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Loss of Medicaid Expansion Will Cost Texas Taxpayers Billions


by: Chaille Jolink

Thu Aug 08, 2013 at 11:30 AM CDT


Earlier this week the Texas Observer sat down with State Representative Dr. John Zerwas to talk about the status of Medicaid in Texas.

The Affordable Care Act provides sliding scale assistance for an individual making more than $15,282 a year. This fails to cover some of Texas's poorest residents living below the 133 percent of the federal poverty level. Medicaid expansion ideally would have taken care of these populations, but thanks to a recent U.S. Supreme Court ruling, states are now allowed to opt out of Medicaid.

Texas is currently leaving a $100 billion dollars of taxpayer money on the table by not expanding Medicaid. This will undoubtedly raise healthcare costs in the long run and in turn also hike up local property taxes as they share the burden of most local emergency healthcare costs. It is also estimated that Texas will lose 1.8 billion dollars in taxes in the next four years, according the Observer.

Read more about Zerwas's attempt to pass a modified Medicaid expansion and the Republican obstruction he faced below the jump.

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This past legislative session Representative Zerwas, a doctor and a Republican, attempted to pass the Texas version of Medicaid expansion. This bill would have insured that $100 billion federal dollars is not left on the table, and it would also have created options for preventative healthcare for Texas's poorest citizens, those that are not under the protection of The Affordable Care Act because (in theory) they are supposed to be on Medicaid. So at least in Texas, the term "Medicaid expansion" essentially means "Medicaid implementation." The bill did not even make it past the House Calendars Committee.

Representative Zerwas -- who represents part of Houston, where one in three people are uninsured -- discussed the difference Medicaid and healthcare in general makes for citizens.

"I think the difference that you see in people that have health insurance vs. people that don't is that they can more easily and readily access health care than those that do not have insurance. So, your people with higher blood pressure get better blood pressure management, your people with diabetes get better diabetes management; your cancer patients get diagnosed earlier as opposed to a later stage of cancer."

He noted that the bill could have passed the full House and Senate, but was anonymously blocked in the House Calendars Committee. He credited this on a fear held by many representatives that this could be framed in a Republican primary as expanding Obamacare (which it doesn't do). As a republican himself, Zerwas believes that the federal grant dollars for Medicaid would be best given as a block grant, essentially making it an almost "no strings attached" money. Currently Medicaid is still federally mandated and there are strings attached to the monies and how it should be spent. In the House Committee hearing, no one testified against it, except for one person representing the conservative "think tank" Texas Public Policy Foundation. Their argument was that they were against any action until the federal government just gives Texas the Medicaid block grant.

Representative Zerwas had this to say about the testimony:

"Probably that's the one point that I differ with the TPPF (Texas Public Policy Foundation) is that even though I am a strong advocate for the block grant as a way to help us rein in the cost of Medicaid, I'm also a realist to know that it probably isn't going to happen and in the meantime we ought to try to do some things in delivering a different model for this indigent population, and that the federal government is willing to provide that money to us to do it, which is ultimately our money anyway. So, my feeling on this really was let's look at this newly eligible population almost as a pilot study and let's try doing something different with them. And maybe if we can prove that that works then maybe the federal government at some point will give us that block grant, and we'll be able to convert the entirety of the Medicaid program to the solution that works best for Texas."

Currently the Health and Human Services Commissioner and the Governor technically negotiate the Medicaid grants. Representative Zerwas's bill, HB 3791, would have created a directive to the HHS Commissioner to negotiate with the federal government (one example of why appointments by the Governor are important). Even if HB 3791 would have passed the Governor would have probably vetoed the bill anyway, but as Zerwas put it, "at least we could have said that as representatives and senators we took up the issue, we debated it and we let the votes fall where the votes fall."  



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