Here’s an early peek at what we have to look forward to next year.
Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.
Far-right conservatives are offering that possibility in post-victory news conferences. Moderate Republicans are studying it behind closed doors. And the party’s advisers on health care policy say it’s being discussed more seriously than ever, though they admit it may be as much a huge in-your-face to Washington as anything else.
State Rep. John Zerwas, R-Simonton, an anesthesiologist who authored the bill commissioning the Medicaid study, said early indications are that dropping out of the program would have a tremendous ripple effect monetarily. He is not ready to discount the idea, he said, but he worries about who would carry the burden of care without Medicaid’s “financial mechanism.”
“Because of the substantial amount of matching money that comes from the federal government, there’s an economic impact that comes from that,” Zerwas said. “If we start to look at what that impact is, we have to consider whether it’s feasible to not participate.”
State Sen. Jane Nelson, R-Flower Mound, who chairs the Senate Public Health Committee, said dropping out of Medicaid is worth considering — but only if it makes fiscal sense without jeopardizing care. Currently, the Texas program costs $40 billion per biennium, with the federal government footing 60 percent of the bill. As a result of federal health care reform, she said, millions of additional Texans will be eligible for Medicaid.
“I want to know whether our current Medicaid enrollees, and there certainly could be millions more by 2014, could be served more cost efficiently and see better outcomes in a state-run program,” Nelson said.
I don’t know about you, but I don’t recall the subject of a total Medicaid withdrawal being part of the just-concluded campaigns. Was this what all you Republicans were voting for?
Let’s consider the numbers for a minute. If Texas’ cost per biennium for Medicaid is 40% of $40 billion, that’s $16 billion. So you could zero out Medicaid, not replace it with anything, and still have a $9 billion gap in the budget. What else you got?
From what Sen. Nelson is saying, there would be some kind of replacement, though it’s hard to imagine what they might have in mind. But assuming there is something, then the net cost reduction would be considerably less than $16 billion. Given our recent experiments with privatization, would anyone be shocked if whatever they proposed as an alternative wound up costing a lot more, and saving a lot less, than they projected? And what do you suppose the effect of not having that $24 billion in federal dollars come into the state be on the economy?
You can only talk about the numbers for so long before you have to acknowledge the effect on the people who currently rely on Medicaid. They’re still going to get sick and need to get medical help. Who will pay for it in the absence of Medicaid? Cities and counties and their associated hospital districts would be my guess. I wonder what all the state’s Mayors and County Judges think about this.
You know when I said yesterday that Job One for the remaining Democrats in the Legislature will be to remind everyone who voted for a more Republican government that they were about to get it, good and hard? This is the sort of thing I had in mind. There will be plenty more where this came from.