Texas draws health care attention
Health and Human Services secretary visits the Houston area as she encourages enrollment in federal marketplace
THE White House will not push back against states like Texas, whose leaders chose not to expand Medicaid to get health coverage to the poor, Health and Human Services Secretary Sylvia Burwell said during a brief stop Wednesday in Houston.
“That is not something we will do,” she said in response to questions about possible retaliation by withholding federal money that helps fund social and health care programs.
Burwell met privately with community leaders and toured the Lois J. Moore Eligibility Center and adjoining El Franco Lee Community Health Center during the second leg of her Texas tour to help kick off enrollment in the 2016 Affordable Care Act’s marketplace, which begins Sunday.
President Barack Obama’s administration has identified Texas as one of four states it will focus on in an effort to boost numbers in the federal exchange as it enters its third enrollment season. With more than 4 million still uninsured, Texas continues to lead the nation in the rate and number of uninsured.
Burwell also made a stop Tuesday in Dallas. Other stops will be in northern New Jersey, Chicago and Miami.
She assured the Houston gathering on Wednesday that “we stand ready” to work with Texas officials to come to some kind of agreement on the issue of Medicaid expansion.
The relationship between the state and the White House has at times been strained. Former Texas Gov. Rick Perry and his successor, Greg Abbott, have steadfastly refused to expand Medicaid, calling it a broken system that does not deserve to grow.
But a cornerstone of the Affordable Care Act was that states
would expand existing Medicaid programs to cover the poor and then millions more lower- to middle-income residents could sign up for coverage through state or the federal exchange and be eligible for tax credits that would lower premium costs.
In 2012, the U.S. Supreme Court ruled that states could not be forced to expand Medicaid.
That’s when Texas said no.
Earlier this year there was concern among some Texas health care leaders that the federal government would push back against the state and not renew its 1115 waiver program that has pumped $29 billion to providers to offset health care costs and initiatives to help the poor and uninsured.
The speculation was fueled in part by events in Florida, which also did not expand Medicaid. A feud there over the proposed cut-off of federal funds escalated to the point where Gov. Rick Scott filed suit, claiming the White House was trying to coerce an expansion of Medicaid. Ultimately the federal government renewed funding, with steep cuts, and the governor dropped the suit.
It is estimated more than 1 million uninsured residents would be covered with a Medicaid expansion in Texas. A recent analysis by the Kaiser Family Foundation found that threequarters of a million others fell into a gap of making too much money to qualify for the state’s Medicaid requirements but not enough to jump to the next threshold of being eligible for tax subsidies.
Burwell remained diplomatic in her brief remarks characterizing an expansion decision as “an issue that states come to.”
She reiterated that during the coming sign-up period the focus would be reaching the 10.5 million across the U.S. who are eligible for coverage through public insurance exchanges, or marketplaces.
“We hope to reach one in four,” she said.
The secretary highlighted the accomplishments of the law so far, as it has reduced the number of the uninsured nationally by 17 million people.
“But we still have a long way to go,” she said.
She also praised the efforts in Texas, where the uninsured rate has dropped by 3 percent.
Burwell has previously stated that this year could prove more challenging as the pool of people who are eligible but have skipped enrolling is shrinking.
On Tuesday the Chronicle reported that there would be no Preferred Provider Organization plans offered on the federal exchange in Harris County. In addition, the number of overall plans offered has dropped to 61 from 74.
Burwell said the narrowing of plan choices was happening prior to the implementation of the Affordable Care Act.