Health Care Ruling: What Comes Next for Texas
With the Supreme Court’s opinion on the Affordable Care Act settled, the conversation shifts to the states and implementation of the law. In Texas, that has lawmakers and health care advocates focused on two specific provisions of the law.
The first one is the creation of a state health insurance exchange to help people find private insurance coverage. Each state has to have one set up by January 2014.
But if Texas isn’t ready, the federal government will step in to put the system in place, according to Anne Dunkelberg with the Center for Public Policy Priorities, a progressive state policy think tank.
“So there’s not an issue that there will not be an exchange in Texas,” Dunkelberg said. “The only question is whether in January 2014 when coverage starts it’s going to be initially a federal exchange or whether the state will have it at the outset.”
As of June 5, only 13 states either already had an exchange or had authorized an exchange through legislative action or executive order. A bill to create an exchange in Texas died in the 2011 legislative session.
Lawmakers can try again in 2013, or Gov. Rick Perry could create one through executive order.
The second major part of the law for Texas is the mandatory expansion of Medicaid. That provision is also set to take effect in 2014. But thanks to the Supreme Court, states can now opt out without worry of punishment in the form of reduced federal Medicaid dollars.
“This could be one of the tricky parts,” said Michael Speer, president of the Texas Medical Association. “Texas can continue its current Medicaid program. The federal government can ask it to expand the program, and that’s now constitutional. But the state can refuse.”
Health and Human Services Commission spokeswoman Stephanie Goodman says the agency will wait for guidance on what to do.
“Our assumption is that if the states are given the ability to opt in or out to the expansion, that that’s the kind of change we would certainly need legislative direction on,” Goodman said. “And the timing in this case means the Legislature has time to come back and weigh in on that, since the expansion wasn’t scheduled until 2014.”
HHS Commissioner Tom Suehs said in a statement Thursday that he was pleased that the ruling “gives states more ability to push back against a forced expansion of Medicaid.” But Goodman says that doesn’t mean Suehs opposes expanding coverage.
“He really feels like you have to reform Medicaid before you expand it,” Goodman said. “And we’re working on those reforms, and we’ll continue to do so. But also that it should be a state decision. And in Texas that really means a legislative decision. So we’re very pleased that it’s back in the hands of our Legislature.”
Rep. Lloyd Doggett, D-Austin, isn’t very happy about that. He has little faith the Republican-led Legislature will act quickly to implement the health care law.
“Gov. Perry will be looking for every way possible to weaken the law in Texas no matter what happens in the rest of the country,” Doggett said.
He may not be far off there. A Perry spokeswoman told KUT yesterday the governor has “no interest in fast-tracking any portion of this bankrupting and overreaching legislation.”