Despite Gov. Rick Perry's declared opposition to Medicaid expansion, there is little doubt that the topic will be much-debated under the Dome in 2013. According to a report from the Kaiser Family Foundation and the Urban Institute, expanding Medicaid – as enabled by the Affordable Care Act – would reduce Texas' uninsured population by as much as 55%, while only raising the state's Medicaid expenditures by 2-4%. Indeed, under national health care expansion, for the first three years, the feds would cover the cost of Medicaid expansion for eligible Texans entirely, with the state picking up just 10% of the tab in the following years – a deal that mirrors the 90-10 funding split in the Medicaid-waiver Women's Health Program that, for the last five years, has been lauded as a great tool to expand health coverage while saving the state millions. Expect an effort by lawmakers to find a way to reap the benefits of expansion, while somehow working around Perry's opposition.
In that effort, Sen. Rodney Ellis, D-Houston, has filed Senate Joint Resolution 8, proposing to amend the Texas Constitution to direct the state to provide medical assistance to anyone who qualifies for Medicaid under the ACA – thereby going around Perry and putting the question straight to the people. Similarly, Rep. Lon Burnam, D-Fort Worth, has filed House Bill 59 as another potential workaround, to allow counties, hospital districts, or "other units of local government" to apply directly to the feds to expand Medicaid using local matching funds.
Both of these measures are long shots at present (and should Burnam's bill pass, Perry could veto). But reconciling the state's growing needs with revenues that are not otherwise growing may yet push lawmakers to be more practical in considering whether the state should accept its share of federal dollars. We can expect to see additional expansion-related bills as the session proceeds, including proposals that would allow for expansion, but only if tied to specific Medicaid reform measures (such as a proposal to charge co-pays).
Look also for measures aimed at beefing up the detection of Medicaid fraud (a current political fad, but controversial among providers who question the state's auditing methods and knowledge of complex Medicaid coding and billing processes). Senate Bill 56, by Sen. Jane Nelson, R-Flower Mound, and chair of the Senate Committee on Health and Human Services, is a fraud hunter.
Nelson is also among a group of lawmakers who made headlines with their first-day filing of SB 11, billed as a welfare "reform" measure that would make certain recipients of the crippled Temporary Assistance to Needy Families program subject to drug testing in order to receive benefits. Applauded by Perry and Lt. Gov. David Dewhurst (see "Point Austin: We Want Your Urine," Nov. 23), 11 Senate Republicans are echoing a similar measure that died an unceremonious death last session. (A bill that tied eligibility for unemployment benefits to drug tests also died; Woodlands GOP Sen. Tommy Williams has promised its return.)
Other states have passed drug test measures – including Florida, where the state has spent far more on the testing program than it has saved by ousting users. Moreover, there are concerns about collateral damage, importantly to the children of TANF recipients, or even to vulnerable clients who receive false-positive tests. Nelson has said that she intends to look further into concerns like these, but that she's "not convinced that putting cash directly into the hands of drug abusers provides any benefit to children."
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