A central conceptual problem with Texas’s ongoing resistance to the federal government’s effort to expand Medicaid is that while Texas’s Republican leadership have a point—it would be better to spend money on an efficient entitlement program than a bloated and dysfunctional one—they haven’t fully specified what a Texas approach to Medicaid would entail.
Some clues are, however, coming out of the current legislative session. On Tuesday, by a unanimous vote, the Senate passed SB 7—one of two Medicaid-related bills authored by Jane Nelson, a Republican from Flower Mound and chair of the Senate’s Health and Human Services committee. This one, SB 7, focuses on streamlining the state’s service provision to Texans with physical and intellectual disabilities who are eligible for long-term or acute care. The other, SB 8, is meant to crack down on waste and fraud in the system and has been recommended for the local and consent calendar.
Both bills have been welcomed by Republicans, with Democrats being more wary. The reasoning behind SB 7 is as follows. As Nelson has explained it, Texas’s current system provides a lot of services to a relatively small number of people, many of whom don’t need all or even most of the services available to them. The overarching goal of the bill, then, is to extend Medicaid coverage for acute or long-term care to some 12,000 additional Texans with physical or intellectual disabilities—without spending more money.
To that end, the bill includes a number of provisions meant to improve efficiency, such as the creation and implementation of