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You can present that “Texas solution” any time now

State Rep. John Zerwas takes to the op-ed pages to assure us that yes, the Republicans really truly do want to do something about the vast number of uninsured people in this state if only they are given the freedom to do it their way.

It’s constitutional – deal with it

The Texas Medicaid program as it presently exists has reached an unsustainable capacity. The current network of hospitals and physicians who care for our state’s Medicaid population has reached a true breaking point. They can no longer welcome new patients under the existing model of coverage.

At the federal, state and local levels, debate has focused on expanding coverage through Medicaid for the nation’s un- or underinsured. This has been a question heavy on the hearts of our state government, healthcare providers and those 1.1 million Texas residents still seeking medical coverage across the state.

It is true that Texas stands to gain coverage for a significant number of now-uninsured residents through any healthcare expansion, but an expansion of Medicaid also results in an expansion of patient need.

As it stands, only about 30 percent of Texas physicians are willing to accept new Medicaid patients. Without reforms, those new patients will still find the Texas healthcare system inaccessible for preventive and primary care, leaving them seeking care in emergency rooms at a continued high cost to Texas taxpayers. The state’s existing system is broken, and placing more pressure on an already broken system sets us up for a crisis.

[…]

No other solution exists for those up to 138 percent of the FPL except for a healthcare expansion that picks up this underserved population. The funding option on the table allows for a significant federal return on our state’s investment. Medicaid expansion, however, is not the answer. Texas needs a Texas-sized, Texas-based and Texas-owned solution.

House Bill 3791 is the birth of such a solution. The bill directs the Texas Health and Human Services Commission to negotiate with the federal Centers for Medicaid and Medicare Services to forge a plan that considers our particular needs, our economy and our unique and growing population. Through House Bill 3791, it is clear that our state must be able to design a Texas-shaped plan while also achieving the flexibility to make these expansion-related decisions without approaching the federal government for approval at every turn.

There’s not really anything new in what Rep. Zerwas has to say, so there’s not really anything new in the three things I have to say about what he said.

1. The reason that so few doctors are taking new Medicaid patients is because the reimbursement rate is so low. Of course, the reimbursement rate is entirely at the discretion of the legislature, which Zerwas doesn’t mention, so this problem is entirely within their power to solve if they wanted to. Yes, that would cost more money, but it’s not like having millions of uninsured people isn’t costing us a ton already.

2. There’s still no clear idea what the Republicans want in a non-Medicaid solution. I presume they’re aiming for something like the Arkansas plan, once their pipe dreams of no-strings-attached block grants are officially beheaded, but nowhere does Zerwas say what he thinks the answer should be.

3. I’ve said it before and I’ll say it again: The Republicans have had ten years to do something about the appalling lack of health care access for so many people in Texas. They have done exactly nothing, unless you count all the things they have done to make the problem worse. The only reason they are doing anything now, however grudgingly, is because they’ve been forced to do it. If it had been up to them, the Affordable Care Act would have been thrown out by the Supreme Court, and they could have gone right back to their preferred system of completely ignoring health care when they’re not cutting its budget. If some kind of system is eventually crafted for the state that the feds will accept, Zerwas and his colleagues will deserve very limited credit for it.

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