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Republican Demands To Change Texas Medicaid Cause Confusion And Skepticism

Some health advocates and Democrats say they’re confused by the latest proposal from Texas Republicans to reform Medicaid, including their ideas such as co-payments and late fees for missed appointments.


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Medicaid provides health care for the poorest of the poor in Texas, mostly children and pregnant women. The costs are split between the state (42 percent) and the federal government (58 percent).

But Medicaid is increasingly coming under political attack in Austin, and is a favorite target for conservatives who claim the program is “broken.”

Earlier this week, Republican legislators sent the federal government a letter requesting lots of changes in the program.

From left to right: State Senator Charles Schwertner and Lt. Governor Dan Patrick in a recent press conference.

For Lt. Governor Dan Patrick, the reason is money: the state is set to spend more than $24 billion in the upcoming budget on Medicaid.

“One of the largest cost drivers in our state budget is Medicaid. The cost trajectory in the current program is quite simply unsustainable,” Patrick said.

State Senator Charles Schwertner, a Republican and a doctor, joined Patrick at a press conference to announce the proposed reforms. He pointed out that the Medicaid rolls in Texas have doubled since 2002. He says the state could save money by imposing restrictions on people on Medicaid, “solutions like health savings accounts, copayments and work requirements for able bodied adults.”

But Democrats and many health advocates scoff at those ideas. First of all, many of the ideas aren’t allowed by law, and so Texas would have to get a legal waiver or even get Congress to change the law. Secondly, Democrats said those ideas don’t make sense because 75 percent of Texans who are on Medicaid are children. The rest are pregnant women, poor seniors and disabled people.

“This is a non-starter,” said Garnet Coleman, a Democratic state representative from Houston.

“You’re going to tell a child they have to pay a co-pay at the emergency room? These are poor people,” he added. “You know we don’t like to say that, but these are people who don’t have a lot of money.”

Some health advocates predicted the demands from the Republicans will go nowhere. But they also wondered if it might indicate a willingness on the part of Republicans to at least talk with the federal government about expanding Medicaid to uninsured adults.

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“We would love for it to be the beginning of a conversation about how we could cover our uninsured working poor adults. That would be great,” said Anne Dunkelberg, associate director at the Center for Public Policy Priorities in Austin, which advocates for low-income Texans.

Dunkelberg pointed out that some of the Republicans’ demands look quite similar to demands from other Republican-led states that did eventually end up expanding Medicaid to more adults.

Schwertner did not return a request for comment, but he indicated at the press conference that he was interested in any expansion unless the federal government agreed to all the demands for the current program first.

“To be clear, until we receive the kind of federal flexibility we’re calling for here today, the kind needed to fundamentally reform our existing Medicaid program in a way that preserves it for our most vulnerable Texans, any expansion of Medicaid in Texas is simply not worth discussing,” he said.

That was disappointing news to many in Texas, such as hospitals and business groups. The CEO of the Harris Health System, which is facing a $14 million budget gap, has said previously that could be easily plugged if Medicaid in Texas were expanded to cover more adults.

Elena Marks, CEO of the Episcopal Health Foundation in Houston, said Republicans in Texas are missing the big picture.

“The reason that there has been a sharp increase in the number of people enrolled in Medicaid is because there has been a sharp increase in the number of poor people — particularly poor children — in Texas,” Marks said.

“If you really want to reduce the cost of Medicaid, we need to reduce those who are living in poverty,” she added.

Aaron Albright, a spokesman for the federal government’s Centers for Medicare and Medicaid, said in a statement that the government is willing to work with any state to make some changes to Medicaid, and it has in the past. But any changes have to include “key consumer protections” that are consistent with the law, including the Affordable Care Act.


Medicaid Letter From Texas Senate Republicans to President Obama


Medicaid Letter From Texas Senate Republicans to President Obama (PDF)

Medicaid Letter From Texas Senate Republicans to President Obama (Text)