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Paul Ryan

PPP polls show “generic Dem” winning in CDs 07 and 32

Via Daily Kos, Public Policy Polling sampled a number of targeted Congressional districts for 2018, including two in Texas, and the results are encouraging, to say the least.


In Texas’ 7th Congressional District, Republican incumbent Congressman John Culberson has an approval rating of 31%, and 55% of voters say they disapprove of the job he is doing. President Trump has an approval rating of 37% and a disapproval rating of 59% in Culberson’s district, while 12% of voters say they approve of the job Congress is doing and 83% say they disapprove. Speaker Paul Ryan is also unpopular with 29% of voters saying they approve of the job he is doing and a majority (65%) responding that they disapprove. These percentages, along with a hypothetical matchup between Culberson (39%) and a “Democratic opponent” (49%), indicate that Culberson is quite vulnerable in his upcoming re-election. The new tax plan is not popular in his district, and a majority (53%) of voters indicated they would be less likely to vote for Culberson if he voted in favor of the Republican tax plan.


In Texas’ 32nd Congressional District, Republican incumbent Congressman Pete Sessions has an approval rating of 36%, and 52% of voters say they disapprove of the job he is doing. President Trump has an approval rating of 39% and a disapproval rating of 58% in Sessions’ district, while 6% of voters say they approve of the job Congress is doing and 85% say they disapprove. Speaker Paul Ryan is also unpopular with 27% of voters saying they approve of the job he is doing and a majority (66%) responding that they disapprove. These percentages, along with a hypothetical matchup between Sessions and a “Democratic opponent,” where Sessions has 43% of the vote and his Democratic opponent has 48%, indicate that Sessions is quite vulnerable in his upcoming re-election. The new tax plan is not popular in his district, and a majority (51%) of voters indicated they would be less likely to vote for Sessions if he voted in favor of the Republican tax plan.

As the Kos post warns, there are ample reasons to maintain a healthy level of skepticism about such polls. It’s way early; polling at this time in the 2014 cycle looked pretty good for Dems, too. “Democratic opponent” has no record to defend or campaign to execute, and may have to survive a rough primary. We have no idea what the question wording was, or what the assumptions were about the partisan makeup of the districts. All that said, if Dems are leading the national Congressional preference poll by double digits, it stands to reason that districts like these would at least be competitive. As always with polling, we’ll see if subsequent results affirm or contradict this one.

Of course Obamacare repeal would have a big negative effect on Texas

I mean, duh.

Right there with them

As many as a half-million Texans could become uninsured under the Republican plan to replace the Affordable Care Act, wiping out at least half the gains the state has made in reducing the number of uninsured residents in recent years, according to health care analysts.

Texas still has the nation’s highest percentage of people without health insurance, but that uninsured rate has dropped significantly, falling to about 19 percent from 26 percent over the past four years. About 1 million more Texans gained coverage under the health care overhaul known as Obamacare, which became law in 2010.

Under the Republican plan to repeal and replace the health care law, 500,000 could lose coverage by 2020, either through changes in federal assistance to purchase coverage and Medicaid, the government health care program for the poor, or the end of individual mandates that require people to have insurance, said Ken Janda, president and CEO of Community Health Choice whose company offers insurance plans on the federal exchanges.

Analysts such as Vivian Ho, health economist at Rice University’s Baker Institute for Public Policy, advocates like Elena Marks, CEO of Houston’s Episcopal Health Foundation, and insurers, such as Molina Healthcare, confirmed Janda’s estimates.

“Certainly, Texas is going to have more uninsured people again,” Janda said. “I don’t see much positive coming out of Congress.”


Dr. Mario Molina, CEO of the California-based Molina Healthcare, a Fortune 500 company, said in an interview he cannot yet commit that his company will be in the Texas market next year on the exchange because of the uncertainty that currently exists surrounding the promise to repeal and replace the ACA. Currently his company is one of only three insurers who offer ACA coverage in Houston.

“I am very nervous,” he said. “There is little that Congress has done so far that indicates the insurance market will be stable.”

Blue Cross and Blue Shield of Texas, which offers plans on the exchange in every Texas county, including Harris, also expressed concerns about the uncertainty of federal health care policy.

“It’s imperative that we have market stability and regulatory certainty,” the company said in an emailed statement. “We will make decisions about our product offerings for 2018 once we have more information about any legislative or regulatory changes that will be made impacting the individual health insurance markets.

