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Without Medicaid Flexibility, Texas Republicans Say No to Program's Expansion

Veronica Zaragovia for KUT
The Texas Senate Republican Caucus has sent a letter to President Barack Obama saying that without flexibility in the current Medicaid program, they won't support any type of expansion of the program in the future.

Leaders of the Texas Senate have sent a letter to President Barack Obama [read a PDF of the letter here] about Medicaid. It says that if Texas can’t make changes to how it runs Medicaid now, there’ll be no Medicaid expansion for Texas in the future.

The Affordable Care Act gives states the option to expand Medicaid to cover more people, or in the case of Texas and some other states, not expand it.

"The truth is, Texans know what's best for Texas," said State Sen. CharlesSchwertner (R-Georgetown), at a Capitol press conference on Monday. 

He says expanding Medicaid under the Affordable Care Act doesn’t work for Texas, which has four million people on Medicaid now – twice as many as the state had in 2002.  

"Until we receive the kind of federal flexibility we’re calling for here today, the kind needed to fundamentally reform Texas’ existing Medicaid program in a way that preserves it for our most vulnerable Texans, any expansion of Medicaid in Texas is simply not worth discussing," Schwertner said. 

For example, Senate Republicans want to require some Medicaid recipients to work if they're physically able, or require what’s called asset testing – taking homes or cars, as well as income, into consideration when determining whether someone qualifies for Medicaid.

Anne Dunkelberg, the Health and Wellness Program director at the left-leaning Center for Public PolicyPriorities, says, however, that children account for most of the increase in Medicaid recipients.

So far no Republican lawmaker has filed a bill that would allow Texas to pursue what’s been called a Texas solution to Medicaid expansion.

"It is really, really concerning for us to be in yet a second session where at this point it’s not clear whether we will offer any solution for at least one million uninsured U.S. citizen adults in Texas," Dunkelberg said.

People who qualify for Medicaid now include low-income children, pregnant women, people with disabilities and the elderly.

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