Houston Press

By Megan Flynn

To pick up the tab, many public health systems across the state, rely on a federal Medicaid waiver intended to reimburse hospital systems for uncompensated care. The waiver was set to expire this year, but last week the Texas Health and Human Service Commission announced that the feds had offered a 15-month extension expiring at the end of 2017. The HHSC called it a “big win” for Texas.

But only for now. There are some who are already wandering about what will happen when those 15 months end — that is, if state lawmakers do not negotiate a longer-term solution for Medicaid in Texas before then.

Texas is one of 19 states that has rejected the Affordable Care Act’s Medicaid expansion. For now, by choosing to forgo the expansion, the state is leaving billions of dollars on the table — which, all Texans are paying for anyway in federal taxes, but can’t benefit from. Instead of accepting the expansion, Texas has been relying on this so-called Medicaid 1115 waiver. But as the feds have warned: After that 15-month extension is up, if Texas continues to refuse to accept Obama’s Medicaid expansion, the feds will simply wean the state off of the waiver funding each year until there is none left.

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“This has really become a fight within the Republican Party,” said Joan Alker, a public policy professor and executive director of Georgetown University’s Center For Children And Families. “I do think it’s fair to say that, really, most of the opposition so far has been ideological opposition, and the intense dislike of Obamacare, the Affordable Care Act.”

Alker’s colleague, Anne Dunkelberg, executive director of the Center for Public Policy Priorities, said that, nationally, the opposition to Medicaid expansion appears to be a knee-jerk reaction, one that hinges on an argument that is not supported by numbers, she said. “There’s a rhetorical response that suggests that Medicaid is somehow particularly problematic in terms of healthcare cost,” Dunkelberg said. “It’s really a talking point that’s not supported by data. Medicaid is only about 16 percent of healthcare spending in the United States.”

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