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Medicaid: Ideologues versus experts

The fascinating thing in this story about the Republican plan to kill Medicaid is just how half-baked the idea is.

GOP Gov. Rick Perry, fresh off a big re-election win and touting his new book on states’ rights, is among those who say it’s a good idea. The election results — which included a huge haul of state House seats for Republicans — have left some Capitol watchers wondering whether they should take seriously an idea that might have been immediately discarded in the past.

Never mind that no state has ever ditched Medicaid. Or that the federal government typically kicks in about 6 of every 10 dollars spent on the health care program in Texas.

Medicaid pays for more than half of all births and chips in for the care of nearly two-thirds of all nursing home residents in the state. And top medical industry officials say opting out of Medicaid would cripple the state’s health care system and hurt the economy.

The opt-out idea surfaced nearly a year ago in a memo by the Heritage Foundation, a conservative think tank in Washington.


Perry hasn’t laid out details of how he envisions that opting out would work. A spokeswoman for the governor, Lucy Nashed , said that “these discussions are just beginning and will continue as we move into the legislative session.”


Arlene Wohlgemuth , executive director of the Texas Public Policy Foundation — the think tank to which Perry is donating the proceeds from his new book — is working on a proposal that would be an alternative to Medicaid.

Wohlgemuth, a former state lawmaker, is not proposing forgoing the federal funds because they’re Texas taxpayers’ dollars, too. She wants to use them in a different way.

“Medicaid is an unsustainable program,” Wohlgemuth said. “We have got to find a better way to deliver care to the people that need care.”

She declined to be specific, though she did say that options could exist through a totally new system, or through waivers or block grants that could give the state freedom to run the program as it sees fit.

But Anne Dunkelberg , associate director of the Center for Public Policy Priorities , which advocates for low-income Texans, said that “those aren’t options under law.” She said that there are no block grant options for Medicaid and that “there’s certainly not any new waiver ability that gets us out of the fact that health care is expensive.”

Perry frequently talks about a Medicaid waiver he proposed in 2007 that he says is languishing in Washington. His program would have redirected some federal Medicaid dollars into a pool to pay for health insurance subsidies for uninsured, low-income adults.

But the George W. Bush administration had concerns about the proposed limits on benefits and asked for a revision, which Texas has not submitted.

Though Perry’s proposal is technically still pending, Goodman said it would need to be revised “if the Medicaid expansion is implemented” as required by the federal health reform law.

Does anybody see a serious proposal on the horizon here, one that addresses the needs that Medicaid and CHIP currently handle while actually saving the state money? Or like me do you see an ideological wish list item that provides “savings” by simply ignoring a need and pretending that doing so doesn’t have its own costs, which may dwarf the alleged “savings” that are being touted? I have the same question for the medical establishment, which has largely been in bed with the Republican Party that is now threatening to do it serious damage with this proposal, that I have for the business interests that claim to be concerned about anti-immigrant legislation: Are you going to actively fight this, up to and including putting resources into defeating the legislators that will be working against your interests here, or are you just going to pay this all lip service because you care more about your other pet causes than you do about this? It’s put up or shut up time.

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