On Thursday, Sen. Jane Nelson, R-Flower Mound, sat facing the two leaders of the Texas Health and Human Services Commission and held up a sheet of paper showing how the state’s Medicaid expenditures have increased by nearly $37 billion since 1990.
“To those of you who are out there who can’t see this, that’s the line,” she said, pointing her finger at its peak. “How can the state do better?”
Medicaid expenditures next year are expected to reach $39.576 billion, up from $3.256 billion in 1990. And, yes, the federal government will pay for 60 percent of that amount. But beyond the ever-increasing expenditures, the state still provides $4 billion in uncompensated care to the uninsured throughout the state, an amount that tops 6.5 million people.
That chart was on page six of a presentation prepared by the HHSC and presented to the Senate committee Thursday afternoon in Austin. The state’s 24.6 percent uninsured rate is the worst in the nation. The meeting was called to discuss market-based alternatives to covering the estimated 1.3 million Texans who fall into the so-called coverage gap: Those who make too much to qualify for Medicaid but not enough to qualify for federal subsidies on the health insurance marketplace.
However, the Health and Human Services committee’s new chairman, Sen. Charles Schwertner, R-Georgetown, said the state’s hope to reach a deal with the federal government to provide Texas with Medicaid block grants and waivers appeared to be dashed for now. As such, no plan emerged to avoid expanding Medicaid while still providing coverage to the uninsured.
Lawmakers have refused expansion, deriding it as a too-broad attempt by the federal government to meddle in state policy. Gov. Rick Perry has called it “misguided” and “ultimately doomed.” However, the federal government would pick up 100 percent of the costs incurred by the coverage gap from 2014 to 2016 and 90 percent thereafter if it were to be expanded.
Even without signing on, more than 700,000 Texans have registered for Medicaid since President Barack Obama’s signature healthcare law went into effect.
And so, Thursday’s meeting turned into a synopsis of the myriad programs the state has in place with local stakeholders and the federal government to help low income residents gain coverage. But funding some of these projects can be tricky: HHSC Executive Commissioner Dr. Kyle Janek said the feds often determine what to give, leaving the state to portion out to the local stakeholders that participate.
“I try to hit that point where I get everybody equally mad at me,” Janek said. “It is a finite number of dollars and our local public hospital districts have done a yeoman’s job at putting up as much local money as they can to get that federal match.”
Hours before the briefing, county judges in six of the state’s most populous counties—Bexar, Dallas, El Paso, Harris, Tarrant, and Travis—sent a letter to the committeeurging them to “find a Texas way” to “fund and increase access to healthcare coverage for low-wage working Texans.”
“As Texas County leaders, we believe a uniquely Texas solution can be found. We again ask for your and your committee’s help in developing this solution. As (Harris County) Judge Emmett has said, ‘Healthcare defines us a society. Leaving people without healthcare is not good for them, our community, or our society.’”
But it still seems too early to see what path lawmakers will likely take. No coordinated plan appeared after the session wrapped.