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Grandstanding over Medicaid

July 15, 2012

…GOV Rick Perry recently rejected a federally funded expansion of Medicaid — one that could provide healthcare coverage for roughly two million uninsured Texans. Maybe such showboating is good for Gov Perry politically. But it’s awful for Texas, where 6.2 million people — 25 per cent of the state’s population — are uninsured…. Under the proposed expansion, somewhere between 1.5 million and 2.3 million low-income Texans — most of them working people too poor to buy insurance — would receive Medicaid. In his letter, Gov Perry wrote that such an expansion would “bankrupt even Texas”.

There, he’s dead wrong. On Thursday Tom Suehs, the Perry-appointed state commissioner of health and human services … said, Medicaid expansion [over the next decade] wouldn’t cost $26bn to $27bn, as previously projected; it’d be $15bn to $16bn. Yes, even that lower cost is a lot of money. But by ponying up over that decade, Mr Suehs notes, Texas would receive an additional $100.1bn in federal money….

That federal money could be used to fix our current indigent-care system — which, unlike Medicaid expansion, really does pose a danger of bankrupting Texans. Right now, people without health insurance ignore alarming symptoms as long as possible, and when they finally collapse, they end up in emergency rooms — the most expensive, least efficient form of healthcare. Of course the indigent can’t pay those bills. Hospitals stay afloat by passing their costs on to taxpayers and insured patients….

As Mr Suehs said sensibly, the question isn’t whether Texans will pay for indigents’ healthcare; we already do. The question is how we’ll pay for it — on a statewide basis, using state and federal Medicaid money; piecemeal but intentionally, letting individual counties apply for federal Medicaid money; or in the clumsy, cost-uncontrolled way that we do now, through insurance and property taxes. Expanding Medicaid statewide, and paying for clinic visits long before a patient is hauled away in an ambulance, is both the cheapest option and the best for keeping Texans healthy…. And without the federal matching funds, it’s hard to see how our cash-strapped state government could begin to fix our broken system. Nor does it make sense to let each Texas county make its own Medicaid deal directly with the federal government. That patchwork system would involve a vast, needless duplication of effort, creating precisely the kind of bureaucratic inefficiency that Gov Perry decries. And clearly, we can’t do nothing, allowing Texans’ healthcare costs to continue spiralling out of control. But that’s what could happen if divisive politics trumps mathematical reality: amid all the rhetorical thunder, Gov Perry hasn’t yet offered any alternative plan.—(July 13)