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Medicaid expansion pressure is having an effect

Despite the mountains of evidence in its favor, I still can’t say that I see a path to Medicaid expansion in Texas. But stories like this do give me some hope.

It’s constitutional – deal with it

Adamantly opposed to expanding Medicaid coverage under President Barack Obama’s signature health care law, Gov. Rick Perry and Lt. Gov. David Dewhurst had seemingly squelched efforts this legislative session to insure an additional 1.1 million low-income Texans under the Affordable Care Act.

But a determined campaign, targeting legislators with public pressure and private persuasion, has kept the issue alive by framing Medicaid expansion as an economic bonanza and tax-relief opportunity that would bring $79 billion in much-needed federal money over 10 years.

The arguments, pitched to Republican ears, have carved out a small space in which lawmakers can work toward an agreement that once appeared impossible.

Several key GOP legislators, though skeptical about expanding Medicaid, haven’t ruled out the possibility of a compromise, provided they can get several important concessions. Democrats are ready to deal.

“I’m tempering my rhetoric,” said state Sen. Rodney Ellis, D-Houston. “I don’t want to say anything that backs them in a corner. I want to get this done.”

[…]

Last week, the Austin City Council voted unanimously to push the Legislature toward expanding Medicaid, echoing a similar call by Dallas County. Influential lobbying groups also have joined in, including the Texas Medical Association, which recently endorsed expansion if accompanied by reforms that include cutting red tape and increasing provider payments.

[State Rep. John] Zerwas, a medical doctor, said he is feeling the pressure to reverse his opposition.

“Absolutely. If you talk to hospitals, if you talk to counties, there is a substantial amount of money that is promised in the law that would benefit Texans. We do have a substantial uninsured problem,” Zerwas said.

But, he added, the expansion as proposed would be a Band-Aid solution, stressing an unsustainable Medicaid system that has grown so large it threatens spending on education, roads and other vital programs.

Still, Zerwas said there could be room to negotiate if Texas wins important concessions from the federal government to create a flexible system. The amount of needed flexibility “remains to be defined,” he said, but could include running the expansion program as a health maintenance organization and requiring co-pays.

Houston’s Rep. Garnet Coleman, one of the Capitol’s leading Democrats on health care issues, is fine with requiring co-pays and similar concessions.

Coleman, however, draws the line at attempts to use expansion as an opportunity to change Medicaid’s promise to children and disabled and elderly Texans. Talk of adding flexibility, he said, has often meant cutting people and services from the Medicaid system.

“Those of us who support the Medicaid expansion, we can walk away from the table, too, if we don’t think what is proposed is good for our constituents. This is a two-way street,” he said.

I presume Rep. Coleman is talking about block-granting Medicaid, which everyone knows would be used to cut benefits. This isn’t the first time we’ve heard about the possibility of a deal on Medicaid expansion, but this is the first time we’ve seen some details, however sketchy. Obviously, the biggest hurdle is Rick Perry, and he’s painted himself into enough of a corner that I have a hard time imagining him signing anything that doesn’t include block grants as a cornerstone. Maybe I’m wrong about that, but no one has gotten rich underestimating Perry’s fanaticism lately. Still, bringing pressure from the county level is the smart move, though it would really help if Harris County would get into the game. If we can’t get that I’d settle for a resolution from Houston City Council. This needs to be a big issue for the 2014 elections, and it needs to be felt at the county level by folks like County Judge Ed Emmett and County Commissioner Jack Morman as well. If you’re not part of the solution then we need to get someone else who is.

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