But that’s not quite the end of the story.
House Republicans on Monday agreed not to expand Medicaid as called for under the federal Affordable Care Act — but left the door open to doing so if the Obama administration grants Texas enough flexibility.
“The current path as proposed is unsustainable from a fiscal standpoint,” said caucus chairman Brandon Creighton, R-Conroe. He said the caucus would continue to “propose solutions on the issue, which we’re formulating and will continue to do so throughout the session.”
Several Republican-led states have in recent weeks reached compromises with the federal government to expand Medicaid coverage to poor adults. Arkansas, for example, has received permission to use Medicaid expansion financing to subsidize private health coverage for individuals who would qualify for Medicaid under the expansion.
“State by state we’re going to study what every state proposes and compare it to what’s best for Texas,” Creighton said. “We are Texas, so we are very different. We’re not making a blanket statement or a hard position on anything.”
Some of the solutions Creighton said GOP lawmakers are considering include implementing co-pays to hold Medicaid enrollees fiscally responsible for their care or using the expansion funds to help subsidize private health coverage for poor Texans — similar to what Arkansas is considering.
The Arkansas option has its share of flaws – it’s likely to be more expensive up front, and in the longer term, especially once the federal match drops below 100% – but it’s a viable path forward that would cover a lot of people and would have a few advantages over traditional Medicaid. I haven’t seen any reaction to the Arkansas plan yet from Democratic leaders on health care, so there may be some gotcha I’m not aware of and I may be speaking out of school, but if the Lege pursues something like this I will consider it to be real progress. But first the Republicans have to decide what they want, and then they have to sell the Centers for Medicare & Medicaid Services that they’re serious. They don’t have a plan yet, so this is all theoretical anyway. Even if they get to the point of formulating a plan and advancing a bill, there’s still the little matter of Rick Perry.
“I’ve known Rick Perry for a long time and there’s nothing to make me believe that he’ll back down,” said Sen. Bob Deuell, a family doctor and Greenville Republican.
Another GOP physician-legislator, Rep. John Zerwas of Richmond, said it would be folly for lawmakers to support expanding Medicaid without first addressing Perry’s demands that the federal government allow Texas to administer the program the way the state wants.
“For us to try to move something at this end that isn’t going to incorporate any kind of flexibility in the program, he’s made it very clear that he would veto something like that,” said Zerwas, chief writer of the House’s budget for Medicaid and social services.
On Tuesday, supporters of the Medicaid expansion will march and rally at the Texas Capitol. On Monday, the House’s GOP caucus hurriedly met and pushed back, calling for continued resistance. In a closed-door meeting, the 95-member caucus supported Perry’s stand and voted overwhelmingly for a motion to reject the Medicaid expansion “as proposed” in the federal law.
Rep. Lois Kolkhorst of Brenham said House Republicans want to see “if we can work out a Texas-centric solution.” But she said House lawmakers are just starting to confer and are nowhere close to putting an alternative proposal to the Obama administration.
“The vote in the caucus reflects the governor’s current position,” said Kolkhorst, who heads the House Public Health Committee. Asked if House Republicans differ at all from Perry on Medicaid expansion, she replied, “I wouldn’t say there’s any daylight now.”
So don’t get your hopes up just yet. There’s still no evidence that the Republicans really care about this problem; they certainly don’t care enough to push Perry on it. While we sit around waiting for them to begin to care, people will die. “Pro-life”, my rear end.