Is a 'Texas way' still possible for state's uninsured?

Texas Governor Rick Perry makes a statement regarding his grand jury indictment on charges of abuse of power at the Texas state capitol, in Austin, Texas on Aug. 16, 2014.
Texas Governor Rick Perry makes a statement regarding his grand jury indictment on charges of abuse of power at the Texas state capitol, in Austin, Texas on Aug. 16, 2014.
A few years ago, Republican state policymakers in Texas created something called the Institute of Health Care Quality and Efficiency. Officials were already committed to rejecting every possible aspect of the Affordable Care Act, and undermining its implementation wherever possible, but Institute members were nevertheless tasked with looking for ways Texas could improve the state's struggling health care infrastructure.
When Gov. Rick Perry (R) endorsed the creation of the panel in 2011, and chose its members, this probably isn't what he had in mind.

A board of medical professionals appointed by Gov. Rick Perry said Wednesday that the state should provide health coverage to low-income Texans under the Affordable Care Act -- a move the Republican-led Legislature has opposed.  The 15-member Texas Institute of Health Care Quality and Efficiency recommended that the state's health commissioner be authorized to negotiate a Texas-specific agreement with the federal government to expand health coverage to the poor, "using available federal funds."

Steve Berkowitz, the board's chairman, told the Texas Tribune, "We're trying to take the politics out of it."
And while that's certainly a noble goal, if state policymakers were willing to take politics out of the decision-making process, they wouldn't have rejected Medicaid expansion in the first place.
Joel Allison, a board member who is chief executive of the Baylor Scott & White Health System, added, "We should be maximizing available federal funds through the Medicaid program to improve health care for all Texans."
Given that Texas has one of the worst uninsured rates in the country -- the Perry-appointed board called the current totals "unacceptable" -- maximizing available federal funds would make a lot of sense.
But Texas Republicans also don't like President Obama. The result isn't pretty.
Of course, pressure for change isn't just coming from the state's Institute of Health Care Quality and Efficiency. The Dallas Morning News reports that state hospitals are increasingly desperate to see Republican policymakers take a more responsible approach.

Expanding Medicaid may be anathema to Texas political leaders. For hospitals, though, it would be a godsend. [...] The Texas Hospital Association ... wants to coax Governor-elect Greg Abbott and the Legislature to use federal funds available through the Affordable Care Act to expand Medicaid with a private insurance model. This "Texas Way" approach, as the hospital association describes it (, would seek out the uninsured not currently eligible for Medicaid but who can't afford the insurance policies offered under the Affordable Care Act's site. That's about 1.05 million Texans, the association estimates.

In theory, the fact that so many state Republicans -- in Arizona, Ohio, Michigan, Pennsylvania, and elsewhere -- have agreed to take federal funds to help low-income families would presumably give Texas some cover to do the same thing. The fact that hospitals and a Perry-appointed panel want the same thing might help push against the prevailing political winds, too.
Indeed, both the Texas Hospital Association and the Perry-appointed Institute of Health Care Quality and Efficiency don't even tell policymakers what to do, exactly, so much as they urge officials to do something. There are alternative avenues and opportunities for compromise with federal officials. All Texas has to do is try.
But under the circumstances, it's probably best to keep expectations low.