AUSTIN -- Republicans in the Texas House voted Monday against expanding Medicaid in its current form, but left open the door to negotiations with the federal government.
The House Republican Caucus met behind closed doors and voted against expanding Medicaid under the Affordable Care Act's current regulations, said Rep. Lois Kolkhorst, Republican chairwoman of the Public Health Committee. In return for spending $15 billion over the next 10 years on Medicaid, Texas would get $100 billion to provide health care to an additional 1.5 million poor people.
But Texas Gov. Rick Perry is adamantly opposed to enrolling more people in the joint federal-state health care program for the poor and disabled. As expected, Republican House members voted to back him.
Perry and House Republicans, though, remain open to expanding Medicaid if given a waiver from federal regulations in order to tailor the program to fit Texas' needs. Democratic lawmakers have said they are talking to Obama administration officials about what kind of deal is possible.
"That was kind of a vote to say, 'we're going to continue conversations,'" Kolkhorst said of the caucus meeting. "We have so many doctors who won't even see the current Medicaid population, so you're actually promoting a system that hasn't worked extremely well in the state of Texas. Instead, we're working toward a Texas solution."
Last week, federal officials granted a waiver to Arkansas that allows Medicaid expansion by subsidizing private health insurance, rather than using the state Medicaid program.
Sen. Tommy Williams, the Republican chairman of the Senate Finance Committee, wrote an op-ed distributed to paper's across the state last week saying that Republicans would like to see people on Medicaid contribute, if even a small amount, toward their health care through deductibles, co-pays or premiums. He also wants a program that encourages people to see their regular doctor rather than rely on expensive emergency room visits.
Kolkhorst said a bill spelling out what kind of federal waiver Texas wants could be introduced this week, setting in motion the possibility of a compromise. Friday is the deadline for introducing new bills for this legislative session.
"Both Democrats and Republicans, there are a lot of smart minds working on this," Kolkhorst said. "There is a divide philosophically on how to cover the uninsured in Texas, but that's OK. Our differences are what make us stronger."
Democrats have said they hope they can reach a compromise that will win support from Perry, who has veto power.
Hundreds of uninsured Texans and activists plan to rally at the steps of the Capitol today, increasing the pressure on Perry and other Republican leaders to switch their stance on expanding Medicaid.
When Perry made his decision official in July, he wrote of standing "with the growing chorus of governors who reject the Obamacare power grab."
In recent weeks, however, that chorus has diminished, as several Republican governors who had resisted the expansion -- including Chris Christie of New Jersey and Rick Scott of Florida -- said they would accept federal money to expand the program. Meanwhile, the number of state organizations and individuals who vocally support an expansion in Texas has grown.
Several cities and counties have passed resolutions calling for expansion of the program -- including the city councils of Austin and Waco -- as have health care and financial experts, including Elena Marks, former director of health policy for the city of Houston, and Ray Perryman, an influential economist in Waco.
The Texas Medical Association, which represents more than 47,000 physicians and medical students, asked state leaders to expand the program while instituting reforms. This report contains material from The New York Times.