Health care providers, meanwhile, worry what will happen if hundreds of thousands of Texas residents lose insurance. Katy Caldwell, executive director of Houston’s Legacy Community Health, which serves many low-income patients, said fewer insured patients will mean longer wait times as clinic staff become overwhelmed. But a jump in the uninsured rate would create more than inconvenience, she said.

“The thing that really concerns me is people foregoing their medication. I hear it all the time now: ‘I have to choose between food and my medicine’ or ‘I cut my pill in half because I can make a 30-day supply last 60 days,'” Caldwell said. “This has every potential to get worse.”

Honestly, I think that half million estimate is very much on the low end, possibly the optimal scenario under the Ryan bill, which to be sure has no obvious path forward at this time. The provision that would not only freeze Medicaid enrollments but prevent anyone who fails to re-enroll for any reason from ever re-enrolling would surely force many more people off, just as the six-month re-enrollment period for CHIP that was passed by the 2003 Legislature contributed to so many more children going without health insurance. And all that is before we consider the possible chaos in the broader healthcare market. So yeah, if a few years from now we come out of this with only a half million people having lost coverage, I’d consider that to be better than I expected.

What do our elected officials think about the plan to kill off Medicare?

Hey, remember when this was a major campaign issue?

With all the other things we’ve discussed so far today, I wanted to return to one critical one. It’s not about mights or maybes or fears of what’s to come. It’s about what’s coming just after President-Elect Trump’s inauguration. Paul Ryan has been pushing to phase out Medicare and replace it with private insurance for several years. But now it’s real with unified Republican government. He just said he will try to rush it through early next year while repealing Obamacare.


I’ve heard a few people say that it’s not 100% clear here that Ryan is calling for Medicare Phase Out. It is 100% clear. Ryan has a standard, openly enunciated position in favor of Medicare Phase Out. It’s on his website. It’s explained explicitly right there.

Ryan says current beneficiaries will be allowed to keep their Medicare. Says. But after the cord is cut between current and future beneficiaries, everything is fair game. For those entering the system, Ryan proposes phasing out Medicare and replacing it private insurance with subsidies to help seniors afford the private insurance. That is unquestionably what it means because that is what Ryan says. So if you’re nearing retirement and looking forward to going on Medicare, good luck. You’re going to get private insurance but you’ll get some subsidies from the government to pay the bill.

Through all the gobbledygook and bamboozlement, you’ll find this line on Ryan’s page: “For younger workers, when they become eligible, Medicare will provide a premium-support payment and a list of guaranteed coverage options – including a traditional fee-for-service option – from which recipients can choose a plan that best suits their needs.”

This means, if you haven’t gone on Medicare yet, when you do, you won’t get Medicare. You’ll get a “premium-support payment” – i.e., a check that will allow you to buy insurance from private insurers. The “support” in the phrase means it won’t cover the whole amount. And in any case, rather than Medicare you’ll have insurance from an insurance company, which everybody should love because haven’t you heard from your parents and grandparents how bummed they were when they had to give up their private insurance for Medicare?

You’ll hear lots of people calling this “reform” and other catchwords. But Medicare is a single payer, universal health care system. Replacing it with private insurance means getting rid of it. Even calling it “privatization” masks what is really afoot.

Every Democrat should be focused and talking about it volubly both as a matter of policy and politics. There isn’t much time.

Yeah, I don’t remember that being a campaign issue, either. Maybe it was discussed in one of those emails that got deleted. But there it is, whether anyone realized it or not. If you need a bit of brush-up on what that means, see here and here.

Now then. The fact that this went basically undiscussed for the last year is unfortunate, but it’s where we are. There’s no time like the present to bring it out from under a rock and shine a little light on it. TPM is on that.

DC journalists tend to think this kind of story evolves in DC. And there’s plenty to follow in Washington. But the real action happens in the states and congressional districts where members of Congress have to sell getting rid of Medicare to their constituents. And that is going to come out in local media, constituent letters, public appearances and so forth. So let us know what you are seeing where you live. In the local paper, on TV, something you hear directly from a representative or senator. Find out where your representative or senator stands on this issue. We want to know.

I’d like to know, too. I live in CD18, and I feel as close to certain as it is possible to be that Rep. Sheila Jackson Lee will not vote to “reform” Medicare. But there are 35 other members of Congress in Texas, most of them Republican. It sure would be nice to know what they think about this, and that includes the Democrats, who may claim to be as in the dark as some Republicans are now claiming to be. So why not give your member of Congress a call and ask them if they support the Ryan plan to privatize Medicare. You might point out to the Republican members that they have voted for it in the past. You might also point out that Trump himself has flipflopped on the issue and now supports it himself. Whatever answer you get, please let me know – is the email address. Expect denial, ignorance, and sheer bullshit, but any answer you get is more information than we had before.

