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July 10--It wasn't a surprise, but now it's official: On Monday Gov. Rick Perry publicly rejected an opportunity to extend Medicaid health insurance to as many as 2 million more Texans through the Patient Protection and Affordable Care Act, popularly known as "Obamacare."
The Supreme Court on June 28 affirmed the constitutionality of most of the ACA, including the law's key "individual mandate" provision. However, Chief Justice John Roberts allowed states to opt out of another ACA provision, one that would expand Medicaid coverage to states' residents by broadening eligibility requirements.
Perry is the sixth governor to reject Medicaid expansion. Medicaid, funded by a combination of state and federal funds, currently covers some 3.4 million Texas residents. Texas has the highest percentage of uninsured residents in the country.
In a June 9 letter to Health and Human Services Secretary Kathleen Sebelius, Perry described the Medicaid expansion plan, and the state-level "health insurance exchanges" called for under the ACA, as "brazen intrusions into the sovereignty of our state."
"Neither a 'state' exchange nor the expansion of Medicaid under the Orwellian-named PPACA would result in better 'patient protection' or in more 'affordable care,'" Perry wrote. "What they would do is make Texas a mere appendage of the federal government when it comes to health care."
He argued that expanding Medicaid would mean expanding an already financially unsustainable system and that Texas could suffer "financial ruin" as a result. The state is already facing an estimated $4.3 billionMedicaid shortfall -- self imposed by the Legislature, which opted to defund the program in order to help balance the budget.
Under ACA, the federal government, beginning in 2014, would pay 100 percent of the cost of Medicaid expansion the first three years, then between 93 and 95 percent the next three years, then 90 percent at least until 2020. The current federal Medicaid reimbursement to states averages between 55 and 60 percent.
According to the Texas Health and Human Services Commission, Texas would receive $76 billion in Medicaid funds between 2014 and 2019, while the state's share would be around $6 billion. The state's anti-ACA forces estimate the cost at several times that.
Although Texas -- which also boasts among the country's most stringent Medicaid eligibility requirements -- would forfeit tens of billions of dollars in federal assistance by rejecting Medicaid expansion, Perry and other critics of expansion argue nevertheless that the cost to the state would be an unmanageable financial burden.
Twenty-five percent of Texans, or 6.2 million residents, lack health insurance of any kind. In the Rio Grande Valley, unsurprisingly, the percentage is much higher -- as much as 40 percent by some estimates. In addition to rejecting Medicaid expansion, Perry also gave the thumbs down to the idea of state-administered health insurance exchange provided for by the ACA on the grounds that the federal government would have too much control.
The exchange would have allowed low-income Texas residents and small businesses with up to 100 employees to buy insurance coverage in a competitive market. Perry's rejection doesn't mean there won't be an exchange, it just means the federal government will run it rather than the state. The same goes for other states that opt out.
Stanley Fisch, a Harlingen pediatrician since 1973, said he finds it odd that Perry -- given his concern over federal influence in state affairs -- would opt for a federally administered exchange as opposed to letting Texas have its own. Fisch added that he was dismayed by Perry's announcement Monday.
"I think it's rather sad and short sighted, as often things are in Texas," he said. "Texas is once again leaving an awful lot of money on the table for other states to grab. We in Texas pay a lot of federal income tax and very little of it is coming back."
That's the economic angle, Fisch said. Looking at it from the "social compact" angle, the governor seems "very stingy and very oblivious to the needs of his fellow citizens," he said.
Elena Marin, a pediatrician and CEO of Harlingen-based Su Clinica, said Perry's decision means that "families most in need will not have access to affordable health care services." She said Americans are caught in the middle of a polarized political debate, and that while the ACA isn't perfect it's a good first step toward addressing the very complex issue of health care. Marin, who began practicing in the Valley in 1986, said she's witnessed first hand how Medicaid dramatically improved children's health and brought down the cost of treatment by getting patients into clinics and out of emergency rooms.
But Perry and other critics of the ASA Medicaid expansion provision say a better solution would be to provide Texas with a federal block grant the state can use to tailor health care delivery according to its specific needs.
"I look forward to implementing health care solutions that are right for the people of Texas," he wrote in the letter to Sebelius. "I urge you to support me in that effort. In the meantime, the PPACA's unsound encroachments will find no foothold here."
(c)2012 The Brownsville Herald (Brownsville, Texas)
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