It’s no secret that Texas Gov. Rick Perry openly opposes federal health care reform. He has used every opportunity to reiterate that he will veto any effort by the legislature to participate in Medicaid expansion in Texas – an option granted to the states by last summer’s Supreme Court ruling. One source counts 14 states that have fully rejected accepting federal funds to extend health care coverage to low-income adults, while 20 states are fully participating in the expansion and 16 are undecided.
A state certain to participate in the expansion is Colorado, my new home state. The bill to expand Medicaid to 330,000 Coloradans passed both chambers of the General Assembly last week. Once the Senate approves amendments to the House version of the bill, it will head to the desk of Gov. John Hickenlooper, who has pledged to sign it into law.
In many respects (to the delight of this Texas native), the two states are very similar. Colorado has its urban capital, several other mid-size cities, and vast expanses of rural space. Residents also have a fierce loyalty to the state. And, until the past decade when control of the House, Senate, and the governor’s mansion has flip-flopped between the parties, Colorado has historically been conservative. The current split in the House is 37 Democrats, 28 Republicans. In the Senate, it’s 20 Democrats, 15 Republicans. And, of course, the governor is a Democrat.
As Colorado considered expansion, opponents (Republican lawmakers) argued that it would drain state coffers and leave the state footing the bill when generous federal funds run out. Proponents pointed to an analysis that shows Colorado will spend $133.8 million less over 13 years and create more than 22,000 new jobs over the same period, boosting the economy by $4.4 billion.
The lone Colorado Senate Republican who voted in support of the expansion told Kaiser Health News that he has “no choice but to support this.” He represents a district that includes several of the state’s poorest counties and says that hospitals in his district are “strained to the breaking point caring for the uninsured.” The Colorado Hospital Association supports Medicaid expansion in Colorado, as does the Colorado Medical Society.
Perhaps it’s no surprise that the fiscal argument is gaining ground in Texas among Republican lawmakers and conservative organizations who acknowledge the economic implications for rejecting federal dollars. George B. Hernandez Jr., president and CEO of the University Health System, said refusing the expansion will impose a 20 percent surcharge on Bexar County hospital district property taxes.
But Texas Republicans must tread carefully around this “radioactive issue,” as demonstrated by a strange sequence of events in the House last week when representatives approved a budget amendment that would have allowed for negotiations should Texas decide to participate in the expansion only to reconsider the vote hours later and ultimately pull it down. The concept still lives through a related budget rider approved by the Senate, and it will be a part of conference committee discussions.
The most promising plan standing, and one supported by the Texas Association of Business, is the so-called “Texas Solution,” House Bill 3791 by Rep. John Zerwas, M.D., R-Simonton. It would create a kind of voucher program designed to extend health coverage to the state’s poorest adults through the private marketplace and create a task force to reform Texas Medicaid. The House Appropriations Committee approved this measure last week on a 15-9 vote and it now waits to be heard by the full House.
Yet the proposal might never get a chance on the House floor. House Republicans in Texas represent chambers of commerce, hospitals, and other powerful entities that want to participate in Medicaid expansion. But if those representatives voted for anything resembling expansion, they would be hammered by powerful factions like the Texas Public Policy Foundation and Michael Quinn Sullivan’s Empower Texans. Why would Speaker Joe Straus put his members through what would most certainly be a damaging debate only to have the bill vetoed by the governor?
The arguments and the issues surrounding Medicaid expansion in both Colorado and Texas are the same. But Colorado will benefit from $12.28 billion of Medicaid funding while Texas will refuse $100 billion over the next 10 years and continue to bear the costs of a large population of uninsured poor citizens. The difference between the two states lies only in the makeup of their state governments. Once again the old adage is proven true: politics drives policy.