The Arkansas way

The state of Arkansas will move forward with a plan to expand Medicaid, except that it’s not really Medicaid even though it will cover all of the Medicaid-eligible population. Here’s the explanation.

It’s constitutional – deal with it

Gov. Mike Beebe met with about twenty lawmakers this afternoon to announce the results of his meeting with Sec. Kathleen Sebelius last Friday.

The feds have given Arkansas permission to pursue a plan that would provide private health insurance to anyone between 0-138 percent of the federal poverty level, giving coverage to more than 200,000 of the currently uninsured. The government would pay for the entirety of the premium, though consumers might be subject to some co-pays.

Beebe brought questions and ideas from legislators to his meeting with Sebelius and “basically they’ve agreed to give us about everything we’ve asked for,” he said. “What that really amounts to is take the Medicaid population that would be expanded…and use those federal Medicaid dollars and purchase insurance through the exchange. So they would buy private insurance through the exchange for the entire population, and [the feds have] given us permission to do that.”

This isn’t “partial expansion.” The full pool of folks that would gain coverage under full expansion of Medicaid would still get it. But Arkansas is the first state to publicly get a deal that accomplishes this not via the Medicaid program but via the exchange (Florida will be allowed to send some Medicaid recipients to private insurance through their managed care system).

Just as with Medicaid expansion, the feds would foot the entire bill for the first three years. Thereafter, the state would have to start kicking in a little bit, eventually settling at 10 percent in 2020. (Technically, these are Medicaid dollars, but they would be flowing to private companies and consumers would be interacting with private companies, not with the Medicaid program.)

Such a deal would potentially be a windfall for insurance companies, as well as hospitals, who would likely see higher reimbursements from private insurance on the exchange. For low-income citizens without health insurance, the deal would be similar to expansion, they would just get private insurance instead of Medicaid.

Gov. Beebe also announced that, prompted by strong support from House Speaker Davy Carter, the state will likely use the “sunset provision” idea from Florida, which would require the legislature to re-approve the deal in three years time, after the full federal match rates run out. States are already allowed to opt in or opt out at any time, but Beebe got approval from Sebelius on the sunset idea as well, just in case. Carter told reporters that a sunset was a prerequisite to any deal.

As for costs, buying private insurance for citizens is likely more expensive than providing Medicaid. That almost certainly means that this deal will have a higher price tag for the feds. And it could mean higher costs for Arkansas once the state has to start chipping in. Beebe acknowledged that possibility but said the sunset will allow lawmakers to analyze the question with hard data in three years time.


Beebe did not offer an opinion on whether this approach was better than simply expanding Medicaid. One way or the other, he believes accepting federal money to cover the uninsured is a good deal and his focus now is on closing the deal.

“My main objective is to make this legislature as comfortable as I can make them,” he said. “With a three fourths vote requirement in both houses, that’s a steep, steep burden….If the majority would prefer to go this way to get this done, I’m happy with that. If they want to go the other way, I live with that as well. The cost to the taxpayer for the first three years in the state of Arkansas is going to be the same.”

Beebe said that for some legislators, subsidizing folks to buy private insurance was preferable to directly covering people through a government program for “philosophical” reasons.

Let’s pause for a second to consider that last paragraph. I’m writing about this story because the main objection to Medicaid expansion here in Texas is the oft-stated belief that “Medicaid is broken”, seen most recently here. I don’t particularly agree with that statement, but I’m not the majority in the Legislature. But whatever you think about this solution, it completely addresses that concern. The federal Medicaid funds would be used to buy private insurance through the insurance exchange instead. Don’t want to expand Medicaid because you think Medicaid doesn’t work? Fine, here’s a way to serve the vast uninsured population that doesn’t use Medicaid? What’s your objection to that?

Now, just because I think this is an interesting option doesn’t mean I think it’s awesome. Ed Kilgore points out the obvious:

So let’s be clear: using the exchanges will be more expensive, and perhaps less generous to beneficiaries, than traditional Medicaid, but because Republicans prefer private insurers for “philosophical reasons”.


