The Healthcare Reform Act in Texas

On July 12, 2012 Texas Governor Rick Perry nullified the Obamacare law in Texas. Going along with 26 other states decisions, Texas has refused in growing or expanding Medicaid with Perry stating that he would not bankrupt his state in direct contradiction to the constitution. Rick Perry had already stated his detest with Obamacare when he compared it with the titanic (Clabough, Raven 2012). Now the government was trying to make the states inforce and expand Medicaid, so of course Rick was not going to accept it. However, was it a really bad idea to refuse Obamacare or the best idea?

Texas, which currently has a large uninsured population and limited Medicaid eligibility, forfeits billions of dollars from the federal government every year by not expanding its Medicaid program as implemented in the Affordable Care Act. In contrast, Medicaid expansion could benefit the state exponentially and give its citizens the fullest potential of what this country offers. A substantial amount of federal funding that could increase uninsured coverage, improve healthcare costs, and provide economic stimulus is left on the table. Additionally, the nation benefits when each state participates, contributing to the success of the healthcare reform.

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

The state of Texas has pulled its Medicaid funding for Planned Parenthood, leaving poor residents with few options for affordable healthcare. Medicaid, a program focused on helping low-income families and individuals receive healthcare, has always been jointly operated by the state and the federal government. But to who this program would be eligible for is entirely up to the state. More conservative states, like Texas for example, strictly reserve Medicaid for only the most severe cases of poverty-stricken families, leaving a large portion of low-income residents uninsured. The Affordable Care Act, a federally mandated reform of Medicaid introduced by President Obama, would provide healthcare for many American citizens in need. Despite being

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

Expanding Medicaid was supposed to to be a main element in the states wide acceptance of the Affordable Care Act, because Medicaid’s sole purpose is to provide coverage for all uninsured adults. Medicaid is mainly used by the working poor or those who don 't make enough money to pay for health insurance on their own. The expansion, however, is part of ObamaCare and Texans hate it, despite the numerous money problems that not accepting it causes. An example would be, the 100 billion dollars that the federal government has set aside for Medicaid over the course of ten years. Even though it seems that the insurance is doing good for many states, Texas Governor Rick Perry could not opt out fast enough. His reasoning behind the

Texas has the largest uninsured population with an estimated 6.2 million uninsured citizens within its stateliness, approximately a quarter of the statewide population (Rapoport, 2012). In 2012, then governor, Rick Perry decided that Texas would not expand Medicaid under the Affordable Care Act (ACA). This decision led to much debate over whether or not Perry made the right decision to leave upwards of a million Texans, who did not receive insurance subsidies and did not qualify for Medicaid, uninsured. These Texans fell under what many politicians refer to as the “coverage gap.” Texas decided not to expand Medicaid under the Affordable Care Act because of the effects it would have on hospitals, financial reasons, and increased number of

Medicaid initially established that each state is responsible for designing their medical costs to pay medical care for the poor. Also, Medicaid created as a voluntary program for each state; they have to have the choice to participate. For one thing, because of the rising costs of healthcare, it has been difficult to bring Medicaid recipients into the “mainstream” of United States (U.S.) medical care. Donald R. Barr notes, “between 1975 and 1989, the cost of the Medicaid program increased by an average of 11.9 percent per year before adjusting for inflation” (172). The rising costs of healthcare are necessary for each state to determine if it is beneficial for them to participate in the Medicaid program. As the government level of payment is determined by each state economic condition. For instance, a state with lower per capita income will receive more government funding. A state with higher per capita income receives less reimbursement for program costs. Therefore, on December 31, 2010, many states continued to experience budget cuts. As a result on August 2010, Congress increased reimbursement rates through June 2011.

So far Gov. Nikki Haley is unmoved. Haley and the state’s conservative legislature have refused to accept the $13.3 billion in federal funds, arguing that the state will be unable to pay the state’s Medicaid bill once full federal subsidies end in 2020 (Haley, 2014). Their working assumption is that Washington will renege on its 90-percent pledge and cut subsidies further, leaving poor states like South Carolina to shoulder more and more of the costs.

The federal part of Medicaid is known as the federal medical assistance percentage (FMAP) (Hegar). The FMAP annually reviews comparison of average state and U.S. per capita income. This means in Texas the federal government pays 60 percent of every dollar spent on Medicaid services (Hegar).

The Affordable Care Act is the new health reform law that was signed into action on March 23, 2010. The Affordable Care Act attempts to reform the healthcare system by providing Americans with affordable health insurance. It helps put individuals, businesses, and families in control of their own healthcare. By the sound of it, it really looks like this is something that will positively impact the lives of Americans, and make it easier for individuals to obtain health insurance. Unfortunately, what many Americans are unaware of is that there are so many underlying issues that make the Affordable Care Act not so affordable. Issues such as penalties and taxes that certainly rack up the cost on individuals, businesses and even hospitals that make it difficult for people and businesses to be in “control” of their health care.

Looking at the different readings which analyzed and discussed the different ways that states are handling the Medicaid expansion under the Affordable Care Act, it seems that each state has their own unique prospective on the expansion, dependent on the political leanings and wealth of the state. For example, one of the article describes Kentucky opting to traditional Medicaid, while Arkansas opted to buy coverage for the poor through the federal marketplace. The states that have limited the expansion of Medicaid seems to be typically Republican states, which obviously has an issue with not only the costs associated with the expansion but also the ideological issues that seems to be in conflict with

Ironically, Texas has the highest number of uninsured citizens in the nation, 6.2 million to be exact. The majority of these citizens are children. According to Goodwyn (2013), “by Texas refusing to participate in the Medicaid expansion, which is part of the ACA, the state will leave on the table an estimated 100 billion dollars over the next decade. It is sad to know many citizens in this state will be denied health care by those who already have the best insurance and will never have to worry about being uninsured. In addition, the Texas politicians fail to recognize the need for health care for neither its most vulnerable citizens nor the burden on the Emergency room as well as the rise in healthcare premiums for citizens who maintain health insurance. Landers (2013) reports, “whether they have a good income or a lower one, Texas lag behind much of the nation in access to and quality health care.” States who fail to expand Medicaid will see their funds distributed to states on board with expanding Medicaid.

This is forcing the doctors to no longer accept certain insurance companies such as medicaid because they aren’t being reimbursed for the services they’re providing to the consumers that are using medicaid. One doctor, Dr. Martha Boone in Atlanta, Georgia, said that she would have to see 20 patients an hour in order to make any reimbursement from medicaid. She said that medicaid paid none of their bills coming from her office for 18 months and when her office sent registered letters to Medicaid to see what the problem was they said it was a computer error and still didn’t reimburse her office (Heritage, 2010). Because most doctors don’t receive money from Medicaid, most of them don’t accept it. “Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.” (Connelly, 2009). This forces the Medicaid consumers to go to the emergency room when they need help since normal doctors rarely take their insurance. Dr. Lloyd Krieger says that the undoing of this healthcare bill is, “an urgent necessity.” because it is, “doing great damage even years before it’s individual mandates and other controls kick in.” (Krieger, 2011).

If Texas expands Medicaid coverage, the largest number of newly eligible Texas would be adults without children. Currently, these individuals are not covered under Medicaid. In addition, parents who have incomes at or below 133% of the federal poverty level (FPL), up from 12% previously. With a 90% federal reimbursement rate going forward, for every $10 of health care services obtained under the program, the State pays $1 and the federal funds pay the other $9. It is estimated that the State would contribute about 15.6 billion, while the federal