes. In
som e instances, this approach w ill result in districts w hich reflect the sam e proportion of a large urban county reporting
identical results. Allocations reflect district m aps as currently defined.
SOURCE: US Multi-Regional Im pact Assessm ent System , The Perrym an Group
40 | P a g e
www.perrymangroup.com
Copyright 2013