03.04.13
Trying to find a way in
When it comes to accepting the Medicaid expansion in Texas the GOP’s stance has definitely changed. While they continue to say they’re against it, their rhetoric has changed. It seems as if they’re trying to find a way in, instead of trying to justify not getting in. Like this report from today’s GOP House caucus.
House Republicans on Monday agreed not to expand Medicaid as called for under the federal Affordable Care Act — but left the door open to doing so if the Obama administration grants Texas enough flexibility.
They’re getting leaned on by business, especially the hospitals, and it’s a really good deal for Texas. And the more it’s in the news, and the more people hear about it, the more they like it. Survey: Majority of Texans Support Medicaid Expansion.
A voter survey conducted by the Texas Hospital Association adds to the growing chorus of statewide support for Texas to expand its Medicaid program. According to the poll, 54 percent of voters said the State of Texas should participate in the expansion of Medicaid. After learning more about Medicaid expansion, 59 percent responded favorably.
What a deal might look like is put forth in this article, Somewhere in Texas is Medicaid middle ground.
Sen. Tommy Williams, chairman of the Finance committee, is inching his way in that same direction (see his related commentary).
It becomes a crucially important question for Texans whether there might be common ground between what these senators are thinking, what Perry is vocally insisting and what federal Medicaid officials will allow.
Go beyond the sound bites, and there is more to what Perry has said.
In July, the governor sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius saying Texas has “no intention” of joining in Medicaid expansion under Obamacare. But a news release about his letter also stated what he wants to do to expand healthcare in Texas.
Topping the list is “the allocation of [federal] Medicaid funding in block grants so each state can tailor the program to specifically serve the needs of its unique challenges.”
In other words, give us billions of federal dollars and back away. It’s too much to expect the Obama administration to go along with a “no strings attached” approach. But there might be another way.
“As a common-sense alternative, Gov. Perry has conveyed a vision to transform Medicaid into a system that reinforces individual responsibility, eliminates fragmentation and duplication, controls costs and focuses on quality health outcomes.”
What does that mean? Almost anything Perry wants it to mean. But it is important that he thinks about alternatives.
“This would include establishing reasonable benefits, personal accountability and limits on services in Medicaid,” the news release said. “It would also allow co-pays or cost sharing that apply to all Medicaid eligible groups — not just optional Medicaid populations — and tailor benefits to needs of the individual rather than a blanket entitlement.”
That means he would go for a plan that might not have all the benefits or services as today’s Medicaid and includes “personal accountability.” That gets further explanation in the next sentence: It means “co-pays or cost sharing.”
“Tailored benefits” means some people might qualify for some Medicaid benefits but not all.
Some elements of Perry’s alternative might even be acceptable to strong Obamacare proponents as a way to get expansion going (see related commentary from Scott McCown of the Center for Public Policy Priorities).
The case for getting Medicaid coverage for more Texans is not hopeless. Much could happen during the current legislative session. But if it does, it’s not likely to be Obamacare all-or-nothing.
Texas has received important Medicaid waivers in the past. The focus now, as in all contentious public policy-making, must be on middle ground.
As stated before, however the GOP wants to rationalize it is fine with me, as long as they get around to accepting the Medicaid expansion.