Texas Considers Medicaid Withdrawal

[TampaYankee]

Texas Considers Medicaid Withdrawal

By EMILY RAMSHAW, The Texas Tribune

Published: November 6, 2010

Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.

Far-right conservatives are offering that possibility in impassioned news conferences. Moderate Republicans are studying it behind closed doors. And the party’s advisers on health care policy say it is being discussed more seriously than ever, though they admit it may be as much a huge in-your-face to Washington as anything else.

“With Obamacare mandates coming down, we have a situation where we cannot reduce benefits or change eligibility” to cut costs, said State Representative Warren Chisum, Republican of Pampa, the veteran conservative lawmaker who recently entered the race for speaker of the House. “This system is bankrupting our state,” he said. “We need to get out of it. And with the budget shortfall we’re anticipating, we may have to act this year.”

The Heritage Foundation, a conservative research organization, estimates Texas could save $60 billion from 2013 to 2019 by opting out of Medicaid and the Children’s Health Insurance Program, dropping coverage for acute care but continuing to finance long-term care services. The Texas Health and Human Services Commission, which has 3.6 million children, people with disabilities and impoverished Texans enrolled in Medicaid and CHIP, will release its own study on the effect of ending the state’s participation in the federal match program at some point between now and January.

State Representative John M. Zerwas, Republican of Simonton, an anesthesiologist who wrote the bill authorizing the health commission’s Medicaid study, said early indications were that dropping out of the program would have a tremendous financial ripple effect. Mr. Zerwas said that he was not ready to discount the idea, but that he worried about who would carry the burden of care without Medicaid’s “financial mechanism.”

“Because of the substantial amount of matching money that comes from the federal government,” Mr. Zerwas said, “there’s an economic impact that comes from that. If we start to look at what that impact is, we have to consider whether it’s feasible to not participate.”

State Senator Jane Nelson, Republican of Flower Mound, who heads the Senate Public Health Committee, said dropping out of Medicaid was worth considering — but only if it made fiscal sense without jeopardizing care.

Currently, the Texas program costs $40 billion for a period of two years, with the federal government paying 60 percent of the bill. As a result of federal health care changes, Ms. Nelson said, millions of additional Texans will be eligible for Medicaid.

“I want to know whether our current Medicaid enrollees, and there certainly could be millions more by 2014, could be served more cost efficiently and see better outcomes in a state run program,” she said.

eramshaw@texastribune.org

A version of this article appeared in print on November 7, 2010, on page A37A of the National edition..

See original article at:

http://www.nytimes.com/2010/11/07/us/politics/07ttmedicaid.html

[RA1]

I am one of those who certainly believes that local control is better. If TX can keep from sending those billions to DC and then, with full accountability, offer local health care, then, more power to them. The federal government is the prime example of more is less and that more volume does NOT save money. The feds suck off the top and then, reluctantly and with many regulations, send some of it back to the states. The states are not error free. The most local control is the best with accountability just a phone call or walk down the street away from recipients. I certainly understand there is some economy of scale but the feds have ruined this concept with their concept of how this works.

Best regards,

RA1

[JKane]

I recently spent quite a bit of time in Texas, and their bullshit is really starting to piss me off.

Yes, sure, RA1 and Ms. Nelson, you can cut 8 billion/year local spending to lose 12 billion a year federal funding and then somehow make up that 20 billion for less than your 8 billion! That math makes PERFECT fucking sense! But as a bonus you also lose the federal medicare/medicaid negotiating power, so it'll be really easy re-negotiate even lower amounts INDIVIDUALLY with all the providers left in the state! Well, the 3 who don't simply PACK UP AND LEAVE.

Anybody with any experience with right-wingers knows the bullshit about 'we can do it more efficiently locally' is just code for 'we can CUT these services on the most desperate of the population but if we pretend different with a little luck the outcry won't be that bad when they start dieing and ERs across the state close'.

Medicare is the best-run health care system IN THE COUNTRY. Ooooh, waste, blargh, fraud, blargle the right-wingnuts scream... yeah, 5% of their budget including administration. It's that fucking simple. Commercial healthcare? 20% including administration, advertising, and PROFIT. Again the MATH IS REALLY SIMPLE.

And these fucking backwater states, every ad during the election was Obama-style spending this, federal gov't that. Except when I was in Texas EVERY SINGLE GOD-DAMNED HIGHWAY was under construction or being re-surfaced. Many in the south had to be rebuilt ENTIRELY because of the hurricanes. GO AHEAD, GIVE UP THE FEDERAL SPENDING IN YOUR STATE!

Most southern states get back more in federal spending then they send in the first place (very similar to the Medicaid math), ooh, but we need LOCAL CONTROL. Yeah, let's put somebody like George W Bush in charge of energy regulation, or somebody like Sarah Palin in charge of education for a state! Some good-old-boy in Mississippi in charge of equal rights.

