Texas Wants More Medicaid Control
CORRECTION: a statement from Dunkelberg on how local healthcare districts would react to Gov. Perry’s stance on Medicaid expansion was mischaracterized. She does not think the local districts will force expansion, but does expect them to work together to figure out some way to get the federal dollars being offered with expansion.
The Texas Legislature will focus on the state’s Medicaid program the moment the 2013 legislative session starts because lawmakers underfunded the program by a few billion dollars in 2011. What the state does may come down to the Affordable Care Act – and who ends up being President.
If President Obama wins a second term and the Affordable Care Act stays in place, then the debate swings to whether Texas will join in an expansion of Medicaid. Gov. Rick Perry says Texas will opt-out of that expansion. But Anne Dunkelberg thinks the state’s largest counties, which have the most to gain monetarily from joining the program, may join together to finds a way around Perry’s expansion roadblock. Dunkelberg is with the Center for Public Policy Priorities, a progressive state policy think-tank.
“I don’t see them doing an end run,” Dunkelberg said. “I do see them potentially coming together and trying to figure out if there is a way outside of the basic state budget general revenue system that they can come up with the rather modest, less than a billion dollars a year, that the state would need to do this expansion.”
Conservatives hope a victory for Governor Mitt Romney would be the end of the ACA. But it could be the beginning of new Medicaid block grants. Arlene Wohlgemuth is with the conservative Texas Public Policy Foundation. She says multiple states have been asking the federal government for the freedom to spend Medicaid dollars the way each state sees fit.
“Governors are saying, ‘We can do a better job for our population than what you’re doing with this straight jacket that we have coming from Washington,’” Wohlgemuth said. “Our research shows that we can deliver better care for more people if we were just given the flexibility to design a program for Texas.”
She says one example of block grant savings would come from instituting a sliding scale that would have families making modest co-pays for coverage based on their income.
“We can save so much money and get the most money to those who need it the most,” Wohlgemuth said. “It’s so common sense that everywhere except Medicaid we’re using it. So it’s time for Medicaid to catch up with that public policy.”
No matter who wins, you can bet any future healthcare debates will include discussions on abortion. It is a topic not directly tied to the Affordable Care Act, but one that Dunkelberg says can hamper policy discussions.
“When arbitrary issues become these enormous, symbolic, philosophical, hot-button issues in the political debate, policy stops being made in the middle where it probably belongs,” Dunkelberg said. “And you stop having practical discussions about how you really govern and how you really create good public health policy.”
But first, lawmakers will need to pass a supplemental budget in early 2013. Without an infusion of about $4 billion, the Health and Human Services Department is expected to run out of money for its Medicaid programs by April.