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Washington’s expanded Medicaid: not right for Texas

By Texas State Rep. Brandon Creighton, R-Conroe

In an effort to pave the way for the Affordable Care Act, President Obama’s administration is proposing a significant expansion of Medicaid. The program, as written, is bad for Texas and bad for Texans.

In March, the House Republican Caucus, which I chair, voted overwhelmingly to reject the federal health care law’s proposed expansion of Medicare. While the proposed program could generate significant healthcare dollars for the state initially, it would expand an inefficient and unfair program that would eventually overwhelm our Texas state budget, costing taxpayers more in the long run.

Rejecting Medicare expansion was not an easy decision. But faced with a short time frame and limited data about the reality of what such a program would do to our economy, the Texas Legislature was faced with one of the biggest decisions of our generation – and one that would impact generations to come.

The proposed program would add poor adults to the existing M e d i c a i d state-federal p r o g r a m. W i t h nearly 6.2 million residents or 24 percent of adult Texans having no health insurance, the goal of providing insurance coverage to those has merit. But the methodology is fiscally irresponsible for Texas.

While the federal government would provide funding for such a program initially, the proposed legislation would begin shifting a significant amount of financial responsibility back to the state after three years.

For some states with lower population and a lower percentage of uninsured residents, such a program may make sense. But a “one-size-fits-all” approach does not benefit Texas. Indeed, nearly half the states in the process of evaluating an expansion of Medicaid have serious reservations about the future implication of expanding a program already known to be a burden on taxpayers. Many are taking a “wait and see” attitude to examine how Texas deals with the Medicare expansion.

The problem is that once the state accepts an expansion of healthcare responsibility for low-income residents, it will continue to be responsible when the federal government begins to lower its level of financial support. Combine that with the fact that 70 percent of physicians have begun excluding new Medicare patients from their practice and it’s easy to see the doubts about the program are growing.

Dr. Kyle Janek, Texas Health & Human Services Commissioner, has pointed out that Medicaid is a jointly funded federalstate program that accounted for 18-19 percent of the state’s budget in 1990. The current existing Medicare accounts for nearly 27 percent of the state budget and is projected to increase to 33 percent in a few years.

An expanded Medicare program would take away money from transportation, education and law enforcement. Allocating a diminishing about of funding and maintaining – or expanding – services is increasingly challenging.

Texas has the twelfth largest economy in the world, but unfunded mandates by the federal government can weaken our state.

This is simply not acceptable, but there are viable alternatives.

The idea of expanding healthcare to low-income families has merits, it’s the universal approach proposed by the Obama administration with which the Texas Legislature has concerns. We would rather see the federal government work with the states individually to determine viable programs for increasing healthcare.

The state of Arkansas has recommended such a program and many in the Republican Caucus see benefits for a similar approach in Texas. There is precedent for the federal government in providing waivers to states based on unique characteristics. The state was given an 1115 waiver allowing Texas to set different rule regarding how hospitals are paid under Medicare. We want some similar flexibility with creating healthcare programs for low-income Texans.

Nearly 80 percent of low-income Texans have indicated an ability and a willingness to contribute to their healthcare. It’s equally important to realize that in the current economy, a significant number of people who could afford insurance have chosen to do without – especially young adults who are willing to gamble on the benefits of youth.

State Senate Finance Committee Chairman Tommy Williams, R-The Woodlands, has suggested a Texas-style Medicaid program that includes co-pays and deductibles, managed-care expansion and requirements that individuals enroll in available private or employer insurance plans.

Every state is different and should have the ability to develop a program that fits the particular needs of its citizens. The current Medicaid expansion proposals from the federal government are not the best solution for Texas.

A better solution is to allow state government flexibility in creating a viable program with the support and backing of the federal government – not financially irresponsible mandates to expand a system that is flawed, inefficient fiscally unsustainable.

That, like the proposed Medicare expansion proposal being pushed by the Obama administration, would be unfair. ▼