Legislators seek ways to insure more Texans

Republicans discuss possible alternatives to expanding Medicaid.

Texas Republicans have drawn a line in the sand, saying no to expanding Medicaid as proposed by the federal Affordable Care Act, but that doesn’t mean the possibility of insuring more Texans is dead.

Meeting privately, leading Republican legislators are working to craft a politically acceptable solution to present to the Obama administration — a negotiating stance that would meld free-market reforms with a desire to reduce the number of uninsured low-income Texans.

Details are sketchy, with numerous ideas being discussed and weighed, but at least in the Legislature, the discussion has shifted from a firm “no” to “what’s available?”

House Speaker Joe Straus, R-San Antonio, said Thursday that he is trying to steer the conversation toward reforms that make sense for Texas.

“After you say no, the next question is: OK, then what? We need to move forward now with something that is more specific, put it on the table and negotiate it,” Straus said.

A central question is whether an agreement can be crafted that wins the approval of Gov. Rick Perry, who adamantly opposes Medicaid expansion and vigorously attacked Affordable Care Act, dubbed Obamacare, in his unsuccessful presidential campaign.

Straus said he didn’t anticipate a conflict with Perry.

“I don’t think there’s separation here,” he said. “Gov. Perry is a good negotiator, and I don’t think he’ll make a bad deal for Texas. I just want the Legislature to be a good, supportive partner in trying to work out something that does make sense for Texas and for Texas taxpayers.”

Perry spokesman Josh Havens said the governor is looking for solutions that reinforce individual responsibility, control costs and address the state’s unique needs.

“Naturally, it all depends on what the proposal is,” Havens said. “The governor is always open to discussing Texasbased solutions because Texas knows best how to take care of Texans.”

State Rep. John Zerwas, R-Simonton, a doctor involved in the legislative discussions, said the goal is identifying reforms to present to the Centers for Medicare and Medicaid Services, or CMS, the agency that would have to approve a Texas-specific plan under the Affordable Care Act.

“I think there are enough people around here who can put their heads together and come up with a potential solution and, hopefully, negotiate that with CMS,” Zerwas said. “The fact that people are really very energized and talking about this now, as opposed to the line in the sand on Medicaid expansion, (means) we are moving toward having that opportunity.”

Two key state senators have, in recent days, floated proposals that are being taken seriously by fellow Republicans.

Sen. Bob Deuell, RGreenville, who also is a doctor, recently sent a letter urging Perry to seek federal money as a block grant, allowing Texas to implement innovations that would cost “much less money” than the $100 billion the state would receive over the next decade to expand Medicaid.

“We should work with the private insurance industry ... to establish a system of modest premiums, co-pays and deductibles based on income,” he wrote. “We could encourage healthy lifestyles by adjusting co-pays and deductibles based on such factors as smoking, weight, blood pressure, cholesterol, etc.”

Block grant money also could help eligible Texans pay employer insurance premiums or reduce deductibles, he added.

Sen. Tommy Williams, R-The Woodlands, chairman of the Senate Finance Committee, said he believes Texas must push for a flexible alternative to an “inefficient” and “broken” Medicaid system.

Among Williams’ suggestions: create a system of co-pays and deductibles for Medicaid recipients; expand Medicaid managed care programs to streamline and cut costs; and create financial incentives for patients to avoid emergency rooms.

Republicans don’t yet have a specific plan to offer, Straus said.

“I cannot tell you what that recipe is, but it would have to include a more efficient system: one where there is personal responsibility; one where there is co-pays involved; and a number of reforms that others have been out there talking about,” he said.

“It’s not about the money on the table,” Straus said. “It’s about a more rational approach to health care delivery for the poor and uninsured population of the state, which is very significant.”

Legislators and the public will have an opportunity to discuss Medicaid spending at a House Appropriations Committee hearing Friday morning.

Straus said the hearing will be a good opportunity to see how members work together “and what they have to talk about.”