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The Battle Over Expanding Medicaid In Texas

Chris Eudaily
Texas Republicans are now trying to find a way to get federal money without going "all in" with Obamacare.

There’s a mounting effort at the Capitol in Austin to try to find a way to do something about Medicaid, the joint state and federal health program for children, the disabled and the very low income.

Early in the week there were rumors that the House GOP caucus was going to vote in favor of expanding Medicaid in line with the Affordable Care Act.

That was met with a flurry of conservative grassroots activism using social media, warning Republican state reps and leadership to forget it. In a closed door meeting, House Republicans voted overwhelming to reject the Medicaid expansion plan.

The next day there was a rally of over a thousand participants -- many in wheelchairs -- called My Texas Medicaid Matters. The group was seeking to motivate state leaders to take the federal dollars being offered to expand Medicaid in Texas.

Progressive activism about Medicaid expansion is getting more aggressive and getting in the face of the top opponent to the expansion, Gov. Rick Perry.

Eight Republican governors, including Arizona’s Janet Brewer, have struck deals with the federal government to expand Medicaid, but Perry has remained firm in his opposition. Last month the protestors followed Perry to Washington D.C. where he was speaking at a luncheon.

Our way or the highway

Meanwhile, back in Texas, House Speaker Joe Straus, R-San Antonio, is publicly calling for a way for the state to reap the benefits of expanding Medicare without triggering a revolt from the right.

He is asking House members to present a clear proposal for how Texas should reform Medicaid by developing a plan to work with the Obama administration to expand the program on the state's terms.

Rep. Brandon Creighton of Conroe, the Leader of the House's Republican Caucus, said the reason for the stalemate has to do more with finding a Medicaid solution that's not a one-size-fits-all plan.

Creighton said House Republicans are interested in block grants and waivers, which would allow the state to receive federal Medicaid dollars without accepting the Affordable Care Act.

Covering the poorest citizens

Anne Dunkelberg, associate director of the Center For Public Policy Priorities, has been leading the fight and organizing to expand Medicaid in Texas.

"It's a tremendous economic engine everywhere in the country, which is why you've seen, over the last several weeks, one Republican governor after another working with the federal government to come up with a way to approach Medicaid expansion in their state that they feel comfortable with because it's simply too many people, too good a fiscal deal for the state, and there just isn't another viable solution for getting basic coverage to our poorest citizens."

The center has this video about how low-income families in Texas survive.


Conservative holdfast

Texas conservatives are also organizing and pushing state lawmakers on the Medicaid issue. They are telling them not to give in or be swayed from their small-government principles.

John Davidson, healthcare policy analyst at Center for Healthcare at the Texas Public Policy Foundation, a conservative thinktank.

"The important thing to keep in mind is that federal funding represents a short-term influx of funds to the state. There is no guarantee that the federal government will continue to uphold its end of the bargain in the long term. The law only requires 100 percent federal match until 2017, it drops don to 90 percent by 2020, and after that there's no statutory obligation for the federal government to maintain a 90 percent match rate. I think with what we've seen with the sequester, I think we should be really suspicious about making a really closed partnership with the federal government when it comes to Medicaid."

Does it make economic sense?

So how good or bad is the deal that the federal government is offering Texas? What will those billions of health care dollars do for the state’s economy? Can Texas afford this deal? Can Texas afford not to take the deal. Texas economist Ray Perryman says that when you take off the political goggles, Texas needs to consider expanding Medicaid.

Ray Perryman is president of The Perryman Group, an economic and financial analysis firm headquartered in Waco.

"It really comes out where there is a huge economic impact -- over 10 years about $250 billion -- but more importantly, from the states perspective, the state would actually make money. For every dollar of state revenue that is put into the plan, the state itself would get more than a dollar back. We've looked at the new proposals that are surfacing now in regard to the Arkansas plan and others and we're finding exactly the same thing."

First-person take

Deborah Walker is an uninsured health care worker in Houston and was recently diagnosed with diabetes. Walker is struggling to pay for her medicine and medical supplies.

"I have to pray that I won't get sick so that I don't have to go to the doctor because in Harris County I'm on this pay-as-you-go plan with the Harris Health System and you pay so much to the doctor and so much toward your medications. If you go to the doctor and they write you three and four prescriptions, it's kind of hard for you to adjust with that... I've got to take away from my bill money to pay for the prescriptions or I can't get all the prescriptions."