Is there a way forward on expanding Medicaid in Texas?

It’s a little hard to know what to make of this.

It’s constitutional – deal with it

The Affordable Care Act is the federal law that Texas Republicans love to hate, but one top lawmaker says expanding health care for the working poor could happen if federal authorities are willing to strike a deal.

Republican Sen. Jane Nelson, chair of the Health and Human Services Committee, said she hopes the Centers for Medicare and Medicaid Services will allow Texas to receive $27 billion to expand Medicaid. But she said the key is to allow lawmakers to develop a Texas-specific program that will not blow the state’s budget.

“I am still open to anything that will allow us to have the flexibility that we need, and that will also give us the assurance that it’s not going to put us deeper in debt,” Nelson told The Associated Press in an interview.

[…]

Gov. Rick Perry has rejected the Affordable Care Act as an affront on state’s rights and said he wants the federal money with no strings attached in a block grant. The Perryman Group, an independent economic consulting company, estimated that Texas will miss out on $90 billion in increased economic activity and leave at least 1.5 million people uninsured if it does not expand Medicaid.

Nelson said a block grant was not the only way to reach a deal. She said a waiver that would allow the state to develop a tailor-made program within certain federal boundaries might be enough.

[…]

Nelson is among those who want to require some recipients to contribute toward their health care costs — such as paying income-based premiums or co-payments — something federal authorities have until now have rejected under Medicaid. She said Medicaid can also be made more efficient.

Last week Nelson announced legislation intended to make it easier to identify and punish those who defraud the program.

“We’ve got to address these root problems before I will support expanding it,” Nelson said.

Nelson identified Rep. Garnet Coleman, D-Houston, as a key player in working toward a deal with federal officials. Coleman has said he supports a limited requirement for some Medicaid patients to pay part of their health care costs, adding that he believes a deal is possible. Health and Human Services Commissioner Kyle Janek has said his staff is working with federal authorities to see what’s possible.

I don’t know where that $27 billion figure cited by Sen. Nelson comes from. The number usually thrown around is $100 billion in federal funds for the first decade of expansion. If I had to guess, I’d say the $27 billion is for the first two or three years when the feds are picking up all of the tab; it goes down to 90% reimbursement after that. It would have been nice for the story to be more clear on that. As for the Perryman study, see here for the background.

Beyond that, it’s not clear what kind of plan Nelson has in mind. This is the first I’ve heard of this, and there’s no detail in the story to indicate what Nelson’s basic idea is. It’s true that the Obama administration has been flexible in working with the states on matters relating to the Affordable Care Act, but such flexibility only goes so far. What is the state willing to do to be in compliance with the law? If Rep. Coleman really is on board with this, then I have some optimism that a deal can be made, but let’s get some information first. And unless part of the plan is to get Rick Perry’s assurance that he won’t veto whatever bill gets passed, it’s all a waste of time.

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