This draws attention to two pretty important national issues: the first is the persistent gap between the faith conservatives place in the “efficiency” of private-sector health insurance and all the available evidence. And the second is the emerging long-term conservative strategy of undermining Obamacare by limiting its “public” elements as much as possible and then chipping away at the regulations that make it available and the subsidies that make it affordable. This is precisely what Douglas Holtz-Eakin and Avik Roy called for in their much-discussed recent op-ed on how conservatives should adjust to the enactment of Obamacare.

Note that providing coverage by this method will ultimately be more expensive to Arkansas as well, once the federal subsidy drops to 90%. The potential for states like Arkansas, Florida, and Texas if they go a similar route to drop the expansion at that time is sure to be a thorny issue down the line. Still, there is some upside to this, as Kevin Drum observes.

I’m a little more willing to wait and see how it works out. In particular, I happen to think this may solve a legitimate problem. Here’s the tail end of [that article in the Arkansas Times]:

Department of Human Services Director John Selig speculated that things would actually run more smoothly. “The most difficult part of the exchange was going to be people going from Medicaid to private insurance, back and forth as they went up and down [the] income line,” he said. “Now, you just keep [the private insurance company] as you go up or down. In a lot of ways this simplifies what happens on the exchange.”

This really is an issue with the Medicaid expansion, and it’s a well known one. If you’re at 130 percent of the poverty level this year, you qualify for Medicaid. If you get a raise and go up to 140 percent next year, you no longer qualify and instead have to navigate the exchanges. If your hours are cut back and you fall to 130 percent again the year after that, it’s back to Medicaid.

How big a deal is this? That’s hard to say. But it’s not a made-up issue, and it’s possible that the Arkansas approach could legitimately be better. What’s more, I’m OK with allowing states to experiment within limits. It’s the only way to find out whether or not the exchanges really are more expensive, and whether or not the Medicaid ping-pong really is a serious problem. The ideology behind this decision might be misguided, but there’s a good chance we’ll get some useful data out of it regardless.

If the Republicans are willing to consider this, I’m willing to see how it goes, too. Providing the coverage to those who don’t have it is Goal #1. If a minor sacrifice has to be made at the altar of ideology in order to achieve that goal, fine. For all of the background chatter about the possibility of a “deal” on Medicaid expansion, predicated on the federal government willing to be flexible, it should be clear by now that the feds will be flexible if the objective of covering the uninsured population is met. Florida, Ohio, and now Arkansas have all found ways to make deals with the feds. As it happens, there is now a Republican “plan” for expanding health care access, but it’s pretty darned skimpy, and even more ideologically driven.

[State Sen. Bob] Deuell said he was considering a plan that would have Texas request a waiver from Medicaid officials in Washington. The request would include asking for $50 billion over 10 years, which is about half the funding the state would otherwise get from Washington over that period to expand Medicaid under the Affordable Care Act.

The state then would use that $50 billion to cover the roughly one million Texans who don’t get Medicaid today but could if the state expanded it up to 138 percent of poverty. (138 percent of poverty equals about $31,000 for a family of four.) The state would give those one million folks the equivalent of what they otherwise would get from Medicaid, which he says is $4,800 per person in Texas.

I admit this is technical, but bear with me for a few more details:

Recipients could use that $4,800 to purchase private insurance, buy into the state health plan that legislators like Deuell use or buy into the state’s Medicaid plan. As part of this waiver, he said, the state would set up health exchanges that would allow the eligible population to shop for health insurance.

Here’s more on the Deuell concept – it’s not really developed enough to be called a “plan”.

[Deuell would] force everyone who benefits to work, even if it’s volunteer work, unless they’re disabled or stay at home parents or caretakers of the disabled. He’d force hospital districts to cut their property tax rates; and health care providers and insurers, their charges and premiums, once more of the 6 million uninsured Texans got private insurance coverage, thereby squeezing down uncompensated care. He’d force all new recipients to be “locked in” to a primary care physician — such as himself. That doc would serve as gatekeeper, and would have to flash the green light before the newly insured people could tap into care from other providers. Children now on government health care would be wrapped into new, family coverage policies. Low-income people with high deductible coverage, and who “act as if they’re uninsured,” would be able to apply the subsidies to their copays and deductibles. And Deuell would encourage healthier lifestyles by charging newly covered Texans more if they smoke or are obese.

