I’m really not sure what to make of this.
State Sen. Tommy Williams, R-The Woodlands, is crafting a Medicaid reform plan that would use premium tax revenue to subsidize private health plans for uninsured Texans, his office confirmed on Tuesday night.
Gary Scharrer, a spokesman for Williams, said the proposal is “still a concept,” one that is designed to “buy some time” as Texas debates how to overhaul Medicaid in the midst of pressure from the federal government to embrace elements of the Affordable Care Act, or “Obamacare.”
According to early details, Williams’ plan would scrape premium tax revenue from newly insured Texans who sign up for coverage under the state’s health insurance exchange — an online insurance marketplace that is mandatory under federal health reform — and use it to subsidize private coverage for poor, uninsured Texans starting in late 2015.
Scharrer cautioned that Williams’ proposal does not call for expanding Medicaid, which the state’s top Republican leaders adamantly oppose. Nor does it call for raising taxes; the premium tax revenue will be a side effect of more Texans being forced to buy insurance under the Affordable Care Act.
Williams is “really emphatic that Texas will not extend or expand the current Medicaid system,” Scharrer said.
I can’t tell what the goal of this is. Is it to help provide health care coverage to people who otherwise wouldn’t have it? In particular, is it intended as a way to provide some kind of health care coverage to people who would be eligible for Medicaid if Texas would agree to expand it? The Express News suggests that this is indeed the case.
Williams said the money from the extra premium taxes could be used to pay for Texas’ cost of expanding health care coverage to those who would otherwise qualify for Medicaid expansion.
His preference would be to add them to the insurance exchange and help them to buy coverage, although he said it also could be done by putting them in a revised Medicaid program.
He would like to wait until September 2015. That would give lawmakers another regular legislative session in 2015 to examine the program.
“And so I don’t want us to get committed to any program that we can’t pay for and that the federal government is not going to pay for,” Williams said.
Of course, the federal government is paying for it, assuming that Williams’ Republican colleagues in Washington don’t succeed in figuring out some way to cripple it. One must admit there is some risk to that, however perverse the whole thing is. Be that as it may, I’d like to know how much revenue Williams thinks he can “scrape” this way, and how many people it would help. I’m going to step out on a limb and guess that the number is smaller than the number of people who would be eligible for expanded Medicaid. More importantly, why this for a revenue source and not the billions of dollars of federal money available? Back to the Trib for that:
State Rep. John Zerwas, R-Simonton, confirmed Wednesday that he will incorporate into his own Medicaid reform bill a proposal by Sen. Tommy Williams, R-The Woodlands, to use premium tax revenue to subsidize private health policies for the uninsured.
“It fits very well with Texas’ attempt to find a unique solution that would be sustainable,” Zerwas said. He said the measure would allow Texas to embrace some parts of federal health reform “earlier versus later,” and would “hopefully bring insurance policies to these people that otherwise wouldn’t have them.”
But the two lawmakers diverge on a key point — whether or not to draw down billions of federal dollars to expand the state’s Medicaid-eligible population under the Affordable Care Act.
Medicaid expansion is “completely off the table — what I’m interested in is a reform program,” Williams said Wednesday morning.
Zerwas said he authored House Bill 3791 to craft a “Texas solution” to Medicaid reform that would allow the state to draw down federal Medicaid expansion financing while implementing cost containment reforms. So far, Zerwas has suggested those reforms include co-payments and wellness incentives, but the details of his plan remain thin.
Still not clear what, other than straight up antipathy to Medicaid and the ACA, is driving Williams’ refusal to draw down federal funds. The sad thing is that even this baby step, two years out, would be a big improvement over anything the Republicans have done to health care in Texas. It’s ridiculously limited and needlessly complicated, which gives you some idea of just how bad the status quo is, but it’s still a tiny nudge forward. I just hope Rep. Zerwas’ perspective wins out in the end.