Forgive me for tempering my excitement about this, but it’s not that much to be excited about.
It’s constitutional – deal with it
Despite opposition from conservative Republicans, the House Appropriations Committee on Tuesday advanced a proposal that would reform Medicaid by allowing the state to request a block grant from the federal government and expand coverage to low-income Texans.
“This is not an expansion of Medicaid — this is the creation of a new program that leverages our private sector,” said Rep. John Zerwas, R-Simonton, the author of House Bill 3791. Members of Appropriations voted 15 to 9 to move the legislation out of committee and continue debate on the House floor.
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The revised bill has four parts: It outlines what the block grant would look like; identifies Medicaid reforms that Texas could implement already, such as cost-sharing requirements and co-payments; sets up a separate program to potentially draw down federal financing to help individuals at or below 133 percent of the poverty level find private market coverage; and sets up an oversight committee for both programs.
Trail Blazers fills in some details.
[HB 3791] would, among other things, attempt to appease hospital leaders and urban county judges and commissioners who are irate over state GOP leaders’ apparent determination to walk away from about $100 billion in additional federal funds that Texas could draw down over the next decade. The money would flow to Texas if it expands Medicaid to more adults — a move that would pull forward to government coverage more than 400,000 poor children who are already eligible but haven’t enrolled. Texas would have to put up just more than $15 billion of its money through 2023.
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The bill by Zerwas, though, would at least force Team Perry to go through the motions [of negotiating with the Obama administration]. Governors in other states have reached some deals with federal Medicaid czars, some involving private insurance subsidies as an alternative to traditional Medicaid.
Zerwas’ measure says any Texas-specific premium assistance plan must include features near and dear to conservative lawmakers’ hearts. The deal must include outcomes-based provider reimbursements, “meaningful cost sharing requirements and wellness initiatives,” tailored benefits, nudges for existing Medicaid recipients to take the premium subsidies and for people to accept employer-offered coverage — and of course, health savings accounts, which allow patients to spend from a pool of dollars that rolls over at the end of the year and they keep.
“I understand the kind of political radioactivity around this particular bill,” Zerwas told colleagues. “But I … am hearing and many of us are hearing especially from our county and local governments that this would have a profound effect not only on the provision of care [but] some of the collateral effects are its potential to reduce property tax rates” charged by county hospital districts, such as one in Dallas County that supports Parkland Memorial Hospital, he said.
Rep. Stefani Carter, R-Dallas, praised Zerwas’ hard work but said she had to vote no because his bill needs more vetting. Carter questioned how many of her constituents would benefit.
Democrats weren’t thrilled by the laundry list of conservative “health care reforms” in the bill but went along.
“Cautiously, yes,” said Rep. Helen Giddings, D-Dallas, announcing her vote.
What Rep. Giddings says. As with the Arkansas option, this is a Rube Goldberg monster whose complexity is a direct result of Republican intransigence to the obvious solution. It’s a kluge on top of a kluge that starts out by wishing for a pony – block grants – then resigns itself to coming up with something that won’t require the state to give up on billions in funding. It’s still better than nothing, which once again gives you an idea of how awful the status quo is. Better Texas has more.
On a side note, the House also instructed conference committee members to not expand Medicaid in the budget reconciliation negotiations. Which they couldn’t do anyway, since you can’t use the budget to make new law, but never mind that. The Republicans in the Legislature are wise to Barack Obama and his sneaky tricks, yes they are. Whatever happens from this point, it needs to happen quickly because time is running short in the session. The issue could be picked up again in a special session, but only if Rick Perry wants that to happen. Getting it done now is the best bet by far.