GOP lawmaker's bill callas for Texas Medicaid expansion

Posted Thursday, Mar. 14, 2013  comments  Print Reprints

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Republican Gov. Rick Perry still rules out federally financed expansion of Medicaid in Texas, but top GOP legislators continue to say "maybe."

State Rep. John Zerwas, R-Simonton, an anesthesiologist and member of the Human Services Committee, introduced a bill Friday that would instruct the Texas Health and Human Services Commission to negotiate with federal officials on the terms of an expansion.

Perry's objects to expansion as called for in Democratic President Barack Obama's signature Affordable Care Act, also known as Obamacare. Perry says Medicaid, a state-federal program that pays for healthcare for needy families, young children and the elderly, is "broken" and "unsustainable."

There is little doubt that strict Obamacare-style Medicaid expansion is off the table in Texas, even though several Republican governors have reversed their stance and said they will accept expansion on the promise of 100 percent federal funding for the first three years.

The Zerwas bill is a shell around which compromise legislation can be shaped. Friday was the deadline for filing major bills for the current session, which ends May 27.

The bill calls for "flexibility from federal requirements," following "a managed-care model" using public funds to help individuals buy private insurance that includes cost-sharing such as co-pays and deductibles.

But it's also clearly a wish list, saying Texas should get federal Medicaid money in a block grant with no strings attached, with enough left over for "meaningful tax relief at the local level" and freeing up state funds to be used for other priorities.

There also are clear differences among Republican lawmakers on how to strike a deal with the feds. The Zerwas bill calls on HHSC and the Texas Department of Insurance to negotiate under the guidance of a special House-Senate committee. But it also says the commission should move ahead and implement whatever plan is negotiated.

On Wednesday, Lt. Gov. David Dewhurst praised the Senate Finance Committee for approving a proposed 2014-15 budget with a rider that says the commission "would have to seek legislative approval before reforming our Medicaid program."

Unless negotiations can be completed by May 27, that would require a special session to approve any Medicaid expansion. Legislative wheels turn slowly, but at least they're not at a dead stop on Medicaid.

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