His four-page letter, though, is more of a sketch than a blueprint. He speaks of how Texas should negotiate with the feds to use the block grant money to “form group or individual policies in conjunction with insurance companies and/or a health system. The recent joint venture of the Baylor system and Scott & White comes to mind.” But no matter how he and others debunk the federal law’s exchanges, his federal counterparts’ conservative template blithely says there will be “guaranteed access and minimum benefit standards” in the non-Obamacare exchanges. And that requires some serious regulation of health insurers, which critics say has not exactly been a Texas bragging point. (For the blithe reference, see question No. 5 on this Paul Ryan FAQ sheet.)

The “exchange” in question is modeled on the Coburn/Ryan “Patient’s Choice Act”, because of course we can’t have the taint of anything Obama-related in Texas. I see this as pretty much a non-starter, since block grants aren’t going to happen and it’s clear that maximizing coverage is not a priority. I give Deuell partial credit for at least coming up with something, however half-baked and impractical, though I will point out again that Deuell has been in office since 2003, which is to say for as long as the Republicans have had complete control of state government, and this is only being proposed just now, because the Republicans have been embarrassed by a Democratic President they hate. It’s something, in the sense that it’s not nothing, but it’s not any more than that. Call me back when they really mean it. Wonkblog has more.


“From the standpoint of looking at how Texas could possibly expand coverage for this group of individuals, it fits very well with what my philosophy is,” said State Rep. John Zerwas, R-Simonton, an anesthesiologist and former hospital executive who called the plan a “private sector remedy.”

“I don’t know if it’s something the governor would particularly smile upon,” he added, “but certainly from my perspective this would be something worth looking at.”

It’s a start.

Fifth Circuit strikes again


Right there with them

A federal appeals court ruled Tuesday that Texas did not act unconstitutionally when it moved to expel Planned Parenthood from a health and contraceptive care program for low-income women.

The ruling overturned a preliminary injunction, issued in April by U.S. District Judge Lee Yeakel of Austin, that banned Texas from enforcing rules designed to exclude Planned Parenthood from the Women’s Health Program. Yeakel found that the regulations violated the organization’s rights of free speech and association.

The 5th Circuit Court of Appeals, however, sided with Texas late Tuesday — ruling that the state had the authority to prohibit Women’s Health Program money from going to health care providers that promote abortion or affiliate with organizations that perform or promote abortions.

Officials said Texas will act promptly to drop Planned Parenthood from the program.

“We appreciate the court’s ruling and will move to enforce state law banning abortion providers and affiliates from the Women’s Health Program as quickly as possible,” said Stephanie Goodman with the state Health and Human Services Commission.

Here’s a copy of the ruling, via TM Daily Post and The Trib. First there was injunction, then the injunction was stayed, then the stay was lifted, and now it’s back. The Fifth Circuit has been quite hostile to women’s health advocates this year.

But this isn’t about women’s health, is it? I mean, the state of Texas pinky-swears that it will have a super-duper Planned Parenthood-free replacement for the Women’s Health Program up and running any day now, assuming there are any clinics left to handle it. Rick Perry and Greg Abbott say this is about abortion, so let’s take their word for it. What do Rick Perry and Greg Abbott and all the rest of them think about abortion?

Mere hours after U.S. Rep. Todd Akin, R-Mo., and an ardent opponent of abortion in almost all cases, made comments on Sunday suggesting that women’s bodies would naturally reject pregnancy in cases of “legitimate rape,” Mitt Romney and Paul Ryan released a statement distancing themselves from him. They said their administration “would not oppose abortion in instances of rape.”

Elected officials from Texas widely condemned Akin’s comments: U.S. Sen. John Cornyn released a statement that seemed to suggest Akin should drop his Senate bid; Gov. Rick Perry’s office called Akin’s words “off-base, insensitive and a distraction from the important issue of protecting life.” Akin, for his part, quickly backtracked, saying he “misspoke” in his “off-the-cuff remarks,” and adding that he understands “that rape can result in pregnancy.”

Yet Akin’s broader opposition to abortion in cases of rape is shared by many top Texas leaders. Perry, Attorney General Greg Abbott, Lt. Gov. David Dewhurst and GOP Senate hopeful Ted Cruz only support abortion when the mother’s life is in jeopardy. The position isn’t uncommon among Republicans; CNN reported on Monday night that a rape exemption is likely not part of the GOP abortion platform set to be adopted at next week’s Republican Convention in Tampa.

Perry’s stance is a relatively new one for him; he revised his position to oppose abortion in cases of rape and incest late last year on the presidential campaign trail, saying the issue had troubled him for a long time.

