Despite Perry’s stance, Texas opposition to the ACA decreasing

Despite Perry’s stance, Texas opposition to the ACA decreasing

One in a series of articles examining the rollout of the Affordable Care Act around the nation

     Now that the biggest challenges to the Patient Protection and Affordable Care Act (ACA) are behind it, all that’s left is the implementation stage. But not all states are on board with the changes being brought about by healthcare reform.

     Texas is moving particularly slowly, though aspects of the ACA are increasingly gaining support across the state.

     Under the ACA, each state will have a health insurance exchange, a marketplace through which Americans can shop for health insurance. The states can run their own exchange or partner with the federal government to get the exchange ready to enroll consumers by Oct. 1, 2013. If a state does not set up an exchange or partner with the federal government to do so, the U.S. Department of Health and Human Services will set up that state’s exchange.

Count Texas as one of the states that is passing the buck to the federal government. In November, Texas Gov. Rick Perry, a Republican, wrote in a letter to Health and Human Services Secretary Kathleen Sebelius: “Texas will not implement a so-called state exchange. In its current form under the Patient Protection and Affordable Care Act . . . the exchange presents an unknown cost to Texas taxpayers. It would not be fiscally responsible to put hard-working Texans on the financial hook for an unknown amount of money to operate a system under rules that have not even been written.”

     The exchanges aren’t the only aspect of the ACA that Perry has no intention of participating in. Beginning in 2014, states can expand Medicaid to cover Americans making up to 133 percent of the poverty level, estimated to be $29,000 for a family of four. Perry announced last summer that Texas would have no part of it.

 Pushback on Medicaid Rejection

     But Perry’s stance against the Medicaid expansion has angered many in Texas, raising questions about whether he will be able to keep the Medicaid expansion from taking place.

     “I am extremely disappointed that Governor Perry said he plans to do nothing to implement key provisions of the Affordable Care Act that would provide access to health insurance for millions of hardworking Texans,” said state Sen. Rodney Ellis, a Democrat, in a statement. “I believe his plan is shortsighted, and it is not the final word.”

     Texas has the highest uninsured rate in the country, with 25 percent of Texans lacking health insurance, compared with 16 percent of all Americans, according to the Texas Medical Association. That adds up to more than 6.3 million Texas residents with no health insurance, of whom 1.2 million are children. Advocates of the Medicaid expansion argue that it would cut down on the number of uninsured Texas residents. In fact, Ellis argues that the expansion could provide health insurance to 1.5 million low-income Texas residents over the next decade.

     Under the ACA, the federal government would pay for most of the Medicaid expansion in 2014. Over the next six years, the states would have to take on more of the burden until they ultimately paid for 10 percent of the cost by 2020. However, a study by the Perryman Group, a financial-analysis firm, found that the Texas expansion would pay for itself: It is estimated that every $1 spent by the state of Texas on expanding Medicaid would yield $1.29 in state-government revenue over the first 10 years of the expansion. Another study, commissioned by Methodist Healthcare Ministries of South Texas, found that Texas would receive about $100 billion from the federal government over 10 years at a cost of only $15 billion to the state.

 Medicaid Expansion Gaining Support

     A January poll conducted by the American Cancer Society Cancer Action Network found that 58 percent of Texans wanted the state to accept federal funds for Medicaid. The state’s two largest health-care trade organizations — the Texas Medical Association and the Texas Hospital Association — have also voiced their support for the Medicaid expansion, though they also called for some reforms to the program, such as changes that would ensure that more physicians agreed to treat Medicaid patients. Most recently, Dallas County officials have adopted a resolution supporting the Medicaid expansion.

     While it is technically not Perry’s decision and it’s up to the Texas Legislature to determine whether the state will take part in the Medicaid expansion, Perry has the power to veto a vote of approval. However, Ellis has proposed a constitutional amendment to let Texas voters decide on whether the state ultimately takes part. The proposed amendment must be voted on by the Legislature.

     “I have filed a constitutional amendment to give the voters of Texas the right to decide whether Texas expands our Medicaid program, and I will continue to work with my colleagues in the Legislature to try to take steps to implement health exchanges and expand access to Medicaid, because the problem is too great for us to sit on our hands,” Ellis said.

     Tamara E. Holmes is a Washington, D.C.-based journalist who writes frequently about health and wellness.