Notice how Texas is in a 'dire' budget shortfall and the republicans first answer is let poor people die? MAKE NO MISTAKE, that's what "cutting payments for acute care" is, nobody pays the ER, first trauma centers then the ERs go broke, the poor and then even the middle class start dying from lack of access to emergency medicine, whether they can pay or not.

IN A STATE WITH UNTOLD BILLIONS IN OIL/ENERGY WEALTH *EVERY MONTH* yet an Alaska-style tax (and god forbid Alaska-style regulation) isn't even a thought with Republicans. No, the answer is cut 20b per year out of the states medical services to 'save' 8b a year!

Four years ago I wondered if there was a Republican alive who'd managed to read the constitution, now I wonder if there's one alive who can do basic math!

[RA1]

Your rant could make perfect sense if it had a chance of being true. How can a state, a city, an individual send $100 to Washington and get $120 back? Not possible. This is like a pyramid scheme; someone has to lose. The ONLY hope of getting 99 cents worth of value for 1 dollar invested (in government) is to invest and spend it locally. The more local, the better.

I hope you will think this over and realize that it has to be true.

Best regards,

RA1

[MsGuy]

RA1, for the US as a whole, you are correct, of course, but individual states can sucessfully game the system. Localities with lots of military bases/contractors &/or a boat load of poor folks tend to be net winners in the tax dollar lottery while wealthier states usually wind up footing the bill. It's not a pyramid scheme, it's a wealth transfer scheme.

For instance, the Department of Homeland Security recently paid for about $25,000 worth of those cute little 2 wheel Segway thingies for my tiny little rural hometown. Now how our elderly part-time night watchman riding around on a Segway to make sure the merchants downtown remembered to lock up after work contributes to our antiterrorism effort is beyond my ken, but that's the distribution formula Congress put in the appropriation bill, so we took the money. It's the fine print that counts.

[RA1]

Isn't that one of the problems, gaming the system? I hear there is a strong effort to eliminate ear marks aka pork. I realize the total dollars spent on pork are just a drop in the bucket but it would show some leadership and make me feel better about the process and the participants.

Best regards,

RA1

[MsGuy]

the total dollars spent on [earmarks] are just a drop in the bucket.

As you say, earmarks don't amount to a hill of beans compared to the real pork. For instance, all kinds of goodies from Highway Trust Fund money to Farm Home mortage money is allocated by state according to distribution formulas embedded in the relevant appropriation bills. Much of the down and dirty political trench warfare in Congress comes in the writing of these formulas. Interestingly enough, funding formula drafting is one of the least partizan activities Congress regularly engages in. All kinds of strange fellows find themselves on the same side of the bed.

This process is absolutely opaque to the public but influences the way tens of billions of dollars are spent, i.e. in the bill that provided money to assist cities like NY, Chicago and LA with their hugh anti-terrorism costs, rural senators plugged in a funds distribution formula that resulted in Homeland Security spending billions on silly shit like Segways for my hometown.

----

By the way, the earmark restraint recently pledged by the Republicans is something of a hornswoggle of the Tea Party folks. True they are (temporarily) foreswearing the earmark process by which individual members of Congress slip appropriations into unrelated bills without even acknowledging their authorship but the exact same itemization of funds will be allowed if done through log rolling in subcommittee. There's less in the resolution than meets the eye. (So what else is new? Regardless of party, guys on the Hill live and die by pork and they are the experts in the process. The peasants are up in arms about earmarks? Sure, no problem, pal, we swear not to do "earmarks" any more. See we even signed a pledge. )

[RA1]

I suppose no one games better than the DC gamers themselves. I understand your comments and recognize them to be true but that does not keep me from hoping for better and acting in any way I can to promote "better". Did they learn all that pledge stuff from the Methodists?

Best regards,

RA1

[JKane]

Your rant could make perfect sense if it had a chance of being true. How can a state, a city, an individual send $100 to Washington and get $120 back? Not possible. This is like a pyramid scheme; someone has to lose. The ONLY hope of getting 99 cents worth of value for 1 dollar invested (in government) is to invest and spend it locally. The more local, the better.

I hope you will think this over and realize that it has to be true.

Best regards,

RA1

It's actually quite simple, states like California and New York pay far more overall and get less than 100% back. 95-98%. Massachusetts too. Then they also have high state and local taxes and provide a lot of services like healthcare. Meanwhile, the southern states have almost no locally provided services so the federal spending is more desperately needed. THEN THEY HAVE THE GALL TO BE UNGRATEFUL FOR IT!

The thing that really gets me, HOW MANY CONTINUOUS YEARS OF COMPLETE REPUBLICAN RULE has Texas had now??? Yet somehow that state's budget crisis is the fault of a just-barely 2-years into his term Democratic president?? And it needs to be made up on the back of the most desperately poor and sick in the state!

COULDN'T be all the unfunded tax cuts for the wealthy in the state, or the complete refusal to responsibly tax or regulate the energy industry in that state, no...