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I’m glad someone is optimistic about the possibility of Medicaid expansion in Texas

Because I sure can’t say that I’m optimistic about it happening.

It's constitutional - deal with it

State Senator Rodney Ellis, Democrat of Houston, said fiscal conservatives have an incentive to reach an agreement “because the alternative is going to cost us much more economically and dig a much deeper hole in our budget.” Some Democratic lawmakers have already proposed legislation that would help them circumvent Mr. Perry or else produce a bipartisan compromise that might gain the Obama administration’s support.

Under the Affordable Care Act, President Obama’s health care overhaul, the federal government would cover 100 percent of the costs of expanding state Medicaid programs for three years, a share that would taper to 90 percent in later years. The Kaiser Family Foundation, a nonpartisan research group, estimated the expansion would cost Texas $5.7 billion from 2013 to 2022, which the organization called a modest price compared with the $65.6 billion that would be covered by the federal government.


Mr. Ellis has filed a bill to put the option of Medicaid expansion on a statewide ballot as a provisional amendment to the Texas Constitution. Giving the deciding power to voters would relieve political pressure on Republican legislators and alleviate fear of a veto, he said.

Representative Garnet F. Coleman, Democrat of Houston, is also trying to provide a path toward Medicaid expansion. He plans to file an omnibus Medicaid bill that could be altered during the legislative session to incorporate Republicans’ conditions for Medicaid expansion. One idea is co-insurance, Mr. Coleman said, which some Republicans have endorsed to get new Medicaid enrollees to pay a portion of their monthly health care premium.

I have a lot of respect for Sen. Ellis and Rep. Coleman and I wish them the best of luck in pursuing these bills. I just wish I could share their optimism, but I feel quite certain that nothing will change as long as Rick Perry is Governor. The conditions under which I can see Perry et al going for this are either more flexibility on determining eligibility for Medicaid – that is, the ability to greatly restrict who qualifies for it – or making it a block grant, which provides a cost ceiling and again gives the state pretty much free rein to decide how to spend the money. Neither of these are particularly likely, for good reason, though the game of chicken that’s going on nationwide between states like Texas and the feds continues. I don’t think we’re anywhere close to a resolution on this.

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