Before Thanksgiving, Ezra Klein asked “Why does Gov. Rick Perry want more uninsured Texans?”
Consider the case of Texas, which with 25 percent uninsured, leads the nation in not providing for its residents. If the state pulls out of Medicaid, as Gov. Rick Perry (R) is suggesting, that would put it at 40 percent uninsured, as Medicaid covers 15 percent of the state. Texas might try some other form of coverage, but it will have lost hundreds of millions of dollars of federal funding. You can occasionally do less with more, but when you have a lot less, you generally just do less. Whatever the state tried next would cover fewer people with less-comprehensive insurance, and it’s a safe bet that the rate of uninsured would ultimately settle above 30 percent. Some legacy.
Conversely, if Perry does nothing, the federal government is going to come in and pick up most of the cost of a massive coverage expansion. Texas, in fact, will be one of the biggest winners from health-care reform, as its huge pool of uninsured residents means the state will get an uncommonly large amount of subsidies to bring that down to manageable levels. Texas “can expect to see Medicaid enrollment rise by 46 percent while state spending on Medicaid rises by about 3 percent.” Pretty good deal.
There is nothing that states can do that would cover residents at a lower cost to their budgets than simply letting the new health-care law take effect. Any governor that is even vaguely interested in covering the uninsured should be celebrating the federal government’s willingness to pick up 96 percent of the tab. Of course, as these trial balloons over Medicaid show, plenty of governors don’t care about that at all. You’d think Perry, who runs a state where one out of four residents don’t have health insurance, would be obsessed with figuring out ways to cover more Texans. Instead, he’s leading the way in concocting schemes to cover fewer of them.
There are several factors that need to be considered here. One is Texas’ huge budget shortfall, for which the only allowable solution will be budget cuts. Simple accounting for those with that mindset notes that Texas spends about $17 billion per biennium on Medicaid, which amounts to somewhere between two thirds and four fifths of the deficit, so if we just simply stopped funding Medicaid, we’d have an almost-balanced budget. Yes, I know, it’s way more complicated than that, but that’s where this is coming from. Second is Perry’s newfound jihad against the federal government, which conveniently coincides with a Democrat being in the White House. Whatever else you make of this, you can’t separate these two things from the whole.
But even without these factors, we should not forget that at no time during his ten years in office has Rick Perry ever done anything to substantially expand health care coverage in Texas. Quite the opposite, in fact. In 2003, Texas threw 300,000 kids off CHIP, and only some of those who lost coverage were able to regain it in subsequent legislative sessions. Texas’ Republican leadership, including Perry, has repeatedly opposed simple things like changing from a six-month re-enrollment period for CHIP and Medicaid to a 12-month period, thus ensuring that a significant portion of eligible recipients lose coverage due to failure to re-enroll in a timely fashion. Even more basic than that, I can’t think of a single program that Perry has introduced or touted that would have attempted to deal with the huge number of uninsured residents we have. Other Republican Governors, like Mitch Daniels and Mitt Romney, have gotten legislation passed in their states, and whether you agree with what they’ve done or not they at least made an attempt to tackle their states’ problems in a way that’s consistent with their stated principles. Perry has done nothing. I can’t help but think that a big part of the reason why he and his cronies are so ferociously opposed to the Affordable Care Act is precisely because it so clearly shows the extent of their failure to do anything about this. After ten years of Rick Perry and eight years of a Republican legislature and mostly the same state leadership, I can only conclude that they genuinely don’t care about making health care accessible for the uninsured. It’s just not on their radar, and so it’s just another line item in the budget that they’d like to target for cuts so they can keep giving Dan Patrick property tax cuts. It’s who they are, it’s what they do, and we should not be surprised by it.
UPDATE: I refer you to Peggy Fikac:
Some Republicans who talk about Texas potentially opting out of Medicaid are quick to say the changes wouldn’t throw people out on the street — but not House Appropriations Committee Chairman Jim Pitts.
Pitts didn’t advocate the change in health care for the poor at a meeting of the Ellis County Tea Party, just noted that it will be discussed by lawmakers.
But unlike others who have painted a rosy picture of a potential health-care restructuring without filling in the details, Pitts gave a stark answer when an audience member asked about an ill friend who is on Medicaid.
The questioner reacted with concern when Pitts said the state is looking at getting out of the program. What will my friend do then? Will you throw him out in the street?
“If we did exactly what we’re doing today, we wouldn’t be throwing him out in the street. But if we have any savings in getting out of Medicaid, we will have to throw some people out in the street,” said Pitts, R-Waxahachie. He noted, “I’m not telling you that your friend would be.”
But he probably would be. Aren’t you glad you voted for that?