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Will Texas Eventually Embrace Affordable Care Act?

July 9, 2012

UPDATE (7/9/2012 – 10:48 a.m.): Gov. Perry announced this morning that his administration will oppose Texas participation in the Medicaid expansion provision of the Affordable Care Act, as well as the creation of a state health insurance exchange. From the Perry statement: “"Neither a 'state' exchange nor the expansion of Medicaid under this program would result in better 'patient protection' or in more 'affordable care.' They would only make Texas a mere appendage of the federal government when it comes to health care."

AUSTIN, Texas - Stunned by the Supreme Court's recent decision to uphold President Obama's health-care overhaul, conservatives found some comfort in one part of the ruling. The Court rejected a provision that would have forced states to expand their Medicaid rolls with the help of federal dollars. The money will still be available, but optional.

Political scientists have described it as a states'-rights victory. However, lawmakers in Texas and other red states may be doing just as much squirming as celebrating, according to University of Texas-Austin government professor Bruce Buchanan.

"If they're having second thoughts, it's understandable, because it is an extremely advantageous package that the federal government is offering the states, with three years of 100-percent coverage."

Texas would leave big bucks on the table if it rejects the Medicaid expansion - probably more than $150 billion over the first decade. Starting in 2017, the state would be responsible for up to 10 percent of the new costs. Critics say that's 10 percent too much. However, rejecting the expansion would leave 1.5 million low-income Texans meant to benefit from the provision with no health coverage.

Buchanan, whose specialty is American politics, predicts that sooner or later most conservative governors and legislatures will set politics aside and choose to fully participate in the Affordable Care Act.

"They're still smarting from a completely unexpected Supreme Court decision. It's going to take a little time. Folks will have to go through the grieving process before they can come to terms with what makes the most sense for their states."

He says a just-released government report card ranking Texas worst in the nation in health-care quality makes it that much harder for politicians to justify turning down the Medicaid funds. The state also has the highest rate of uninsured residents, with 6.5 million people lacking coverage.

While decrying "Obamacare" as fiscally unsustainable, Gov. Perry and fellow Republicans have stopped short of declaring they will fight the Medicaid expansion. A Perry spokesman says Texas will not "fast track" participation. Buchanan thinks, ultimately, practicality will trump popular red-state political philosophies.

"There's resentment at federal control: If you take federal money, you have to cleave to federal guidelines. Texas is famous for having resented those kinds of things, which is partly rooted in the ideology of states' rights."

The legislature may take up the Medicaid expansion issue in January. Meanwhile, Texas leaders face another predicament: whether to set up the state's new insurance exchange or refuse to participate - thereby handing control to the feds.

Peter Malof, Public News Service - TX