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From the “Get your government out of my Medicare” files

This ought to be fun.

Across the nation, U.S. House Republicans are getting an earful from their constituents about a GOP budget proposal to overhaul Medicare, the federal health care program that insures the elderly.

The Republican plan, written by Wisconsin Rep. Paul D. Ryan as part of his sweeping budget overhaul, would turn Medicare into a program that subsidizes private health care coverage for seniors instead of directly paying medical costs as it does now. Some Republicans, unnerved by the public reception, have even begun to retreat from it.

But that message hasn’t made its way to Texas, where state lawmakers are moving full speed ahead on their own efforts to take control of — and then restructure — both Medicare and Medicaid, the joint state-federal health care program that primarily serves poor children and the disabled.

Rep. Lois Kolkhorst’s “health care compact” bill, HB 5 — which would effectively ask the federal government to give Texas and other states block grants to run Medicaid and Medicare as they see fit — passed easily out of the House, and was heard in a Senate committee on Tuesday. That’s despite Democrats’ warnings that any effort to redesign Medicare will terrify, or potentially harm, seniors and a failed attempt by Rep. Craig Eiland, D-Galveston, to remove Medicare from the Texas compact bill.

“The reason I offered the amendment is exactly because of what’s going on nationally — it’s an ‘I told you so,’” Eiland said. “Before we start messing with our seniors, let’s try to prove we can run Medicaid.”

Republicans in the state House say they have no intention of curbing services or compromising care for the nearly 3 million Texas seniors on Medicare. But they say the health care compacts under consideration by other states are all written to include Medicare, and that they must align. And they argue there’s no way to get at the country’s escalating medical inflation and spiraling health care costs without addressing overutilization, fraudulent spending and other inefficiencies in Medicare. Medicaid mostly covers children; Medicare’s seniors are far more costly to insure.

First and foremost, I rather doubt that the Obama administration is going to hand over control like this to Texas. Remember, the Bush administration denied Texas’ request for Medicaid waivers before on the grounds that the program the state had in mind wasn’t sufficient in its coverage. I suspect this is more political than anything else. Having said that, the concern in progressive circles is that all the bluster about Medicare at the national level is a smokescreen for an attack on Medicaid, which serves a much less politically powerful group and is thus much more vulnerable. As such, regardless of how the feds may react to HB5, this is worth keeping an eye on. I mean, nobody doubts that the goal here is to slash benefits, right? The point of a block grant is that it’s a fixed sum of money, so if it actually winds up costing more to provide the coverage, that’s just too bad. The state won’t pay anything beyond that. That’s the goal the Republicans are working towards.

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