San Antonio Healthcare Leaders Push for Medicaid Expansion and Safety Net Protections

Medical providers in San Antonio are broadening their legislative agendas following major Democratic victories in Washington and Austin.

Key Clinical Takeaways:

• San Antonio healthcare leaders are pressing for Medicaid expansion, safety net protections, and funding for community health workers ahead of the 90th Legislative Session.
• An estimated 1.1 million uninsured Texans could become eligible for coverage if the state expands Medicaid under the Affordable Care Act.
• Local providers report that application backlogs and strict federal work requirements under H.R. 1 continue to complicate healthcare access in South Texas.

Their goals involve bringing back safety net safeguards rolled back under the second Trump administration, securing financial support for community health workers, and advocating for Medicaid to be expanded in Texas. Democratic lawmakers at the state level have already initiated the filing of healthcare legislation leading up to the 90th Legislative Session, which features roughly twelve bills centered on Medicaid expansion.

Public health advocates and local medical authorities note that San Antonio and the wider South Texas region — characterized by high chronic disease rates and a large uninsured population — stand to benefit significantly from the upcoming legislative session and a more responsive Congress.

“This is probably the best time in the last 20 years for that to happen,” San Antonio Medical Foundation President Richard Perez said.

But a Republican-controlled state Senate and federal Medicaid changes under H.R. 1 could still limit how many local priorities become law. Texas remains the most populous state in the country to not expand Medicaid, which provides health insurance for people with limited incomes, under the Affordable Care Act.

Gov.-elect Gina Hinojosa has made expanding the program a top priority for her administration. KFF Health News estimates that roughly 1.1 million uninsured individuals in Texas could qualify for health coverage if the state adopts Medicaid expansion. In Bexar County, 18% of residents under 65 are uninsured, according to the U.S. Census Bureau.

South Side Clinic Realities

Dr. Lyssa Ochoa has seen the consequences firsthand. Ochoa oversees and established the SAVE Clinic, a South Side vascular practice that cares for numerous diabetic patients facing amputation risks.

“A lot of patients that I see, especially in the South Side, come in often very late in presentation when they don’t have health insurance, which means that they haven’t seen a primary care doctor,” she said.

“They may have wounds on their feet that aren’t healing, and they don’t get seen until the very end stage,” Ochoa said. Even individuals who carry health insurance frequently miss scheduled visits because they are unable to cover out-of-pocket copays for every required specialist, she noted.

The expiration of enhanced marketplace premium tax credits under the Affordable Care Act caused some of Ochoa’s patients to lose their coverage this year, raising monthly expenses significantly for numerous early retirees, part-time employees, and owners of small businesses. Congressional Democratic leaders have identified the reinstatement of these tax credits as a key priority, though any resulting legislation would still require the approval of President Donald Trump.

Methodology and Health Equity Advocacy

Methodist Healthcare Ministries chief financial officer Alan Kramer, representing the San Antonio-based health equity nonprofit, said that his policy group has spent years advocating for clean drinking water, healthy food access, medical affordability, and Medicaid expansion.

Expanding Medicaid “would have a significant impact on individuals in San Antonio and would allow them to access healthcare they’ve never had before,” Kramer said.

Offering low-cost medical services across 74 counties in South and Central Texas, Methodist Healthcare Ministries also tackles foundational social barriers to wellness, including poverty, educational deficits, limited food availability, and other conditions that exacerbate health disparities.

Furthermore, the nonprofit shares a 50-50 ownership stake with HCA Healthcare in Methodist Healthcare System, which constitutes San Antonio’s biggest hospital network. Kramer said that the organization intends to expand its policy and advocacy division, which currently utilizes retained lobbyists in Washington, D.C., and Austin.

“There’s going to be some opportunities for work that we weren’t necessarily expecting prior to the election,” he said.

Texas Hospital Association Supports Expansion Despite Legislative Hurdles

Texas Hospital Association CEO John Hawkins noted in a written release that while his association — representing more than 500 hospitals statewide — backs expansion, federal lawmakers must first address specific components within H.R. 1, frequently referred to as the Trump administration’s “One Big Beautiful Bill.”

The legislation introduced stricter work mandates for adults receiving coverage through Medicaid expansion alongside modifications to how states fund hospital payments—adjustments that, according to Hawkins, might complicate administration and financing for newly expanding states to an unworkable degree.

“We support more coverage, without unintended consequences,” Hawkins said in a statement. “Options need to be studied and understood before finalizing an expansion strategy.”

Hawkins additionally mentioned that the hospital group hopes the Legislature will concentrate on eliminating obstacles to enrollment within the existing Medicaid framework while simultaneously capitalizing on current avenues for coverage growth in rural, women’s, and mental health services. Congressional scrutiny has also been drawn to delays in processing Medicaid enrollment applications throughout Texas.

State metrics revealed that the processing backlog surpassed 200,000 delayed submissions by August. On Wednesday, U.S. Rep. Joaquin Castro, D-San Antonio, joined fellow Democrats in dispatching a formal inquiry to Texas Health and Human Services Executive Commissioner Stephanie Muth and U.S. Health and Human Services Secretary Robert F. Kennedy Jr., urging a federal probe into the accumulated delay.

Providers Push for Community Health Worker Funding and Reimbursement

Methodist Healthcare Ministries and other regional providers have also prioritized advocating for enhanced financial backing and better reimbursement rates for community health workers, also referred to as promotoras, who are trained local residents helping peers navigate the healthcare system.

“Unfortunately, Medicare, Medicaid, and a lot of the federal systems and government oversight don’t really give as much support for those types of workers and those types of programs,” Kramer said.

“There is a huge medical workforce shortage in our country across all aspects of the medical workforce, and we have a growing population,” Kramer said.

Sharing that viewpoint, Ochoa emphasized the pressing demand for additional community health workers to link South Side residents with medical care.

“If we could bring in payment for those connectors in our community, such as community health workers and health navigators, that’s really how we close the gap,” she said.

Ochoa also serves as the founding board chair for the Center for Health Empowerment in South Texas, a newly established health equity nonprofit dedicated to reducing the life expectancy gap between affluent and disadvantaged neighborhoods in the city.

Kramer said that Methodist Healthcare Ministries additionally wants Congress to reconsider modifications made under H.R. 1 to the Supplemental Nutrition Assistance Program (SNAP), which imposed stricter qualification rules and enrollment criteria. According to reporting by The Texas Tribune, Texas saw a 20% reduction in SNAP participation between September 2025 and September 2026.

“We’re optimistic about the change in politics,” Kramer said of the midterms, “that there’s going to be more ears willing to hear our message up in Austin and in D.C.”

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.