The difference between Todd Akin and other such troglodytes and the likes of Perry, Dewhurst, and other “pro-life heroes” is simply this: Akin et al are too insulated from reality to believe that rape of any kind can and does lead to pregnancy, and thus he is free to oppose a rape and incest exception for abortion since it won’t make any practical difference as far as he’s concerned. Perry, Dewhurst, Abbott, Cornyn, Ted Cruz, and all of the other tut-tutters who are shocked, shocked that Todd Akin would say such an impolitic thing, oppose rape and incest exceptions because they are perfectly happy to force the victims of rape and incest to carry their assailants’ pregnancies to term. They’re too slick to say it out loud, of course, but give them an opening and you can be sure they’ll take it. Paul Ryan agrees with Todd Akin. The GOP platform agrees with Todd Akin. What kind of Supreme Court justices – and Fifth Circuit Court of Appeals justices, for that matter – do you think Mitt Romney and Paul Ryan would appoint? If you want more like this, vote for them and find out.

Anyway. For now, Planned Parenthood remains in the WHP, at least until the state figures out what it’s going to do with it. Given how little they care about women’s health, that could still take awhile. A statement from Rep. Carol Alvarado is here, a statement from Melaney Linton, the CEO of Planned Parenthood Gulf Coast, is here, and a statement from Ann Johnson is beneath the fold.



Game on. You’ve probably read all you can stand to read about this by now since it was everywhere on the internets yesterday, but do read Charlie Pierce if you haven’t already – he’s the best cure for mainstream media stuffiness – and Michael Grunwald, who seems to have escaped the reality distortion field in the mainstream media regarding Ryan. I agree with Ed Kilgore that this sets up the election as a choice between competing visions rather than a referendum on the incumbent. This is also what Team Obama wanted the election to be about. Bridge players have a saying that “if both sides are playing the same suit, one side is crazy”. We’ll know soon enough who’s crazy here.

From the “Get your government out of my Medicare” files

This ought to be fun.

Across the nation, U.S. House Republicans are getting an earful from their constituents about a GOP budget proposal to overhaul Medicare, the federal health care program that insures the elderly.

The Republican plan, written by Wisconsin Rep. Paul D. Ryan as part of his sweeping budget overhaul, would turn Medicare into a program that subsidizes private health care coverage for seniors instead of directly paying medical costs as it does now. Some Republicans, unnerved by the public reception, have even begun to retreat from it.

But that message hasn’t made its way to Texas, where state lawmakers are moving full speed ahead on their own efforts to take control of — and then restructure — both Medicare and Medicaid, the joint state-federal health care program that primarily serves poor children and the disabled.

Rep. Lois Kolkhorst’s “health care compact” bill, HB 5 — which would effectively ask the federal government to give Texas and other states block grants to run Medicaid and Medicare as they see fit — passed easily out of the House, and was heard in a Senate committee on Tuesday. That’s despite Democrats’ warnings that any effort to redesign Medicare will terrify, or potentially harm, seniors and a failed attempt by Rep. Craig Eiland, D-Galveston, to remove Medicare from the Texas compact bill.

“The reason I offered the amendment is exactly because of what’s going on nationally — it’s an ‘I told you so,’” Eiland said. “Before we start messing with our seniors, let’s try to prove we can run Medicaid.”

Republicans in the state House say they have no intention of curbing services or compromising care for the nearly 3 million Texas seniors on Medicare. But they say the health care compacts under consideration by other states are all written to include Medicare, and that they must align. And they argue there’s no way to get at the country’s escalating medical inflation and spiraling health care costs without addressing overutilization, fraudulent spending and other inefficiencies in Medicare. Medicaid mostly covers children; Medicare’s seniors are far more costly to insure.

First and foremost, I rather doubt that the Obama administration is going to hand over control like this to Texas. Remember, the Bush administration denied Texas’ request for Medicaid waivers before on the grounds that the program the state had in mind wasn’t sufficient in its coverage. I suspect this is more political than anything else. Having said that, the concern in progressive circles is that all the bluster about Medicare at the national level is a smokescreen for an attack on Medicaid, which serves a much less politically powerful group and is thus much more vulnerable. As such, regardless of how the feds may react to HB5, this is worth keeping an eye on. I mean, nobody doubts that the goal here is to slash benefits, right? The point of a block grant is that it’s a fixed sum of money, so if it actually winds up costing more to provide the coverage, that’s just too bad. The state won’t pay anything beyond that. That’s the goal the Republicans are working towards.