The Affordable Care Act (ACA) was enacted by a Democratic President. But how, or if, certain parts of it will be available to Texans is all going to be up the the elected members of the Texas GOP. Will the health care exchange in Texas be setup and run by the state or federal government? It’s up to the GOP. Will millions of Texans now be insured because of the expansion of Medicaid? It’s up to the GOP.
It seems the first step for the GOP in Texas will be to wait until November, Texans may face federal insurance exchanges.
By Nov. 16, the state is supposed to declare whether it intends to create its own exchange or leave it to the federal government to create one. If Mitt Romney wins the election that month and can get Republican majorities in both houses of Congress, the prospect of a federally administered insurance exchange for Texans may disappear through repeal of the law.
But there’s not much time left if Texas wants to design its own exchange rather than accept the Obama administration’s approach. And that worries insurers, benefit analysts and even some conservative health economists.
Under Obama’s health care overhaul, each state would have an insurance exchange for individuals by 2014. (The law also creates separate exchanges for small businesses.) Most Texans could expect to continue to get their health care at work as an employee benefit. The individual exchange would offer markets to people between jobs, people who can’t get insurance because of their health or who work for firms that don’t offer comprehensive insurance.
Families making less than $88,000 a year would qualify for federal subsidies. The law limits the amount a family would be expected to spend at 9.5 percent of income; the amount drops to 3 percent for individuals making about $15,350.
Two years ago, the state’s Health and Human Services Commission told the Legislature that as many as 43 percent of an estimated 6.5 million uninsured Texans could qualify for subsidies under Obama’s individual insurance exchange.
That would be almost 2.8 million Texans who would qualify. The next part is Medicaid expansion. Which will cost the state a pittance in relation to how many will get insurance. And in the long run will drive down health care costs. Via the CBPP, Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion.
In short, the Medicaid expansion will significantly increase coverage at a modest cost to state Medicaid programs, and it will lower state costs for providing care to the uninsured.
It’s a good deal for getting many more Texans health insurance. And keeping them out of the emergency room saves money for everyone with insurance.
To assess the fiscal impact on states of the Medicaid expansion, one must look at more than just Medicaid, because the health reform law’s coverage expansions will reduce some state and local costs. As a result of health reform, Medicaid will essentially pay for many health services now provided to people who are uninsured. Thus, the federal government will bear a substantial share of the cost of providing health care services to people whose health care costs otherwise would be borne in part by state or local governments.
In other words the ACA could be a boon for county governments. If Perry and the statewide elected GOP don’t accept the Medicaid expansion, it may save the state money, but it will almost certainly force local governments to raise taxes. Which is just more cost shifting from the state to city and county governments.
As is stated in this article, Politics, ideology clash over expanding Medicaid, the GOP’s fight has little to do with what is best for Texas.
“It’s ideology,” said Bruce Buchanan, a political scientist at the University of Texas at Austin. “It’s stubbornness.”
Buchanan suggests Texas’ GOP leadership could be subjected to “moral pressure” if most other states participate in the expansion.
“They’re not going to admit it at the moment, because they are so opposed to the whole fundamental health care requirement,” he said.
Taking the money and expanding coverage would be the smart thing to do from a policy standpoint, suggested Rice University political scientist Mark Jones.
“It’s free money for a relatively long time period,” Jones said. “It sends money into the economy. But politically, it’s difficult.”
The GOP has never succumbed for “moral’ reasons and they won’t start now. But this also makes great economic sense.
But things may change.
Patricia Gray, who represented Galveston in the Texas House from 1992-2003 and now is special assistant for health policy at the University of Texas Medical Branch in Galveston and an adjunct professor at the University of Houston Law Center, said state leaders may change their minds, especially if Congress allows more flexibility.
“Texas sends more money to Washington than it gets back,” she said. “If we don’t do this, we’re subsidizing New York’s Medicaid expansion, and California’s Medicaid expansion.”
That’s one argument.
Rep. Garnet Coleman, D-Houston, will make another.
“If history tells us anything, it’s that Texas won’t do the Medicaid expansion,” he said. “But I have to argue the consequence to Texans if we don’t.”
Coleman, who served on Obama’s Working Group of State Legislators for Health Reform, estimates the expansion could bring the state $189 billion in federal funding over a decade, money spent in part to pay doctors, nurses and other health care workers.
“If we don’t do the expansion based on ideology, it has a real economic impact,” he said.
And he noted that the discussion has just begun.
“I’m not nervous about it yet,” Coleman said.
This won’t happen, no matter how much sense it makes, because this is about the GOP making sure the other side loses. No matter how much benefit it would bring to the people of Texas. This is about the GOP’s “..single most important thing [they] want to achieve“. And they could care less about the 30 million Americans that will get health insurance as a result. Whether uninsured Texans get health care is up to the Texas GOP. Let’s hope the uninsured remember who is to blame if they don’t get health insurance.
Kuff, What will Texas do now?
Dems Copy Romeny: Individual Mandate Is About Punishing ‘Freeloaders’
GOP Governors May Turn Down $258 Billion In Obamacare Funds, Leave 9.2 Million Americans Uninsured
[UPDATE]: More from Digby.
As I’ve said from the beginning, the moral heart of the ACA is the medicaid expansion (and the banning denial of pre-existing conditions.) This was the big payoff for liberals in this thing. The rest is an experiment in using “markets” to make it “more affordable” for middle class people in the private insurance market. (Like me.)Hopefully the subsidies and exchanges will work and many people will be better off. Certainly they’ll have better preventive coverage and no lifetime limits, so that’s something.
But expanding Medicaid to cover more than 10 million people, mostly working poor, who cannot afford to buy health insurance at all was the real liberal accomplishment of the Act, although some of us predicted from the beginning that it would also be the most vulnerable. (Hell, even the Obama administration has been willing to cut existing Medicaid, so it’s hard to see how this won’t be on the chopping block going forward.)
In any case, this is the one piece of the ACA that truly offends the right wingers. It actually is government paid health care, after all. I think Kilgore is right and that it’s not a given that these governors will accede to the federal law on this without a long drawn out battle.
As I said on the morning of the decision, there will be those who follow in the footsteps of their forebears: “no health care now, no health care tomorrow, no health care forevuh!” States’ rights were invented for people like this.