Texas eyes impact of new GOP health bill

Latest repeal effort may be boon to state, but some voice skepticism.

The latest iteration of Republican efforts to replace the Affordable Care Act appears at first blush to be a potential boon to Texas by making it eligible for an estimated $34 billion in additional federal health care funds through 2026 if the plan wins approval — more than any other state.

But some health care advocates say they are skeptical of the prize.

“In the short term, it looks like the impact isn’t terrible” for Texas because of the extra money in the form of block grants, said Stacy Wilson, president of the Children’s Hospital Association of Texas, which represents eight nonprofit children’s hospitals, including Dell Children’s Medical Center of Central Texas.

But “we are very concerned that (once the block grants expire after 2026) we are going to see huge, draconian cuts to the Medicaid program,” Wilson said. “We think children, especially disabled children, are going to suffer under this.”

In addition, states would have only until 2020 to determine how to use their block grants and set up systems for doing so — a tall order for Texas and others that opted to rely on the federal government instead of establishing their own health insurance marketplaces under the Affordable Care Act.

“Under this bill, (Texas) would have to provide the infrastruc-

ture,” said Kay Ghahremani, chief executive of the Texas Association of Community Health Plans, a consortium of 11 health plans across the state serving mainly Medicaid patients. “That is a big, new administrative function that the state would have to take on.”

The U.S. Senate is expected to vote next week on the bill, sponsored by Republican Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana, which would repeal key elements of the Affordable Care Act, former President Barack Obama’s 2010 law that’s known as Obamacare, and dismantle an expansion of Medicaid eligibility that it instigated.

Medicaid is the federal program that pays for health care services for low-income families and individuals under a cost-sharing arrangement with states.

The Obamacare repeal effort — which comes in the wake of the GOP’s failure to repeal Obamacare two months ago using a different plan — would eliminate key Obamacare features and replace more than $1 trillion in federal funding earmarked for the Medicaid expansion and for insurance subsidies with block grants to the states from 2020 to 2026.

Under the formula that the Graham-Cassidy plan would use to determine the size of the block grants, states such as Texas that opted against expanding Medicaid programs would get significantly more money than those that expanded Medicaid.

An analysis by the Kaiser Family Foundation found that Texas would receive $34 billion more in federal funds through 2026, followed by Georgia at $10 billion and Tennessee at $7 billion. California, which substantially expanded coverage under Obamacare, would see its federal funding drop by $56 billion, according to the Kaiser study.

Meanwhile, the plan would cut federal funding for the traditional Medicaid program by putting a per-person cap on it. Some area health care advocates said the change could hurt Texas in particular because the cap would be locked in based upon the relatively low amount Texas now spends on Medicaid relative to the size of its population, with only small increases for inflation.

But U.S. Sen. John Cornyn, R-Texas, said the state “would end up doing very well financially” under the Graham-Cassidy bill, and he said it would “shift a lot of responsibility back to the state in order to come up with plans that would actually serve the interests of Texans.”

During a visit Friday to Austin, Cornyn said he isn’t certain if the bill has enough GOP support to win approval.

“The idea, though, I think has a lot of merit, and that is to return more of the authority to spend health care dollars and to design health care plans that meet state and regional and local needs, rather than to try to do that on a one-size-fits-all out of Washington, D.C.,” Cornyn said.

JoAnn Fleming, executive director of Grassroots America-We the People, a tea party-aligned organization that has the ear of conservative Texas lawmakers, said she has concerns about the legislation but supports it as an “interim step” toward a health care system based more upon free-market principles.

“We do believe that it is good that we move toward a more federalist model of block-granting Medicaid to the states,” Fleming said. “Texas decision-makers know Texas better than Washington, D.C., does.”

Fleming said Gov. Greg Abbott and other top state leaders should convene a state task force soon to begin preparing for such a change and devise a plan for “how to provide the most service to eligible (Medicaid) recipients at the best price.”

A spokesman for Abbott didn’t respond to requests for comment.

U.S. Rep. Lloyd Doggett, D-Austin, called the bill “a disaster” and said Texas is only in line to get the biggest block grant under it “because it did the least” regarding health care for its citizens to begin with.

In addition, he said, Texas would lose a large amount of health care funding in the long term as the bill cuts overall Medicaid funding. Doggett said the state likely would end up rationing “care to the elderly, children and people with disabilities.”

Bob Jackson, Texas state director for the AARP, said he’s worried about the kind of plan Texas leaders will come up with if the bill wins approval, because it would allow states to apply for waivers to opt out of many provisions guaranteed under the Affordable Care Act — such as the mandate that pre-existing conditions be covered and the cap on how much higher insurers are allowed charge older people compared with younger people for premiums.

“Texas policymakers don’t have a track record of taking care of very vulnerable people,” Jackson said. The bill “could be really good if you’re young and healthy and don’t need health care. (But) if you’re sick and need health care, it could be catastrophic and you could be priced out of the market.”

Texas currently has the highest percentage of people without health insurance in the country, with an uninsured rate in 2016 of 16.6 percent, according to the U.S. Census Bureau.