Texas Governor Rick Perry has announced that Texas will not expand its Medicaid programs. He is doing this to make a political statement against the Affordable Care Act, (which he calls “Obamacare”). Texas has the highest percentage of uninsured residents in the entire United States.
About a year ago, Texas Governor Rick Perry announced that Texas would not create a state health insurance exchange. He made it clear that he was very strongly opposed to the Affordable Care Act, and insisted that he would veto any legislation that would enable a state run exchange to be created in Texas.
At that time, a spokesperson for the governor, Lucy Nashed, said that Governor Rick Perry was hopeful that the Supreme Court would ultimately decide that the health care reform laws are unconstitutional. About a year later, on July 28, 2012, the Supreme Court decided that the Affordable Care Act was constitutional, and would be upheld.
There only portion of the Affordable Care Act that the Supreme Court did not uphold had to do with the expansion of state’s Medicaid programs. The court decided that it was ok for the federal government to offer states funding that would be used to expand their Medicaid programs. The court said that if the state chooses to accept that funding, that it would have to actually use it to expand its Medicaid program.
The court also said that a state can choose not to accept the funding, and that the federal government cannot impose any consequences for doing so. The federal government cannot, for example, decide that it will cut off all Medicaid funding to a state that doesn’t want to expand its Medicaid program.
The result is that Governor Rick Perry can, legally, choose not to expand the Texas Medicaid program. (Assuming that he has not already accepted funding from the federal government to expand it). In an announcement, Governor Rick Perry said:
“We in Texas have no intention to implement so-called state exchanges or to expand Medicaid under Obamacare. I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government.”
It is worth noting that the federal government would pay for 100% of the Medicaid expansion for the first three years. This means that Texas would not be paying anything at all to expand its Medicaid program for an entire three years. Each state would gradually increase financial participation, until 2020, when the federal government would be paying 90% of the cost, instead.
It is also worth noting that if Texas doesn’t create a health insurance exchange, the federal government will set one up for the state. This is not something that Governor Rick Perry will be able to avoid. The exchange will identify uninsured people who are eligible for the Medicaid program, and help them to enroll in it.
It is also worth noting that the Agency for Healthcare Research and Quality, which is a branch of the Department of Health and Human Services, has deemed healthcare in Texas as “week”. Texas has the highest percentage of uninsured residents in the country. 27.6% of people in Texas are uninsured. That comes to around 6,234,900 people.
Image by Ed Schipul on Flickr