• Is this for real?

    Texas is evidently considering abandoning the Medicaid Program:

    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.

    Far-right conservatives are offering that possibility in impassioned news conferences. Moderate Republicans are studying it behind closed doors. And the party’s advisers on health care policy say it is being discussed more seriously than ever, though they admit it may be as much a huge in-your-face to Washington as anything else.

    “With Obamacare mandates coming down, we have a situation where we cannot reduce benefits or change eligibility” to cut costs, said State Representative Warren Chisum, Republican of Pampa, the veteran conservative lawmaker who recently entered the race for speaker of the House. “This system is bankrupting our state,” he said. “We need to get out of it. And with the budget shortfall we’re anticipating, we may have to act this year.”

    There’s so much that’s strange here that I don’t know where to start.

    Yes, the PPACA will increase Medicaid eligibility once it really starts going in 2014, but for the first few years, newly eligible people will be covered 100% by the federal government,  By 2020, that drops to 90%.  So maybe they can complain about it in 2020.  But to blame “Obamacare” for the cost of new eligibility now and in the next few years is completely wrong.  If, they are worried that there are lots of people in Texas who are already eligible and not covered, well, that’s a different complaint.  But that’s a problem in Texas, and not with the PPACA.

    The article goes on to state:

    The Heritage Foundation, a conservative research organization, estimates Texas could save $60 billion from 2013 to 2019 by opting out of Medicaid and the Children’s Health Insurance Program, dropping coverage for acute care but continuing to finance long-term care services.

    I don’t doubt it.  They could also save money if they just shut down the public schools, too.  And hey – what about roads?  Or fire departments? They all cost money.  They could save a bundle if they got out of those, too.

    Of course, the long-term costs to the state would be huge.  And the reason many of those things cost money is that they provide a good, too.  Dropping Medicaid and SCHIP will mean less spent on paper, but the overall costs to Texans would be huge, especially for the poor.  Moreover, it will devastate the health and well-being of that already disadvantaged population.  They also seem to have forgotten that for all their complaining, hospitals and physicians do accept a fair amount of money from Medicaid.  That would all disappear, too.

    Let’s not ignore the fact that Texas already has the highest rate of uninsurance in the country.  Think this will help?

    I want to believe that this is just posturing and saber-rattling, but I don’t know anymore.  I think they may be serious.  And I wonder if they have any idea what they are talking about.

    • fun times!

      rick perry is also promoting the idea of opting out of social security

    • It would be interesting to see them try. Kids who are about to lose their wheel chairs make for very good television.

    • Adding on to Bill’s comment, there’ll also be a large number of poorer Republicans who will find that they’re going to get some pain.

    • I think this is a lot of posturing for the base. I would expect this to proceed cuts in Medicaid rather than eliminating the program. Paladino running on large cuts to Medicaid. I dont really expect pictures of kids in wheelchairs to do much in Texas. The kids probably did something to deserve ending up in a wheelchair.


    • Plus, for all the misery such an insane act would cause, I doubt it really would save money. Pure posturing, I expect.

    • Maybe I’m misunderstanding this:

      State Senator Jane Nelson, Republican of Flower Mound, who heads the Senate Public Health Committee, said dropping out of Medicaid was worth considering — but only if it made fiscal sense without jeopardizing care.

      “I want to know whether our current Medicaid enrollees, and there certainly could be millions more by 2014, could be served more cost efficiently and see better outcomes in a state run program,” she said.

      If this is just a “Let’s check this out” kind of thing. (Can we do it better/cheaper on our own) then that’s one thing. Which is quite different than just cutting off all the Medicaid recipients without any other options.

      On the other hand, Texas really isn’t in a position to take on any new, large costly programs. They won’t find a better deal that the one they’re already in…

      This is posturing, nothign else…

    • Texas may be in a better position than most states to pull this off. Each of the major cities has a public hospital for the indigent (Parkland in Dallas, Ben Taub in Houston, I forget the one in San Antonio) and the UT Medical Branch in Galveston was established to cover indigents from across the state. If they contracted with Minute Clinics and home health nursing agencies for local care (on a capitated basis) they could cover a great deal of care at most likely much lower cost.