Editor’s note: This is a response to a story Erica Grieder wrote about the politics of Medicaid expansion called “Come and Take It, or Not.”
Last month Lieutenant Governor Dan Patrick and the Senate Republicans sent a letter to the White House saying that they were unwilling to discuss any options for Medicaid expansion unless the federal government gives Texas more flexibility in managing the program as it stands. This request for negotiation is fine—what works in other states might not work in Texas—but the Senate’s proposed reforms include cutting health care benefits to the children, seniors, pregnant women and Texans with disabilities who currently receive coverage. These proposals have sparked a debate that has generated misinformation, questions, and even claims of “incipient math denialism.” But more troublesome is that as everyone draws lines in the sand, we collectively risk stifling a valuable conversation about Medicaid expansion and negotiating a smart compromise. That was clear last week in the Texas Senate, when Rodney Ellis, a Democrat from Houston, offered an amendment proposing Medicaid expansion, explaining that legislation to that effect has been effectively stifled in committee. To that end, there are five things to consider when discussing Medicaid expansion in Texas, points that could help evolve the conversation and result in policies that best serve Texans:
THINK OF THE CHILDREN
Texas Medicaid enrollment has grown in recent years, as the letter indicates, but the enrollment growth is almost entirely due to program changes that allow a greater number of children to be covered. As a result, the rate of uninsured kids in Texas has dropped from 25 percent in 1997 to 12 percent in 2013. Blindly enacting the lieutenant governor’s proposals could cause Texas to roll back health care coverage for children. That would be a shame, and it could well have long-term consequences: Research has consistently shown that good health in childhood has a long-term positive impact on a person’s adult health, educational attainment, socioeconomic status, and the health of his or her children in turn.
THERE’S ROOM TO MAKE A DEAL
Of the other states – many of them conservative – that have negotiated with the federal government and received waivers for expanding Medicaid under more flexible parameters, none of them has rolled back coverage for children or lowered protection standards for pregnant women, seniors, and adults with disabilities like the Senate is suggesting. All of the negotiations have been focused on program requirements for newly eligible adults, a signal that federal officials are willing to entertain a more nuanced approach to adjusting standards.
LET’S NOT CUT OFF OUR NOSES
In addition to proposing undue burdens on our most vulnerable residents, the Senate’s demands do not appear to be good-faith negotiations. Texas is within its right to negotiate with the federal government for a good health care deal, and states like Indiana and Arkansas present successful cases for how to tailor Medicaid programs to fit each state’s needs. But they embraced the spirit of the law, proposing reforms that focused on groups who were not previously covered by Medicaid and who would not be eligible for coverage unless the states expanded the program. This willingness to make Medicaid expansion work as it was intended gave them greater power at the negotiating table, and those states ultimately ended up with agreements that allowed them to extend affordable health care coverage to a large number of people who were previously uninsured. If Texas wants similar flexibility, taking an inflexible, arms-crossed, stubborn stance that includes abandoning all federal minimum standards doesn’t help the cause; in fact it could squander opporunities and ultimately embarrass the state and its leaders.
OR LOOK A GIFT HORSE IN THE MOUTH
The federal money that Texas receives for the Medicaid program is the number one source of federal funds in our budget and every other state’s budget. No other source of federal funding comes even close. Federal highway funding is a distant second. The federal match for Medicaid expansion would cover ninety percent of the expansion’s cost, compared to about 60 percent for Texas’s traditional Medicaid program. Congress set this generous match to shield states from the impact of medical inflation and growth in the number of uninsured adults. Put differently, closing the health care coverage gap in Texas would mean some $6 billion in new federal health care investments for the state.
WE NEED TO ADDRESS SEPARATE PROBLEMS SEPARATELY
Because Medicaid is the second-largest category of state-funds spending after public education, the growth of Medicaid has been blamed for threatening Texas’s ability to fund public schools. This argument ignores context and is ultimately unfair. It’s more accurate to blame the deep cuts made to education systems by the Legislature during Rick Perry’s fourteen years as governor. Investments in public and higher education increasingly come from local taxpayers and tuition deregulation, and the Legislature could – and should – increase investments in public education.
The real problem isn’t Texas Medicaid; it’s that there are one million uninsured U.S. citizen adults in Texas stuck in the coverage gap waiting for the state’s leaders to act. A strong, diverse coalition including business groups, chambers of commerce, and county judges is calling for a Texas approach to expanding health care coverage to more Texans. That is where we will continue to focus our energy, to ensure a Texas where everyone is healthy and financially secure.
Eva DeLuna Castro is the Invest in Texas Program Director at the Center for Public Policy Priorities. Anne Dunkelberg is CPPP’s Health and Wellness Program Director.