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How a Renewed Medicaid Expansion Fight Could Play Out in Texas

Michael Stravato, via Texas Tribune
Lawmakers are gearing up to discuss the possibility of a state Medicaid expansion over the next two days.

Starting this morning, Texas lawmakers will spend two days discussing the state’s Medicaid program. On the docket is a look at services and ways to cut costs, but there's a big question looming in the discussion of whether a big chunk of that Medicaid money will even be there next year.

For the state to get that big chunk, the federal government will need to approve the state's Medicaid waiver – the money used to pay for care hospitals provide to people without insurance. It also covers some health care delivery services in the state. This deal with the federal government is set to expire in the fall and the state is waiting to hear if it will be renewed. Joan Alker, executive director of the Georgetown University Center for Children and Families, has seen how this exact situation play out in other states over the last decade.

Alker says probably the best test case for what Texas might go through this year is what happened in Florida last year. State lawmakers there – just like in Texas – have refused to expand Medicaid. During negotiations last year, the federal government told Florida officials any waiver money, which also pays for uncompensated care, would be tied to whether the state accepts federal Medicaid expansion dollars.

Florida officials weren’t happy about that and sued the feds. In the suit, Gov. Rick Scott alleged President Obama coerced the state into expanding Obamacare by cutting off federal money for healthcare. But, Alker says, the federal government had a pretty compelling reason as to why they were doing this.

“The most clear position that the federal government took was we are not going to give you federal Medicaid dollars to cover folks who are uninsured in your state because essentially you have chosen to keep them uninsured by not taking the Medicaid expansion dollars,” Alker says.

This standoff between federal health care officials and Florida officials was eventually resolved, sort of. The state ended up receiving a lot less money, and Alker says that could be something to watch out for in Texas.

“I don’t think Texas is going to get what they are asking for,” she says. “I do think they are going to see cuts, but it’s going to be a complex negotiation.”

Just like in Florida, hospitals in Texas will be hit the hardest if the state doesn’t get its waiver renewed, or if the state doesn’t use federal Medicaid expansion dollars to cover more low income adults. Texas currently has the highest number of uninsured people in the country. 

The House Appropriations Committee will meet today and tomorrow to discuss the state's Medicaid program.

Ashley Lopez covers politics and health care. Got a tip? Email her at Follow her on Twitter @AshLopezRadio.
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