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.
The federal government’s offer to provide funding to pay for the uninsured to be added to the Medicaid in Texas is effectively intended to cover those persons who are unable to afford insurance and have incomes at or below 138 percent of the federal poverty level (FPL). Texas will be mandated to accept a federally driven health insurance exchange in early 2014. Unfortunately, even with a federal insurance exchange in Texas, many people still won’t have access to healthcare. Such an exchange subsidy isn’t the only needed solution, although it would serve to reduce our state’s uncompensated population by a third. A further expansion in healthcare could reduce our state’s uncompensated care by up to half.
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.
If negotiated successfully, Texas stands to pilot a new way of serving the remaining population already enrolled in Medicaid. This is an opportunity to not only roll the new population into our state’s health care system in a sustainable way, but to bring long-term vitality and viability into our current Medicaid program.
In our current legislative session, many of us have made clear that we do not want to expand Medicaid as prescribed by Obamacare. We must make positive steps toward a remedy for the astonishing costs of uncompensated care. What we need now is a meaningful attempt to explore our state’s options under the offer of significant financial assistance from the federal government.
House Bill 3791 simply provides a legislative opportunity to have a genuine conversation while debating what is best for the state of Texas.
Zerwas, a Republican, is from Katy.