Sen. Tommy Williams
The Port Arthur News
One of the more interesting and important issues still churning inside the Texas Capitol this legislative session involves Medicaid.
Medicaid consumes approximately 25 percent of the state budget, and every dollar we spend on the program is less money for Texas parks, public education, higher education, road construction, mental health and a long list of other important programs and services.
Medicaid impacts the state’s budget and your pocketbook.
Texas continues to lead the country with the number of uninsured. Some 6 million Texans do not have health insurance. When someone lacking health insurance ends up in an accident or becomes ill, they often land in the hospital. Uncompensated health care costs amounted to $5.4 billion in 2011, according to the Texas Hospital Association, and you and I pay for much of it through our county property taxes and county hospital district property taxes. Individuals who have employer-based health coverage pay in the form of higher premiums to help cover health care bills of those who lack coverage.
While I remain opposed to “Obama Care” and expansion of the current Medicaid program, the federal Affordable Care Act will take effect in 2014. The act will set up health care exchanges to provide subsidized health care for lower income people who earn too much to qualify for Medicaid. When Texans obtain health care through the exchanges, revenue will be generated from existing premium taxes paid by insurers on health insurance policies.
The revenue would reach approximately $190 million by 2017, according to the Texas Department of Insurance, and could subsidize a large number of private-market health insurance premiums for many lower-income Texans.
I believe it makes sense to use this revenue to help Texans purchase health insurance in the private market rather than expanding Medicaid. Reports suggest the Affordable Care Act will drop the number of uninsured Texans from over 6 million to about 1 million. While this number is probably overly optimistic, the Texas legislature returns in January 2015, and could examine how many uninsured Texans actually obtained coverage via the exchanges.
The existing Medicaid program is not sustainable. Our Medicaid costs are growing twice as fast as the state budget, and double nearly every seven years. At that rate, Medicaid will eventually swallow much of our state budget.
We cannot expand Medicaid as we know it. It’s time we look at a Texas solution featuring a variety of ways to make our state health care safety net more efficient.
In addition to the above proposal, a solution should include at a minimum:
• Co-pays and deductibles;
• Pay for performance initiatives promoting positive outcomes;
• Discounts rewarding Texans who embrace healthier lifestyles and higher premiums for those who don’t; and
• Medicaid managed care programs.
Texas needs an effective, efficient and a well-researched program which provides a reliable safety net for those who can’t take care of themselves. Using the revenue created by the federal exchanges to provide private market coverage could be an important part of our solution. Additionally, these reforms must be at a price the taxpayer can afford. Under our current system no one is really being served well — not the people who need health care, not the physicians or hospitals and certainly not the taxpayer.
Senator Williams represents Senate District 4 covering all or portions of Montgomery, Chambers, Harris, Jefferson and Galveston Counties, and serves as Chairman of the Texas Senate Finance Committee and is a member of the Senate State Affairs, Open Government and Administration Committees.