AUSTIN -- Like six million other uninsured Texans, Monse Cigarroa's trip to People's Community Clinic in Austin for an annual checkup was also a luxury.
"For all the people that don't have insurance it's really bad, so I'm very appreciative that this place is here," Cigarroa told KVUE Thursday.
People's serves 10,000 working patients without insurance each year, and it's where the debate over expanding the state's Medicaid system meets reality.
The Medicaid expansion recommended as part of the Affordable Care Act would increase the amount of patients who qualify under Medicaid and could result in additional compensation of up to a million extra dollars a year, something CEO Regina Rogoff says would allow her clinic to serve even more patients.
"It's a pretty significant amount of new money and it's a pretty significant number of new people," said Rogoff. "We would be looking to expand our services."
State legislators met Thursday at the State Capitol to discuss the impact of Governor Rick Perry's decision not to expand Medicaid, effectively turning down $164 billion in federal funds for which the state wouldn't be required to contribute for the first three years.
Those who oppose expanding Medicaid argue that the $17 billion price tag spread over the next eight years places an unaffordable burden on the state's already slim budget.
"It's always been my belief there's enough money in the Medicaid system, we just don't spend it very wisely," said Texas Health and Human Services Commissioner Tom Suehs.
"If Texas' program is so damn good then why do we have the highest rate of uninsured in the nation?" State Rep. Dawnna Dukes (D-Austin) questioned Suehs.
Suehs responded that the rate was largely due to the number of illegal immigrants in the state, a contention Dukes countered with data indicating Texas trails California and Arizona in illegal immigrants per capita. Suehs then assented that Texas' poor ranking was likely a combination of factors.
Others on the panel questioned the Medicaid program's original intent.
"We do need to look at a judgment call as a legislature whether or not we want to expand a program that's really been for aged, blind, disabled, the needy children and pregnant ladies to a group of individuals that are single adults," stated State Rep. Charles Schwertner (R-Georgetown).
In an interview with KVUE, Central Texas Congressman Lloyd Doggett (D-Austin) argued the deal is simply too cost-effective for Texas to pass up.
"Texas would get one hundred percent of the cost of any expansion to poorer Texans over the next three years, and after that Texas would have to pick up a nickel of every dollar and eventually a dime of every dollar," explained Doggett.
"Let's fix [Medicaid]," Suehs told KVUE after the hearing. "Let's get the things in there to make the thing more efficient, and then let's look at what you should do in the expansion."
Meanwhile millions like Cigarroa can only fantasize about health care that for now seems out of reach. Some policy watchers believe Texas will ultimately strike a deal with Washington that would fund some expansion.
For now, it's still a waiting game to see what Texas does next.