Texas Lawmakers Considering Medicaid Withdrawal
Emily Ramshaw reports that some Republican lawmakers in Texas are considering withdrawal from the federal Medicaid program in response to the state’s budget shortfall. As 3.6 million children, expectant mothers, people with disabilities and other Texans are enrolled in Medicaid and CHIP, this withdrawal would have a major impact on the lives of many people.
Budgeting is serious business, of course, and asking where the money will come from to pay for expansions of Medicaid is more than fair, but a change of this magnitude, one that could literally have consequences for people’s lives, demands that those proposing the withdrawal offer a workable alternative for providing care for these millions of people.
Whatever its inefficiencies and weaknesses, Medicaid has done a tremendous amount of good. It enables expectant mothers, especially those who need extraordinary care to maintain a pregnancy, to get that prenatal care and those other necessary health serves. It also helps keep from bankruptcy those with and without insurance who are faced with six-figure bills for life-saving surgeries, therapies, and medical equipment. And, of course, it allows those who are uninsured and under-insured to get the care they need.
The program is not beyond critique, and perhaps there are alternatives that would prove more cost-effective and provide better care, but the Texas lawmakers proposing withdrawal from the program had better be sure that their alternative meets those needs now being met by Medicaid. They have a moral responsibility to do so.
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The other very major constituency for Medicaid are elderly folks in skilled nursing facilities (aka nursing homes/rehab centers) who’ve depleted their assets.
It seems Texas is in a rush to beat “Obamacare” to “death panels”. Except, of course, the death panel would be the state government itself.
Not a big deal. With two or three phone calls, Austin could call some of his big time Republican charitable giving friends and have them divert some of their contribution to the Opera to fund a private charity that would pick up all of the slack here.
It’s easy to target Texans (and many of them kind of enjoy it). But the legistlators have a moral obligation to their citizens to govern within the limits of their powers. Every state is going to have to decide what gets funded and what gets cut.
Kansas – where I live – is facing the same federally mandated expansion of Medicaid, with federal subsidy for the increases expiring in 2017. You can’t produce a large number of doctors and nurses to address the predicted increased demand in three years.
Moreover, the budget of state governments have significantly less pork to trim than the federal budget. It is quite likely that several states will not be able to afford their portion of the payments.
Unlike the federal government, all the states except Vermont have a legal requirement of a balanced budget. Some are constitutional, some are statutory, and some have been derived by judicial decision from constitutional provisions about state indebtedness that do not, on their face, call for a balanced budget.
If this was as simple as “good Republicans (or Democrats), bad Democrats (or Republicans)”, it would already have been done. From whatever political direction one approaches it, this unhappy situation is not easy.
Oh my God how tragic!
Bruce,
You points are valid.
I would just add that if, as you say, you can’t produce a large number of doctors and nurses to address the predicted increased demand in three years, that indicates that the uninsured are truly going without needed health care and are not (as some claim) doing just fine with charity care.
“If this was as simple as “good Republicans (or Democrats), bad Democrats (or Republicans)”, it would already have been done. From whatever political direction one approaches it, this unhappy situation is not easy.”
I’m surprised to hear even this much conceded. I had thought that “socialized medicine” was an obvious evil that the nation was clamoring to abolish.
To suggest that the decision is “not easy” strikes me as being soft on communism.
:-)
As 3.6 million children, expectant mothers, people with disabilities and other Texans are enrolled in Medicaid and CHIP, this withdrawal would have a major impact on the lives of many people.
Texas isn’t the only state considering this. If a state did opt out of Medicaid, this wouldn’t mean that people currently on Medicaid wouldn’t be covered. Rather, they would be eligible for the new federal subsidies in the PPACA and would get coverage through the exchange.
As the article I linked to above indicates, this is hardly an unforeseen consequence of the bill. If you require cash strapped states to increase their Medicaid expenditures while simultaneously creating an alternative means of covering the poor that the state doesn’t have to pay for, you shouldn’t be surprised if at least a few states decide continuing in Medicaid isn’t worth the trouble.
Rather, they would be eligible for the new federal subsidies in the PPACA and would get coverage through the exchange.
Blackadder,
What new federal subsidies in PPACA?
“Texas isn’t the only state considering this. If a state did opt out of Medicaid, this wouldn’t mean that people currently on Medicaid wouldn’t be covered. Rather, they would be eligible for the new federal subsidies in the PPACA and would get coverage through the exchange.”
The exchanges would not be set up until 2014. Until then they would be crammed, perhaps, into the temporary high-risk pulls. But what if the Republicans follow through with their plan to attempt not appropriate funds through the mechanisms that the health care law calls for?
And regarding Texas beating “Obamacare” to the punch, “google” the Texas Advanced Directives Act — “death panels” on steroids and attempts to reform it by the state’s pro-life group and the ACLU (what a combination) has been undermined by the Republicans.