Getting Texas from 'we will not' to 'we will' on healthcare

Posted Thursday, Mar. 14, 2013  comments  Print Reprints
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norman Politics can be a game of subtleties. Without subtle differences and nuanced statements, public officials and wannabe public officials could not be solidly against something right up until they are for it.

Gov. Rick Perry has been solidly against expanding Medicaid to cover more of the state's needy and currently uninsured population, but the exact nature of his opposition has evolved in subtle ways.

That evolution continued Thursday when he sent a letter to the Texas congressional delegation urging the members to push for federal flexibility that would allow the state to expand healthcare coverage.

"With this increased flexibility, my goal is to better serve Texas' most needy, while promoting a sense of personal responsibility and ownership in an individual's own healthcare," Perry wrote.

Compare that with what he wrote in a letter to Health and Human Services Secretary Kathleen Sebelius in July.

"I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government," Perry told Sebelius.

Now, it turns out that the governor is willing to be a party to something very similar to Medicaid expansion, so long as he and other Texas officials obtain "flexibility" in the way they spend federal dollars.

Also in July, in a commentary published in The Washington Times, Perry had ugly things to say about those dollars.

"First, this 'federal money' is being printed out of thin air -- racking up trillions of dollars of debt on the backs of our children and grandchildren," Perry wrote. "Then, this money will run out, and then we'll be faced with mounting state costs and millions more people on public health rolls."

The governor may still have those concerns, but he didn't mention them in his letter to the Texans in Congress.

His emphasis now is on "securing flexible funding so we may tailor our program to specifically meet the needs of our citizens in a fiscally responsible manner."

Maybe flexible dollars aren't printed out of thin air, and maybe they don't run out.

Perry said he supports Medicaid changes outlined Tuesday in a federal budget proposal from Rep. Paul Ryan of Wisconsin, the former GOP nominee for vice president. Ryan proposed providing the ultimate flexibility, turning federal money over to states in block grants.

That's not likely, at least not until after President Barack Obama leaves office almost four years from now.

Obama didn't push his healthcare plan through Congress just to turn it all over to the states and have no say in what does or doesn't get done.

Perry has shown that his tone can change. Does that mean he can be flexible, too?

He told the Texas congressional delegation he wants to implement Medicaid changes including:

Cost sharing: Co-pays, deductibles and premium payments based on a sliding scale.

Asset testing: Ensuring care only "for those who need it."

Health savings accounts.

Promoting existing private coverage and employer-sponsored coverage.

He also wants every state to be allowed to take advantage of any waivers of Medicaid rules granted to any other state.

With many of the biggest changes specified in Obama's healthcare plan scheduled to take effect next year, and with the Legislature meeting in Austin and working on a state budget now for the next two years, there's pressure to get Medicaid expansion worked out.

Perry has gone from "we won't do this" to "here's how we want to do this." That's progress.

The subtleties of how Texas moves away from having the highest uninsured rate in the nation matter less than how far the state can move.

Mike Norman is editorial director of the Star-Telegram.

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Twitter: @mnorman9

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