Messing with Texas…

When in DC this week, I was with health and consumer advocates from other states, including from Texas, which recently has made news considering withdrawing from the Medicaid program–something that is unlikely but sort of shocking just to think about.

Suzy Khimm of Mother Jones magazine, guest-posting on Ezra Klein’s Washington Post blog, has been all over this story, asking what if states ditch Medicaid?

Tough budget times mean people look at extreme options, and California has not been immune–remember Governor Schwarzenegger proposed eliminating California’s state child health insurance program, Healthy Families, as well as dramatically scaling back Medi-Cal coverage for millions of Californians. But those options were rejected by the Legislature for what they were–extreme, absurd, unworkable, costly, and counterproductive, if not simply wrong and immoral.

Finally, she responded to conservatives who say Governors could somehow replace Medicaid without the benefit of federal matching funds–a notion I dismiss in the article. The reason and impact of eliminating Medicaid would be to several cut health care services–and not just for low-income people, but also for the health system as a whole. While there is always ways to make any system more efficient, it’s hard–no, impossible–to provide the same quality of coverage to the same number of people without the federal government’s 50% share (which, in Texas, given the formulas, is actually 60%). Even with some continued alternative program, the result would be to dramatically scale back those services, and that investment in the health system and the economy. And speaking of alternatives, the federal government does provides waivers to allow for some innovation, although given the significant dollars by the federal government, there should be some basic standards and requirements that go with such funding.

In another post, Khimm compares the different approaches of Texas and California, calling the two states the “Jekyll and Hyde” of health reform, in which she highlights our state’s just-finalized Medicaid waiver as a way that California is taking advantage of the benefits of the new federal health reform. She appropriately writes that after seeing the final law, Schwarzenegger switched from seeing the federal health law as a burden to seeing it as a benefit for the state–and went to work using it to help, not hurt, our budget and fiscal situation. The Medicaid waiver provides California with ways to not just help our budget deficit, but to actually expand coverage–given the state budget crisis, using county funds matched with federal dollars.

Texas’ thinking makes sense if health care is merely seen as a line-item in a budget, a drain in the state’s coffers. Health care should be seen as in investment, a valued asset alongside our education, transportation, and public safety systems, and a way to bring in new federal funds and toward economic vitality and recovery.

California’s waiver helps provide a map, one we shouldn’t backtrack from as we embark on the next stage of the budget crisis, with both Governor Schwarzenegger and Governor-elect Brown.

Health Access California promotes quality, affordable health care for all Californians.
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