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Will Legislature reverse course and expand Medicaid?


The once taboo subject of expanding Medicaid in Texas has been broached in recent weeks by some Republicans and GOP-friendly organizations, as the Legislature prepares to reconvene early next year.

Few topics in the state Capitol were as toxic in 2013 as expanding Medicaid as part of the Affordable Care Act, or Obamacare. Conservative leaders exploited the public’s displeasure with President Barack Obama’s health care overhaul and rejected the idea of expanding the entitlement for Texans with incomes below 138 percent of the poverty level. Those legislators said they didn’t trust the federal government to fulfill its promise to reimburse 90 percent of the cost of the expansion.

With Gov. Rick Perry leading the charge against the expansion — even as most states, including some with Republican governors, opted to expand Medicaid — there was never any chance that members of the Legislature would widen the program.

In 2013, state Rep. John Zerwas, R-Richmond, wanted to use federal dollars and a Medicaid waiver to create a new insurance program for poor Texans, but he was never able to build much support among his Republican colleagues.

“Last time, everybody was pretty reactionary,” said Zerwas, a physician. “We were playing defense.”

But with Perry leaving office in January and a new legislative session set to begin, Zerwas and his allies once again are pushing for a new program.

The difference this time is the dialogue is more thoughtful and the effort is more organized, he said.

Zerwas and other legislators had the chance after the 2013 session to go back to their districts and listen to their constituents. Many expressed interest in insuring people who can’t get coverage under the new law, he said, but many more have indicated that they want to see the already stressed, safety-net hospitals get some relief from being forced to care for so many uninsured people.

Gov.-elect Greg Abbott said on the campaign trail that he opposed Medicaid expansion, but spoke of seeking a block grant from the federal government to reform Medicaid in the state, echoing some other Texas Republicans.

In Texas, up to 1.5 million uninsured people fall into a health insurance gap. They don’t make enough money to qualify for federal subsidies to buy coverage on the federally run insurance marketplace — where consumers can compare and buy plans — and they earn too much to be eligible for Medicaid.

The Texas Association of Business, an influential group with close friends in the Republican Party, has come out again in support of expanding Medicaid, just as it did in 2013.

Bill Hammond, president of the organization, said it will take a “massive effort” in 2015 to increase coverage for Texans, but it’s a fight he is willing to take on.

“It just makes sense for us from the business perspective,” he said.

Taking advantage of the federal dollars is a common-sense way to reduce the number of uninsured people in the state, he said. Plus, the costs of caring for the uninsured are always shouldered by the people with insurance and the companies that provide it. And ultimately, many members of the Texas business community end up paying the tab, Hammond said.

A broader population of insured people also leads to better students and a healthier work force, Hammond added.

Dan Stultz, president and CEO of the Texas Hospital Association, said in a presentation that hospitals need meaningful coverage expansion.

Stultz told the Associated Press earlier this year that hospitals agree with Perry that the Medicaid program is “severely flawed,” but he also said that “without the Medicaid expansion, many will remain uninsured, seeking care in emergency rooms, shifting costs to the privately insured and increasing uncompensated care to health care providers.”

The Texas Medical Association, one of the most powerful lobbies in state government, also supports allowing state leaders to work with the federal Centers for Medicare and Medicaid Services to come up with a solution that fits Texas’ health care needs.

The association’s leaders are pushing the Legislature to create a concept, as it says on the group’s website, that “works for the state and helps Texans in the coverage gap get affordable and timely care.”

In particular, the medical association wants to grab all available federal dollars — up to $100 billion over 10 years, by some estimates — available to expand access to health care for poor Texans.

But it’s not just lobby groups that want to expand the program.

The Texas Institute of Health Care Quality and Efficiency — a panel of 15 medical professionals appointed by Perry — announced this month that it recommends the state negotiate with the federal government to channel the available federal funds to help insure the state’s uninsured population.


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