Rick Perry’s post-policy approach to Medicaid

Rick Perry's post-policy approach to Medicaid
Rick Perry's post-policy approach to Medicaid
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Over the last few months, we’ve seen a growing number of Republican governors, none of whom is especially fond of the Affordable Care Act, accept reality and expand Medicaid in their respective states. We were reminded yesterday, however, that Texas Gov. Rick Perry (R) will not be joining the club.

Texas Gov. Rick Perry (R) doubled down Monday in his opposition to expanding Medicaid under President Obama’s healthcare law, even though opposing it could cost his state $90 billion.

At a press conference where he was flanked by other conservatives, Perry argued expanding the health insurance program for the poor would make Texas “hostage” to the federal government.

“It would benefit no one in our state to see their taxes skyrocket and our economy crushed as our budget crumbled under the weight of oppressive Medicaid costs,” Perry said at the state capitol.

It’s times like these when Texans would benefit greatly from a governor who better understood health care policy, or at a minimum, cared more about the policy’s outcomes.

The Lone Star State is literally dead last in the nation when it comes to the percentage of residents with health care insurance. Medicaid expansion is practically a godsend for a state in Texas’ position – it would bring coverage to 1.5 million low-income Texans and $90 billion in federal funding to state coffers. State hospitals have pleaded with the governor, urging him to accept the deal so they’re not stuck with higher costs, but Perry, at least for now, doesn’t care.

I generally don’t expect much in the way of policy excellence from the Texas governor, but his position on Medicaid expansion is, for lack of a better word, kind of crazy.

Remember, Texas’ health care system is already a national disgrace, with a jaw-dropping 28.8% of the population going without basic health insurance. But as Ezra Klein explained yesterday, Perry and his GOP allies, ignoring the life-preserver that’s been thrown in their direction, are instead poised to make Texas’ mess “much worse.”

Right now, Texas doesn’t offer Medicaid to poor, childless adults. The state’s incredibly stingy Medicaid program is one reason it has so many uninsured residents. The Affordable Care Act would change all that, using Medicaid to cover all adults up to 133 percent of the federal poverty line – and it would do it on the federal government’s dime. Above 133 percent of poverty – and until 400 percent of poverty – residents would get subsidies to buy private insurance on the exchanges.

Here’s the catch: Although Texas can legally refuse the Medicaid expansion, it can’t opt out of the subsidies provided to encourage participation on the exchanges. So while a Texan making $13,000 might get no help with her health insurance, one making $23,000 might get the whole tab picked up by the feds. The possibilities for confusion – and, once the situation becomes clear, anger – are both obvious and immense.

Moreover, because Medicaid’s expansion was conceived in part as a new source of revenue for hospitals, Obamacare ratchets back payments – called “disproportionate share payments,” or “DSH payments,” in health wonk parlance – that the federal government currently makes to providers who treat the uninsured. Texas, for instance, received almost $1 billion in DSH payments in 2011. Under Obamacare, they’ll receive far, far less.

This is one of the reasons so many Republican governors looked at the facts and decided it’d be nuts to turn down Medicaid expansion – the deal for states is just too good, and the needs of state hospitals is just too overwhelming.

Rick Perry sees this and chooses to pursue deliberate failures in governance – fewer struggling families with access to care, fewer dollars in state coffers, and fewer resources for state hospitals. Why? Apparently because he doesn’t like President Obama, and thinks his recalcitrant opposition to “Obamacare” will impress Republican primary voters should he launch another national campaign in 2016.

Talk about Republicans and a “post-policy” approach to governance – Perry is a walking, talking case study of a policymaker who embraces, to borrow a phrase, pure politics, just positioning himself vis-a-vis the president, choosing not to be invested in any particular outcome for his own constituents, whose interests he’s ostensibly supposed to care about.

It’s a painful fiasco to watch a distance; I can only imagine how frustrating it must be for people in Texas.