This ought to spark some interesting conversations.
It’s constitutional – deal with it
Two Democratic lawmakers called Wednesday for Texas leaders to explore a new type of Medicaid waiver that they say could provide health coverage to many of the state’s millions of uninsured.
The waiver, characterized by the legislators as the kind of block grant that Republicans favor, is not predicated on a Medicaid expansion and would allow Texas to avoid many provisions of the Affordable Care Act unpopular with the leadership in the Legislature – including the individual and employer mandates. The waiver, known as 1332, takes effect in 2017.
“Based on where we are now in this state, (the waiver) probably is the best chance or possibility of an agreement… toward coverage expansion,” Rep. Garnet Coleman, D-Houston, said at a news briefing with Sen. Jose Rodriguez, D-El Paso.
In a letter sent to colleagues earlier this week, Coleman added that the waiver must not reduce access to care, increase costs to the federal government, or make insurance more expensive than under the current law. The waiver effectively tells states that “if they know a better, more efficient way to provide health care, then have at it,” Coleman wrote.
[…]
Arlene Wohlgemuth, executive director of the Texas Public Policy Foundation, a conservative Austin think tank, said she had spoken to Coleman Wednesday morning about developing a 1332 waiver aligned with the principles laid out by the foundation.
“Of course, we are interested in reform of the program that truly gives flexibility to the states to provide for better health outcomes in a way that is affordable for the taxpayer,” Wohlgemuth said. “Thus far, the federal government has been unwilling to give exception to the requirements in the Social Security Act (the law that embodies Medicare) that have hamstrung true reform. We are interested to see what Representative Coleman has in mind through a 1332 waiver.”
Vivian Ho, a health care economist at Rice University’s Baker Institute for Public Policy, said there are so many unknowns about the waiver that it’s hard to know what to conclude.
“I can’t believe any waiver is the answer unless the state agrees to some sort of Medicaid expansion, and I don’t see how 1332 is going to help that,” said Ho. “It’s unclear how much money it would actually supply and whether it would provide access to tax credits for people below 100 percent of the federal poverty level.”
Ho added that block grants are a questionable idea unless the amount of money increases with population growth, given Texas’ continual migration and growing uninsured pool.
But Ken Janda, CEO of Community Health Choice, a nonprofit health care organization, called the suggestion “a very good idea” and said it “definitely seems worth talking about.” He said it answers a lot of concerns raised about Medicaid expansion and presents a possible solution to the health-care crisis that’s caused the closure of some private hospitals and threatens the existence of safety-net hospitals.
Rep. Coleman and Sen. Rodriguez filed bills this session to pursue this waiver and the reforms that it would allow. Here’s the letter they sent to fellow legislators outlining what this waiver would mean. Here’s the key bit:
However, there is a catch – the waiver must not reduce access to care, increase costs to the federal government, or make insurance more expensive than it is under the current law. The 1332 Waiver effectively tells states that if they know a better, more efficient way to provide healthcare, then have at it. Texas should take the federal government’s offer and consider ways to reform both Medicaid and private marketplace coverage in this state.
Basically, this is a put-up-or-shut-up challenge to Greg Abbott and the Republicans that have dug their heels in so fiercely against Medicaid expansion, the insurance exchanges, and every other aspect of the Affordable Care Act. You think you can do better? Prove it. My guess is that this will be roundly ignored, since Abbott and Rick Perry before him have shown zero interest in doing anything about the millions of uninsured Texans. Abbott appears to be perfectly willing to set fire to billions more dollars in his continued quest to not do anything about health care. But who knows, maybe someone will rise to the challenge. I agree that it’s at least worth exploring to see what might be possible.