Point Austin: Perry's Tantrum

Given a bad health care report card, the governor points fingers

Rick Perry
Rick Perry (Photo by John Anderson)

Never let it be said Rick Perry doesn't know how to grandstand. Last Friday, his team was telling The Dallas Mor­ning News that he had made no decision on whether Texas would comply with the new federal health care law. Indeed, the DMN's Robert Gar­­rett reported "a spokeswoman confirmed Friday that [Per­ry's] aides have begun canvassing health care provider groups for their opinions about expanding Medicaid and creating a state health-insurance exchange."

"Such decisions will be made at the appropriate time," Catherine Frazier told Garrett. Apparently no one had told Frazier that the appropriate time had already passed. Perry's pugnacious letter to U.S. Health and Human Services Secretary Kathleen Sebelius rejecting the programs was released Mon­day, July 9. Presumably the opinions of the provider groups – most long on record as supporting the Patient Protection and Affordable Care Act – were no longer necessary.

It was more urgent for Perry to beat his chest, defy the president in scathing terms for the benefit of Fox-TV, and posture about Texas independence. Citing the recent Supreme Court decision that allows states to reject the Medicaid expansion without federal sanction (but which also ruled PPACA constitutional), Perry told Sebelius, "Please relay this message to the President: I oppose both the expansion of Medicaid ... and the creation of a so-called 'state' insurance exchange, because both represent brazen intrusions into the sovereignty of our state."

Health and Money

According to the Center for Public Policy Priorities, with the expanded funding offered by the federal government beginning in 2014, roughly 1.5 million Texans – working adults who have no other insurance – would be able to enroll in Medicaid, and another half-million currently eligible children would also enroll. Moreover, for the first three years, the feds would pay 100% of the cost, and beyond that time the state contribution would be capped at 10%. More than 6 million Texans – one in four, the highest rate in the country – are currently uninsured, and the Medicaid expansion, plus the federal support for expanded private insurance under the ACA, could reduce that number by half or more.

And every Texan would benefit from more people being insured.

If the simple logic of providing better access to health care doesn't convince you, what of the $20 billion in federal money flowing back into the Texas economy via the health care industry? The estimate on the Medicaid expansion is $13 billion a year; the annual federal subsidies on private insurance would add another $7 billion – all of this at an expense to the state of $1 billion a year. "Paying just one state dollar for every 20 federal dollars to support health coverage for Texans," concludes the CPPP, "is a great deal for the state."

The Fort Worth Star-Telegram adds more impressive numbers: "One state estimate says Texas would spend about $5 billion for the expansion [through 2019] and the feds would contribute $76 billion. A Kaiser Commission report estimates that Texas would spend $4.5 billion and the feds, $62 billion. Actual numbers will depend on how many enroll." In the political wars, Medicaid is unfairly portrayed as some sort of unearned "welfare" for the poor; more accurately, it provides a safety net subsidy for the health care industry and therefore for private businesses that cannot or will not provide insurance benefits.

Perry turned his back on all that federal funding on the libertarian principle that in Texas, the rich and poor alike are free to go without health care. One quarter of Texans do without health insurance and, therefore, regular and preventative care, while the rest of us pay (an estimated $10 billion a year) for their emergency care, through both higher premiums and local property taxes. The governor's response: "Let them eat state sovereignty."

Texas: We're No. 51!

Perry's letter declares, "I stand proudly with the growing chorus of governors who reject the PPACA power grab." That reactionary "chorus" currently includes all of a half-dozen Republican governors, mostly from southern states (the exception is Wisconsin's Scott Walker) that just happen to have enormous numbers of uninsured residents, and underfunded and inequitable state health care resources.

Not coincidentally, Perry's headline-grabbing announcement closely followed last week's annual report by the federal Agency for Health Care Research and Quality, which ranked Texas dead last (below even Washington, D.C.) in the provision of health services, based on comparisons in 155 categories ranging from acute hospital care to home health services. Asked about the ranking, the governor responded like a schoolboy bringing home a poor report card: "The idea that this federal government, which doesn't like Texas to begin with, can pick and choose and come up with some data and say somehow Texas has the worst health care system in the world is just fake and false on its face."

That's our manly governor. Called to account for his administration's extremely poor provision of basic resources to Texas citizens, he says we should blame the messenger.

Follow on Twitter @pointaustin.

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state health careMedicaidnational health care, Rick Perry, Affordable Care Act, PPACA, Medicaid, health insurance

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