Lawmakers Discussing Dropping Health Care Program — Health Reform and Texas | The Texas Tribune

Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.

via Lawmakers Discussing Dropping Health Care Program — Health Reform and Texas | The Texas Tribune.


Welcome to entitlement reality, Texas-style.  Currently 20Bn/year and going to go up with expanded eligibility, the article does say the Feds pay 60%, but doesn’t say: 1) it’s temporary, then the Federal contribution goes down or away, and 2) the Federal component doesn’t come from magical money fairies, it’s money takes from taxpayers then funneled back into a particular program.

Medicaid is not loved or respected in Medicine.  Decreasing reimbursements coupled to increasing requirements mean it’s at a minimum inefficient for both patients and providers.

I’m not against kicking Medicaid to the curb PROVIDING the state has some kind of replacement program.  Which I’m not sanguine about.


  1. In WA about half of the OB care is paid for by medicaid. Not sure about TX, but suspect it is similar. Does TX plan some alternative for this or just leave them uninsured. This sounds like post election puffery to me.

  2. Yes, an awful lot of our OB care is Medicaid funded, but I have no idea what percentage. It’s going to be a big number, though.

    I’d agree this is post-election puffery except obviously there’s been a study going on for a while (from the article).

  3. shadowfax says:

    I agree that it would be great if something could replace medicaid, and that the states are perfect laboratories for that sort of experimentation. Oregon had a neat program in the late nineties that could have been a model, but they kind of screwed it up at the end. HHS does give waivers for states to innovate.

    On the Medicaid expansion costs, much more than 60% will be covered: the PPACA provides for a federal cost sharing mechanism which provides for federal payment of 100% of costs for the “newly eligible” in 2015-16, 95% in 2017, 93% in 2019 and 90% for 2020 and thereafter. There’s also a bonus for states with generous eligibility pre-reform, so they don’t get punished by having to bear more of the costs while the stingier states get the whole thing paid for. I think this is a great stepping stone to federalizing the whole damn program.

    Weirdly, Perry also was talking about having TX “Secede” from social security. I’m not sure what the hell he is even talking about there. I’m all for political posturing, but that is on the dumb/crazy continuum.

  4. Glen in Odessa says:

    Yes, do away with it. At same time, convert SS to a true pension. Charity care will be given, and can be paid over time a 6 percent interest (by both mom and dad in case of OB -by payroll deduction, much as child support is taken out now). Fail to pay, that money is removed from your SS 24 months after services are given. In an honestly run SS program, money out in youth will certain cause quite a reduction at 70.

    The time has come to quite pretending the nation can afford to provide free care. For those truly destitute, charity wards, fees written off as charity on provider’s taxes. Everyone else *pays*.

    Glen in Texas

  5. Rae the Tech says:

    Medicaid wouldn’t be quite so bad if we had radical reform and some much needed oversight. For instance, states should institute a program that requires medicaid abusers to pay restitution in the form of wage and/or federal tax refund garnishments, etc. There should be some type of recourse for the state for people coming to the ED six times a month, via ambulance no doubt, for a sore throat!

  6. The “make Medicaid abusers pay” thing sounds good… except you can’t get blood out of a stone.

    Plenty of Medicaid patients have no potential financial recourse available against them… they have no assets you can attach, they don’t work (and if they do it’s under-the-table for cash), and they’re not going to ever have assets/money… because their parents are Medicaid too!

    They’re truly a financial drag on the system. You can’t recoup your costs with multi-generational Medicaid families… and the only realistic way to cut costs with these folks is to tell them “no.”

    And the lawyers certainly aren’t going to allow you to do that for very long.