As Legislative Session Wraps Up, 4 Reasons State Leaders Might Stop “Just Saying No” to a Texas Health Care Plan
On Tuesday, the Texas Legislature will finish its 2015 session without accepting – or seriously discussing – federal funding to expand access to health coverage for child care workers, cooks, construction workers, and others who don’t receive insurance from their employers. Heading into the session, chambers of commerce, doctors, and a long list of Texans urged state leaders to develop a Texas plan to use available federal funding to expand access to coverage, using commercial insurance with co-pays and other “personal responsibility” features.
Supporters cited the well-documented economic benefits of a health care solution, including new jobs, lower insurance premiums, less pressure on property taxes, and reduced state budget spending. Supporters warned that inaction would have dire consequences for uninsured workers -- a concern tragically illustrated by the recent news of an uninsured Texan woman who died of treatable cancer. In all likelihood, she would have received the treatment she needed if the Legislature accepted the funds intended to cover her.
So what happened this session?
With a new Governor, Lieutenant Governor, and chairs of key House and Senate committees, state leaders focused on establishing themselves in their new roles and passing their top agenda items. Senate leaders sent an odd list of demands to the federal government in lieu of a serious conversation. In the absence of any signals of support from the leadership, committees didn’t schedule hearings on the bills filed to address the issue, including the ones to get the ball rolling on the block grant approach state leaders have endorsed. The closest the Legislature came to taking action was when one Senator offered an amendment to accept the funding. It lost on a party-line vote.
But with the next legislative session 19 months away, and calls for a special session on health care already starting, here are four new dynamics that suggest state leaders might stop saying "no" and start figuring out a plan for the future:
1. The Waiver: The federal government recently informed state officials it will not automatically renew the temporary funding it granted Texas for unpaid hospitals bills under the "1115 Waiver." In making its decision, federal officials will consider whether Texas should be getting special payments for the uninsured patients who could be enrolled in Medicaid, but because of the state’s inaction are instead generating those unpaid bills. A recent hearing highlighted the need for a solution and the inconsistency in the Legislature’s acceptance of these 1115 waiver federal health care funds while it rejects the Medicaid expansion funds.
2. HurtingHospitals: There's growing attention in the media and across the state on the closure of rural hospitals and cuts to other hospitals. Accepting Medicaid funds would significantly reduce the uncompensated care provided by these hospitals to uninsured patients. It's the number one step state leaders can take to provide long-term support for our hospitals, the people who rely on them for a job, and the communities that rely on them to stay healthy.
3. Obama’s Out: When the Legislature convenes in 2017, there will be a new president. The “Obamacare” politics that date back to 2009 congressional debates provided the context for the state’s Medicaid discussion in the 2013 legislative session and the primary elections for current state leaders. The reflexive political stalemate over “Obamacare” will recede further after President Obama leaves the White House.
4. New Options: By 2017, there will be new policy options on the table, particularly in comparison to the 2013 legislative session, which was the last time state leaders had a real discussion on the matter. Other conservative states continue to develop and implement market-based approaches in collaboration with the federal government. Some Texas Democrats have signaled greater willingness to explore Republican block grant proposals. And a new “1332 Waiver” option will be available in two years to partner with a solution for uninsured low-wage workers.
In the meantime, we appreciate all the Texans who have worked on this critical issue. As we move into the interim, state leaders can expect more Texans to demand that they come up with a health care plan that gets more Texas workers care in clinics and doctors’ offices, while helping to keep the doors of our hospitals, large and small, open for business.