Texas almost opens the door to Obamacare Medicaid exchanges


Last week, the Texas House almost opened the door to expanded Medicaid coverage via the Affordable Care Act. Fortunately, conservatives stepped up to prevent this disaster from happening. The Texas Tribune has the story:

Hours after approving the measure, the Texas House backpedaled on an amendment to the 2013-14 budget that would have opened the door to negotiations on expanding Medicaid, a key provision of federal health care reform.

“A lot of us didn’t really understand what was taking place,” said state Rep. Phil King, R-Weatherford, who voted in favor of the amendment earlier in the day, then joined a united House Republican delegation in voting to reconsider the measure.

Rep. Geanie Morrison, R-Victoria, who also originally voted in favor of the amendment, proposed that the House reconsider the vote. The House voted 93-54 to reconsider. Rather than have the House vote on the amendment again and likely reject it, the amendment’s author, Rep. Lon Burnam, D-Fort Worth, withdrew the measure.

The amendment said that if the state were to negotiate with the Obama administration to expand eligibility, it must reach a deal that reduces uncompensated care costs, promotes the use of private insurance plans and health savings accounts, and establishes wellness, cost-sharing and pay-for-performance initiatives. It also called for creating customized benefit plans for different Medicaid populations. The Legislative Budget Board would have been charged with determining whether such a deal addresses those reforms.

The amendment itself doesn’t give Texas any authority regarding supporting or opposing the expansion. However, it had support from Progress Texas and the Democratic author of the amendment, both supporters of Obamacare:

It’s a step in the right direction. In the political climate we’re working in, this is as good as we can get them to do,” said state Rep. Lon Burnam, D-Fort Worth, the author of the amendment. “Obviously there are some members that are not enthusiastic about Obamacare, but they don’t represent a district like mine.

According to Erick Erickson, the issue isn’t what many fiscal conservatives feared it was – weakness on the part of Texas Governor Rick Perry. Instead, it’s mostly an attempt by some in the legislature to put their imprint on future negotiations:

Several reporters and others I talked with explained that while Governor Perry is “rock solid” on the issue, his staff has sent mixed signals on the issue and Joe Straus, the squishy Speaker of the Texas House, and others were taking advantage of it.

I talked to people close to the Governor this morning and they make clear that there is no shadow between the Governor and his staff on this issue. While others may have that impression, they are adamant it is not the case.

More particularly, I’m told that from the Governor to his staff, their position is that the alternative to [M]edicaid expansion pursuant to Obamacare is freedom.

The confusion here seemingly arises in many people in and out of the Texas legislature expecting there to be some alternative to the [M]edicaid expansion in Obamacare. The Governor’s position is there will be no expansion under any alternative and he will hold the line.

At first glance, this does not appear to be all that threatening a bill. Governor Perry opposes expanding Medicaid, and so the legislature’s opinion on expansion guidance is an academic discussion. However, according to Texas Representative and Tea Party Caucus Advisory Board member Katrina Pierson, the threat is quite real:

Texans from all backgrounds have joined together with Texas leadership, state and federal, to protect our state solvency by refusing to expand Medicaid. The expansion of such an unsustainable program has the potential to bankrupt our state. In dental coverage alone, Texas has uncovered over $400M in Medicaid fraud and abuse in just the last few years.

This amendment, though not expanding Medicaid immediately, would have opened the door to the negotiations of expansion mirroring the Medicaid expansion in Florida under Governor Rick Scotts “exceptions.” We are witnessing Republicans working with President Obama to expand Obamacare regardless of the fact that it has been outright refused by the elected body of the state and the people who put them in office to fight against it.

In the short-term, activists can breathe easy. However, the state Senate’s budget has similar language in it, so Tea Party Patriots will be working with Texas activists to make sure whatever final budget bill Governor Perry signs into law stands against Obamacare absolutely.