Hearing highlights Medicaid expansion rift
By Chuck Lindell
Medicaid expansion got its first Capitol hearing Friday, with new numbers revealed and deep divides further exposed between Republicans and Democrats in the Texas House.
But most of the action on Medicaid expansion continues to take place in private meetings among leading Republicans, including members of Gov. Rick Perry’s office, as they search for a politically palatable way to negotiate concessions from the federal government. The primary goal is to insure more low-income Texans without significantly expanding a Medicaid program they consider to be bloated and unsustainable.
Against that backdrop, the House Appropriations Committee hearing had an anticlimactic feel, leaving one key Democrat to question its purpose.
“I just need to know where we’re going,” said Rep. Sylvester Turner, D-Houston.
“If this hearing is to put information before us so we can design something in a positive way … then I am more than willing to take the time,” Turner said. “But if this meeting is only for informational purposes so we can say you all came, you spoke, we heard, thank you very much — and nothing is going to move forward — then I got that, and I’m through with it.”
Kyle Janek, head of the Health and Human Services Commission, which administers Medicaid, assured Turner that his agency is not crafting a Medicaid expansion plan, nor would it do so without direction from the Legislature.
On Friday, Rep. John Zerwas, R-Richmond, said he filed a bill giving Janek authority to negotiate with President Barack Obama’s administration to find a “solution for expanding this Medicaid program in a way that would be suitable to Texas.”
House Bill 2791 provides general instructions, such as building a program that requires patients to take greater responsibility for their health care, including co-pays and deductibles. But the bill is designed to be fleshed out in the coming months, he said.
“It is intended to try to get some movement going on this. We know the current Medicaid program is not going to be the solution, we are quite clear on that,” Zerwas said. “Now have the opportunity to build something out of that bill if we can get some agreement on what this program should look like.”
The private talks among Republican leaders are partly in response to pressure tactics being applied by Medicaid supporters who argue that, for a minimal investment, Texas can insure more than 1 million low-income people and boost its economy.
During Friday’s hearing, the Legislative Budget Board said that if Texas opted to expand Medicaid as proposed by the Affordable Care Act, the state would spend $900 million to receive almost $19.5 billion in federal money from 2014-19.
Turner said he feared a backlash in his district if Texas turned down a roughly 20-to-1 return on investment.
But Zerwas warned that with only one-third of Texas doctors accepting new Medicaid patients, expansion would short-sightedly plow another million patients into an already stretched system.
“The numbers, they’re dramatic, certainly. But when you really dive deeply into the consequences … I think that is something that will severely compromise the Medicaid network,” he said.
Friday’s hearing came as Gallup released a 2012 poll showing that Texas had the nation’s highest rate of uninsured citizens, with 28.8% of adults lacking health care coverage. The Texas uninsured rate has topped the nation every year since the poll began in 2008, Gallup said.
The second-highest rate, in Louisiana, was 24 percent.