Dickensian Texas

If Texas goes ahead with the Tea Party plan to drop out of Medicaid, that will mean that Texans suffering from horrible, life-threatening diseases will be thrown out in the streets.

That's not our term for it: That's how House Appropriations Committee Chair Jim Pitts, R-Waxahachie, described the situation.

The Ellis County Oberver was at a meeting of Ellis County Tea Partiers and Pitts on Nov. 20. Inevitably, the conversation turned to "Obamacare" and the demand from fringe groups to pull Texas out of the terms of the Patient Protection and Affordable Care Act. Pitts told them that there is a state study pending on that issue: Mandated by House Bill 497 last session, he said that its purpose "is to get out of it" – the "it" in question being the Federal health care reform.

A crowd member then asked Pitts what that would mean for a friend of his suffering from a brain tumor and receiving support from Medicaid. Pitts responded:

I'm going to tell you that we're looking into getting out of Medicaid, not have Medicaid program in the state of Texas."

The crowd member asked Pitts a very simple question: What will his friend with cancer do? Pitts' answer was blunt and to the point.

The legislature's gonna have to determine who will be eligible for certain things. The problem that he is having today is the Medicaid reimbursement rates to our doctors are so low, it's lower than the Medicare rates, it's typically about 80% of our Medicare rates. We're losing providers for our Medicaid.

Again, the obvious question: If Medicaid goes away, what happens to the victim of cancer? Will he be thrown out on the street? Pitts' answer:

If we do exactly what we're doing today, we wouldn't be throwing him out on the street. But if we have any savings in getting out of Medicaid, we will have to throw some people out in the street. And I'm not telling you that your friend will be, but the eligibility to receive state benefits will go down. Let me make sure that I said that right. Fewer people will be on our Medicaid rolls if we get out and have some savings.

Pitts is bound to get flack for saying that the state is going to throw sick people out on the street. Probably most of that flack will come from conservatives angry that he's let the cat out of the bag.

Rep. Donna Howard, D-Austin, watched the Senate Health and Human Services Committee discuss quitting Medicaid, which she said they had dubbed "the nuclear option." She added, "They were trying to get more information about what the reality of that would be, both in terms of the impact and in terms of what Texas can do with the limited pool of money that would remain."

Howard, a former critical care nurse, echoed what her fellow Travis County Dem Rep. Dawnna Dukes said about Pitts when he dared suggest gambling as a new revenue stream for the state. Telling Tea Partiers that they had voted to kick sick people out in the street is "about as bold as you can get," Howard said. "Jim laid it out clearly, and he's a very honest broker."

Pitts also made it clear that any savings made will not go into more health care provision. Instead it will go into trying to fill the ever-spiraling deficit Texas faces, which now looks to be $28 billion and rising. What he didn't mention, but what been reported by the Houston Chronicle, is that Indiana's experiment in a Medicaid alternative called Healthy Indiana Plan has been a complete financial and coverage disaster. Considering Texas already has the nation's greatest percentage of citizens without medical insurance, making that switch could be down-right catastrophic.

No matter how the GOP tries to color the picture, and make their claim that they passed a balanced budget, the simple fact is that they can't cover the spending they approved a little over a year ago. Their catastrophic 2007 reform of the business margins franchise tax and subsequent failure to fix their error has left Texas in a financial hole. And now the solution involves throwing sick people out in the street.

What's most bizarre here is that the economics of opposing health care reform make no sense. As Ezra Klein noted in the Washington Post, Texas stands to be one of the big beneficiaries of the changes. A 3% increase in state contributions would see Medicaid enrollment increase by 46%. That means fewer sick people, and less pressure on county emergency rooms, which have become the last (and only) source of medical care for many uninsured Americans.

The one bright hope here is that Tea Partiers listen to what Pitts told them, and cool their rhetoric. Unfortunately, Howard said, "I'm still hearing from some people that everyone should be able to take care of themselves, and that if we didn't provide health care that they would be taken care of by the philanthropic and faith communities."