There are a few things to keep in mind regarding Gov. Rick Perry’s announcement yesterday that he would turn down the federal Medicaid expansion in Texas, as a result of the Affordable Care Act (ACA). The main thing is that nothing has actually been decided yet. And that a certain amount of this is just political posturing, his attempt to stay relevant, for the November election.
If President Obama is reelected there’s not chance the ACA will be repeal. And ever hard core GOP partisans acknowledge that, no matter who is elected in November, the ACA will be very hard to repeal. Likely GOP nominee Mitt Romney stated that he wants to keep what’s in it, he just doesn’t want to pay for it. The GOP will fight this, tooth and nail, as they’ve historically done with landmark legislation. It takes time, years even, to get controversial laws like this implemented. A few excepts from a Melissa Harris Perry show from July 1st.
Now, that`s three years after the Supreme Court ordered southern states to move with quote, “all deliberate speed” to desegregate public schools. Now, the affordable care act line is more specific. States have until January 1, 2013 to demonstrate by the department of health insurance services that their exchanges, the marketplace where is customers can shop around for insurance, will be up and running next year.
The governor`s threats of delays now as they did then, have very real implications for the lives and the liberty of American people. By 1964, for example, a full ten years after brown, less than two percent of black children in the south attended desegregated schools. And the health of individual Americans and the already astronomical cost of caring for the uninsured can`t afford the cost of that kind of delay today.
But there is a cruelty, in not just southern governors, but governors like Kasich, Walker, and the governor of Florida, Rick Scott, in turning down federal funds[...] But on this, it`s just putting lives on the balance for ideological reasons.
I also think this decision and I defer to the constitutional experts here, was crafted, the finesse, it still puts limits on the federal government and that relationship between the government and the states is still up for
grabs, though the immigration decision was interesting, because there was very clearly the federal government has the prerogative in the immigration area, so I think it`s a very fluid moment, and last point on the brown versus board, it will take movements, it will take movements, fused with court decisions, to bring about the real progress in this country. We saw it with the civil rights movement, having to push years after brown to make real the promise of that decision and I think that will be the case with this.
That’s the point, change doesn’t come easy, and this is just another step in a decades long process of making sure all Americans have health care. As FDR referred to it in his Economic Bill of Rights – The right to adequate medical care and the opportunity to achieve and enjoy good health.
What Perry and the wing nuts are screeching about it ideological, it must be kept in mind that Texans will pay, whether he takes the federal money or not, it’s just cheaper if Texas takes the federal money. Because Perry turning down the money hurts hospitals, and shifts the cost from federal and state government, to local governments, Perry’s rejection of Medicaid expansion could burden local taxpayers.
Many opponents had pinned their hopes on victory in the courts and now hope Republicans can sweep this fall’s elections and repeal the law.
“We’re just not going to be a part of … socializing health care in the state of Texas,” Perry told Fox News.
Parkland Memorial Hospital, which treats many of the North Texas region’s uninsured patients in its emergency room, said Perry’s resistance to the proposed Medicaid expansion won’t stop the flow of indigents seeking care at safety net hospitals.
“If our state is going to turn away hundreds of millions in federal funds, we are eager to see what our leaders will propose to replace them,” the Parkland Health & Hospital System said in a written statement. The system said that last year it provided $605 million in uncompensated care.
Dan Stultz, an internist who heads the Texas Hospital Association, said Medicaid offers only paltry payments to providers, but having uninsured people flock to emergency rooms for care simply shifts costs to those with insurance. It also places more burdens on the county property owners whose taxes support hospitals such as Parkland.
“With a strained state budget, it’s hard to imagine addressing the uninsured problem in Texas without leveraging federal funds, which will now go to other states that choose to expand their Medicaid program,” Stultz said.
Houston neonatologist Michael Speer, president of the Texas Medical Association, said he’s especially worried about uninsured adults under the poverty line who were intended to be added to Medicaid and may not qualify for subsidies to buy private plans.
That sets up a very good set of issues for Democrats to run on in Texas. To fight to make sure the almost 2 million uninsured Texans get insurance, and to keep the GOP from raising local property taxes, by accepting the federal Medicaid expansion.
Another issue to keep in mind is that the hospitals, the insurance corporations, and the drug corporations we’re all on board with the ACA. They know Medicaid is being expanded because it’s the least expensive way to get almost all Americans insured.
Unfortunately logical and sound fiscal arguments aren’t the most effective ways to sway enough people. But maybe the utter cruelty of rejecting health care coverage for so many that don’t have it. Especially those who need it the most.
The provision that Perry wants the state to reject would add to the state’s Medicaid rolls more than 1.5 million poor, childless adults who are currently ineligible, plus as many as 300,000 pregnant women, children and extremely poor parents who already qualify but aren’t enrolled.
Fortunately it’s not just up to Perry, but it will take many from the, “let him die!” Party to join with Democrats to keep this provision alive. The legislature can still “assert itself”, though unlikely, on this issue.
Legislators could attempt to buck Perry on the issue next year, though it’s unlikely enough other Republicans will want to do so.Either way, Medicaid — one of the largest parts of the state budget — will again be a major issue. Last year, lawmakers helped bridge a $27 billion shortfall by underfunding Medicaid between $4 billion and $5 billion of state funds. They’ll have to pay the tab in 2013, even though state finances are expected to again be tight.
Rep. Garnet Coleman, a Houston Democrat who is a leading health policy writer, said Perry “chose the policy that’s best for him politically” but ignored the plight of poor adults, many suffering from diabetes, cancer and mental illness.
“The governor said it’s better to follow his ideology and throw those folks under the bus than to provide health coverage that the state of Texas would pay zero for, at least for the first three years,” Coleman said.
House Speaker Joe Straus, R-San Antonio, said he agrees with Perry that the state could offer bare-bones health coverage more efficiently than the federal government.
However, Straus said the biggest problems in U.S. health care originate with the federal tax code. Federal income taxes encourage employer-provided coverage, which keeps consumers from having “skin in the game” and being prudent purchasers, he said.
“The Legislature will have a say in this once we know past November who is in the federal government making decisions,” the speaker said.
The reality is that it’s going to take a movement, sustained pressure, over the course of years to get all Texans the health care that is their right.
Kuff has a great rundown of the timeline and reaction across Texas to Perry’s decision, No Medicaid expansion for you!