At a Senate Finance Committee hearing this week, Health and Human Services Commissioner Kyle Janek told senators that Texas Medicaid enrollment will increase with the implementation of ObamaCare – whether or not lawmakers opt for the full expansion of the program called for in the federal law.

Without expanding Medicaid to cover low-income, non-disabled adults, the implementation of ObamaCare will nevertheless cause enrollment to rise, reducing the number of uninsured Texas to about 15 percent of the state’s population, Janek said. The current uninsured rate is about 24 percent, or 5.6 million Texans.

The enrollment increase is due in part to ObamaCare’s individual mandate. Between now and January 1, 2014, when the mandate takes effect, many low-income parents are expected to find out whether their children are eligible for  a subsidized program such as Childrens Health Insurance Program (CHIP). When they do so, Janek said, some will discover they are eligible for Medicaid, and will enroll in the program.

Full expansion of Medicaid under ObamaCare, which Gov. Rick Perry and other Republican leaders have said Texas will refuse, would make low-income, non-disabled adults eligible. Janek said full Medicaid expansion would reduce the state’s uninsured rate to about 12 percent.

That group, commonly referred to as the “expansion adults,” would cost more than $87.5 billion over the next decade.

Later in the hearing, Sen. Judith Zaffirini pointedly asked Janek, as head of the HHSC, about his position on Medicaid expansion. “I see good and I see bad that can come of it, not necessarily bad, but problematic,” he said. “My emphasis will be on strengthening the safety net.”

If the state does not expand Medicaid, Janek said he will look to teaching hospitals and other providers to get involved as Disproportionate Share Hospitals (DSH), which provide care for low-come Texans without health insurance.

Asked about the possibility of counties and municipalities opting to expand on their own, Janek said the problem is that counties would not get the enhanced matching federal payment rate under ObamaCare – 100 percent, dropping down to 90 percent by 2020 – but the standard rate, which in Texas is about 58 percent. That lower rate makes the prospect of going it alone much less attractive for counties, given the huge administrative burden such a scheme would involve.