By: Carrie Feibel and Laurie Johnson, June 05th, 2014 04:50 PM

Under the new health law, all states had the option to expand Medicaid to insure more adults. California did it, and now that state has fewer uninsured people than Texas, which is now number one. Robert Greenwald is director of Harvard Law School’s Center for Health Law and Policy Innovation. He spoke to a group of Houston health leaders, suggesting they use new ways of framing the issue in the next legislative session. Greenwald says one major problem is refuting Governor Perry’s repeated claim that Medicaid is a broken system.

“It’s not that Medicaid is broken, it’s that Medicaid is expensive. And the reason it’s expensive especially in a place like Texas is that it’s limited to the most disabled, sickest, elderly population,” Greenwald said.

Greenwald says it would be different if Medicaid was offered to low-income, working adults. That population is relatively healthy and young. Getting them covered would not cost as much as the current program, and it would save money in the long run by keeping them healthy.

“This is a completely different program,” he said.

Laurie Glaze is head of One Voice Texas, an advocacy group. Glaze organized the conference. She says that’s a good talking point, and true. But it’s still tough to convince some Republicans that it makes fiscal sense to take the federal dollars and do it.

“We’ve done all that. We have tried educating, we’ve done the financial aspect of this issue, the humankind aspect of this issue, the community aspect.  But I think a lot of this truly is a political position,” Glaze said.

Glaze says it might take a few years for the message to sink in, and for Texans to watch Texas federal tax dollars flow to other states to care for their uninsured people.

Greenwald says the federal government has made it easy for both Democrats and Republicans, by offering politicians some leeway in designing the program.

“It’s really just saying we’re going to do it but we’re going to do it ‘Texas style.’ And ‘Texas Style’ may be to not put these people into Medicaid. It may be to buy private health insurance for people using those dollars.”