Sounds like a sincere effort, though whether it can get anywhere is an open question.
Amid hours of testimony from advocates in support of Medicaid expansion on Tuesday, state Rep. John Zerwas, R-Simonton, described his proposal to create an alternative program that could draw down federal financing to provide health coverage for poor and uninsured Texans.
“I think it’s incredibly important that we do something that can be discussed and debated on the floor of the House,” Zerwas said before outlining House Bill 3791 during a meeting of the House Appropriations Subcommittee on Budget Transparency and Reform. “I think the citizens of Texas expect us to have that conversation.”
“The bill is intended to not be an expansion of Medicaid,” he added.
HB 3791 would require the state’s health commissioner to craft a “Texas solution” to health care expansion by pursuing a waiver or authorization from the federal government to reform Medicaid while expanding coverage to poor adults. Under Zerwas’ proposal, the waiver must be cost-neutral and allow Texas to leverage tax revenue collected from premiums on health care plans to pay for the state’s portion of the program’s costs. It must also allow the state to save money by tailoring Medicaid recipients’ benefits, implementing “personal responsibility” cost-sharing measures, such as co-pays and deductibles, and prioritizing premium assistance for private market health plans.
If negotiations with the federal government were to fail, the bill would require Texas to set up the same program with state funds.
“This is intended to try to promote personal responsibility,” said Zerwas, explaining that the program would support many options for poor individuals to find health coverage through the private market. “It’s not a one-size-fits-all.”
The bill was left pending in committee.
State Rep. Garnet Coleman, D-Houston, a joint author on Zerwas’ bill, said it would allow the Legislature to weigh in on the best way to cover the poor and uninsured.
“Let’s take what we want up there and let’s advocate for what the majority of the people in this Legislature think,” he said. As an example, he said, the bill would allow the state to help people who want one to obtain a health savings account.
If Rep. Coleman is involved then you can be reassured the bill will be meritorious, if not ideal. At least it’s intended to be expansionary, unlike some other proposals that have been floated. But it’s still not the best we could do.
“This is not Medicaid expansion; this is Texas Plus or Medicaid Plus One,” said state Rep. Sylvester Turner, D-Houston, who laid out his House Bill 3376 at the House Appropriations Subcommittee on budget transparency and reform.
HB 3376 would expand Medicaid coverage to individuals below 133 percent of the federal poverty line. The bill includes a severance clause that requires the state to stop financing the program if the federal government reduces its share of financing below 90 percent and — “in the spirit of conservatism,” as Turner put it — also includes cost-sharing requirements such as co-payments.
“I don’t think anyone can dispute the numbers. We may dispute whether or not we want to do it,” said Turner, emphasizing that the state comptroller estimates expanding Medicaid coverage as proposed in HB 3376 would save the state $50.4 million in the 2014-15 biennium. “From a fiscal, financial, budgetary point of view, the numbers are overwhelming.”
Unfortunately, so are the odds against Rep. Turner’s bill passing. What’s best is not always politically doable, and though the opposition has no good argument, they have the numbers. What are you going to do? Let’s support Rep. Zerwas’ bill and hope for the best. Texas Well and Healthy has more.