After the Election: Texas At A Crossroads With 'Obamacare'

Texas should get ready to jump in and take full advantage of Obamacare. That’s what some public health advocates say now that the election is over.

Ken Janda is president of Community Health Choice, a not-for-profit HMO that covers children on Medicaid. It operates in 20 counties in southeast Texas.

“We need to stop talking about that it’s going to go away and it’s going to be repealed and replaced. We need to live with it and do what’s best for Texas, given that this is the federal law and the political landscape isn’t going to change in Washington in the next four years.”

Right now Medicaid in Texas mostly just covers children and pregnant women.

But if Texas decided to expand the program to low-income adults, perhaps 1.7 million uninsured people would be covered. (Click here for a presentation on Obamacare’s impact on uninsured Texans from the Center for Public Policy Priorities.)

The expansion of Medicaid is the only part of Obamacare that the Supreme Court said was optional for states.

A Perry spokeswoman, Lucy Nashed, says the governor still rejects the option and hasn’t changed his mind.

“It’s not responsible government and it’s not fiscally feasible and it’s not something that Texas is interested in doing, expanding a government program that is already overburdened and overwhelmed is not a solution.”

But the Legislature may push Perry to reconsider when it convenes in January.

“The door is not closed.”

State representative Garnet Coleman is a Democrat from Houston. He says the state should expand Medicaid, because the federal government will pay for most of the cost.

“I think it’s very hard to turn down between $100 and $150 billion dollars over ten years.”

Coleman hopes the governor might negotiate on a compromise plan: bring more adults onto Medicaid, but perhaps require co-pays or co-insurance.

Ken Janda will also be pushing for a compromise in January.

“You could stage it if you were worried about doing the whole population at one time and say ‘Okay, maybe year one we do just the parents of the Medicaid kids, because we already know their income levels. We have them sort of in the system already. And then do the childless adults, do that a year later or two years later. So that you don’t have this big wave of pent-up demand that might swamp the safety-net health system.”

Many states also need to decide whether to set up a health insurance exchange, which is an on-line marketplace for people to shop for individual coverage.

Nashed says Governor Perry also has no plans to do that.

If the state doesn’t set up its own exchange, however, the federal government will do it for Texas.

From the KUHF Health and Science Desk, I’m Carrie Feibel.

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