Is expanding Medicaid still possible?

If there’s any truth to a recent report that Gov.-elect Greg Abbott might be open to a compromise that would allow the state to cover more of its uninsured, it would be the stuff that stunning political reversals are made of.

According to the Houston Chronicle, during a private meeting with lawmakers in December, Abbott signaled, if ever so subtly, that he may be warming to the possibility of finding an alternative way for Texas to use federal tax dollars under the Affordable Care Act to provide health insurance to low-income Texans.

Abbott reportedly “asked for more information about a compromise recently struck by the Republican governor of Utah and the federal government that could pave the way for that heavily conservative state to expand Medicaid through the president’s signature health care law.”

Asking for more information isn’t necessarily the harbinger of a drastic ideological shift, but for some observers it’s cause for optimism.

Especially given the governor-to-be’s vehement opposition to the ACA, the sweeping legislation that originally required states to expand their Medicaid programs to cover more of the uninsured.

As Texas attorney general, Abbott joined a legal challenge to the law that reached the Supreme Court. And in 2012, he and more than two dozen co-plaintiffs won the right for Texas and other states to opt out of the Medicaid expansion provision.

During his campaign for governor, Abbott vowed to follow in the footsteps of his predecessor and not expand Medicaid — a program he and many conservatives deem costly and ineffective. However, he hasn’t to date provided an alternative.

Perhaps that’s why his comments in Houston, whether sincere or misinterpreted, have set off a flurry of speculation. Might the soon-to-be-governor be willing to compromise with the Obama Administration?

It’s not surprising that Abbott’s office recently attempted to clarify his remarks: “Fear not — Governor-elect Abbott has fought Obamacare and will continue to fight against it,” spokeswoman Amelia Chasse told the National Review Online.

But his curiosity about alternatives has already renewed the discussion over how state lawmakers might work to extend medical insurance to millions of Texans who have fallen into the “coverage gap.” That, in itself, is a good thing.

Proponents of Medicaid expansion have long argued that the state’s refusal to grow the program is permitting billions of dollars in federal taxes paid by Texans to go to other states to fund their programs. That’s the same argument Sen. Wendy Davis used in her campaign for governor, although the majority of Texans didn’t seem to buy it.

Other policy and healthcare analysts have argued that some sort of state-specific compromise, like the one reached with Utah, would be more effective. Utah’s plan, for example, would use Medicaid expansion dollars to buy private coverage for low-income adults earning below 138 percent the federal poverty level, with some cost-sharing requirements.

Perhaps prompted by the recent scuttlebutt, Dallas’ conservative think tank, the National Center for Policy Analysis, last week released a study urging lawmakers to continue rejecting Medicaid expansion, which it argues would overwhelm healthcare providers and actually further decrease access. Instead, the study pushes for an alternative that would provide subsidies to low-income uninsured so they could enter the private insurance market.

In November of last year, a board of medical professionals appointed by outgoing Gov. Rick Perry provided a series of recommendations to policymakers, including one that the state’s health commissioner be authorized to negotiate with the federal government to expand health coverage to the poor “using available federal funds.”

Those available funds would include an estimated $100 billion of federal taxpayer money over 10 years.

In contrast, the Code Red Task Force on Access to Health Care in Texas also released a report last week that determined the state’s failure to expand Medicaid will cost Texans an estimated $32 billion in federal taxes over 10 years. The Code Red report similarly recommends Texas negotiate with the federal government on an alternative plan to use Medicaid funding.

It would be stupidly optimistic to assume Abbott, who has spent the last several years fighting the ACA, is suddenly willing to negotiate with the federal government on Medicaid expansion, particularly with the very conservative Legislature about to convene. But momentum for some kind of solution for covering uninsured Texans seems to be building, and even he can’t avoid being caught up in it.