Senator Pollyanna takes a run at busting down a wall

Posted Saturday, Jan. 26, 2013  comments  Print Reprints

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These days, it's sometimes difficult to recognize cracks in political walls. The walls have been built up to be so thick, and any cracks might only be foolish, hoped-for illusions.

State Sen. Jane Nelson, R-Flower Mound, whose District 12 covers large and populous parts of western, northwestern and northeastern Tarrant County and more than half of Denton County, hinted last week at what might be a crack in one of the thickest of those walls.

Nelson is a 20-year Senate veteran and the powerful chairman of the Health and Human Services Committee.

The wall in question is the one between top Texas officials, led with steadfast determination by Gov. Rick Perry, and the administration of President Barack Obama over expansion of Medicaid healthcare benefits for low-income Texans.

There might be a way, Nelson told The Associated Press last week in Austin, to reach a compromise.

She later expanded on that thought in a telephone interview with the Star-Telegram Editorial Board.

"We know what we want to do" to expand the joint state-federal Medicaid program in Texas, she said. "We know how to do it."

The trouble is, several aspects of what she said Texas leaders want to do are, and long have been, quite different from how Medicaid currently is done.

That means doing it the Texas way would require getting a waiver of some Medicaid rules from federal officials.

"I'm an optimist," Nelson said. "What I'm saying is, let's give it a chance. Let's send a delegation to Washington and talk to them about it. I think we could get a waiver."

Don't go changing her name to Pollyanna just yet.

Great political compromises -- those cracks in thick walls -- start with talking about the problem.

The potential payoff is certainly worth the small risk of looking silly. Provisions of the federal Patient Protection and Affordable Care Act (Obamacare) would deliver $27 billion to Texas to help pay for the initial stages of an expansion plan.

More to the point, success would mean better healthcare for many of the state's 6.3 million uninsured residents.

No great solution will happen overnight. Texas received a major Medicaid waiver a year ago for a state plan to improve rural healthcare, but it was several months in the making.

And the wall between the two sides this time is discouragingly thick. Even the optimistic Nelson has reservations.

One of the biggest sticking points is that the huge federal contribution toward expansion is not guaranteed over time.

Perry, who has built much of his political persona around being all things anti-Obama, has said the state could be left holding the bag for an additional $30 billion to $60 billion in the state budget.

Nelson says she won't go for a compromise that leaves the state so exposed.

Some points of what she and Perry have proposed are not just different but far different from Medicaid policy.

They want participants in an expanded Texas program to help pay for their care on a sliding scale according to their ability to pay.

Some other points seem doable.

They want payments to healthcare providers to be based on outcomes, not the number of patients they see or the procedures they perform.

They want incentives for getting care not in emergency rooms. They want more doctors in Texas.

This much is sure: The rhetoric of the past won't get better healthcare for anyone in Texas.

Millions of them need it.

Officials on both sides of the wall can see that.

They all should be interested in talking about it and finding ways to make it happen.

Do what Nelson says. Send a delegation. What could it hurt?

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