Contrary to some hopeful liberal trumpeting, incoming Texas Gov. Greg Abbott hasn’t decided to expand Medicaid under Obamacare — yet. Thanks to pressure from the state’s hospital lobbyists, though, he might.
Texas hospitals — one of Abbott’s major sources of campaign cash — are lobbying for an alternative Medicaid expansion, which they call “The Texas Way.” Rumors have flown that Abbott is leaning towards this plan, but his team tries to tamp the rumors down. Nevertheless, the hospitals hold out hope, and Obamacare opponents worry.
Here’s the story so far:
Title II of the Affordable Care Act provided extra money to states who expanded their Medicaid programs to include all individuals earning up to 138 percent of the federal poverty level, including able-bodied working-age adults who don’t work full time.
Most Republican governors and legislators have turned down the extra Medicaid money because they didn’t like the strings attached.
Some red states, such as Indiana, Arkansas, and Utah, have implemented or considered alternative Medicaid expansions that include private insurers and work requirements on able-bodied recipients. Such states want the Obamacare cash as long as they can get waivers from Uncle Sam.
Outgoing Texas Gov. Rick Perry opposed Medicaid expansion. On the campaign trail, Republican nominee Abbott did, too.
After Abbott easily won election, though, some promising signs for Medicaid expansion began to appear.
A panel for the state’s Institute of Health Care Quality and Efficiency, populated by Perry appointees, recommended Medicaid expansion.
Abbott picked as his Secretary of State a public supporter of expanding Medicaid, Judge Carlos Cascos. As his deputy budget director, Abbott tapped the Chief of Staff to Rep. John Zerwas, the legislator who had proposed a Medicaid expansion bill in 2013.
The Houston Chronicle reported in December that Abbott was seriously eyeing an expansion.
Health-policy experts dialed into the Texas GOP dismiss the Chronicle report as a misunderstanding. It appears that, at a meeting with Houston-area legislators, someone brought up Utah’s proposed Medicaid expansion. Abbott, unfamiliar with Utah’s plan, asked his staff for a report on it. This query was soon trumpeted in the liberal media as a sign Abbott was about to expand Medicaid.
This buzz was merely “wishful thinking from the Left, trying to create an echo chamber,” Christie Herrera, a senior fellow at the conservative Foundation for Government Accountability, told me.
“Governor-elect Abbott has fought Obamacare and will continue to fight against it,” spokeswoman Amelia Chasse told Joel Gehrke of National Review. “He believes the ACA is not the best option for patients, doctors or taxpayers.”
Yet, Obamacare opponents remained worried. “It didn’t have a denial in there,” Michael Cannon, director of Health Policy Studies at the libertarian Cato Institute said. Cannon’s worry, shared by others, is that Abbott will be swayed.
“You don’t know if you’re dealing with a Bobby Jindal,” Cannon said, referring to the Louisiana governor who steadfastly resisted a Medicaid expansion, “or if you’re dealing with a Rick Scott.” Scott, Florida’s GOP governor, loudly opposed Medicaid expansion until he flip-flopped in 2013 (though the state’s Republican legislature has so far blocked it).
The Jindal-Scott contrast is important for the Texas case. In both Louisiana and Florida, the hospital lobby pushed Republican governors to expand Medicaid. Industry lobbying swayed Scott, himself a former hospital executive. Jindal, in contrast, pushed back on the hospital lobby, warning them that their short-term gain would bring greater government control of their industry.
The Texas Hospital Association has been pushing for a waiver-expansion program, these days calling it “the Texas Way.” Under this plan, Texas would apply for a waiver, and try to get Obamacare money through its own type of Medicaid expansion, involving health savings accounts, private insurers, and work incentives.
John Davidson of the Texas Public Policy Center calls this push “a concerted effort by the hospitals underway to seek a Medicaid expansion waiver without calling it that.”
John Hawkins of the Texas Hospital Association disagrees. “I guess it’s a question of language, but this isn’t what we would call a Medicaid expansion.”
Others in the industry have been more direct. “We should be maximizing available federal funds through the Medicaid program,” Joel Allison, CEO of Baylor Scott & White Health System said in the days after the election, endorsing the Institute of Health Care Quality and Efficiency’s recommendation to expand Medicaid.
Baylor Scott & White operates hospitals throughout the state. The chairman of the company’s board, Drayton McLane, was Abbott’s most visible donor, giving him $350,000.
Abbott takes office on January 20. After then, Texans will learn how much sway the hospital lobby has over their governor.
Timothy P. Carney, The Washington Examiner’s senior political columnist, can be contacted at [email protected]. His column appears Sunday and Wednesday on washingtonexaminer.com.
