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The Beltway’s Not Big Enough…

November 08, 2010
4:26 pm

…to hold, that is, the entirety of the health reform debate. 

While Republicans and Democrats on Capitol Hill are still sorting out the reverberations from last Tuesday’s elections and what it means in terms of legislative strategies to repeal or pare back the Affordable Care Act, it’s becoming increasingly clear that the states are going to play their own important role in this process.

Texas state legislators, for example, are contemplating dropping out of the Medicaid program and instead creating their own state-run healthcare program for low-income citizens.  This is no idle rhetoric.  The Texas Health and Human Services Commission is going to release a study within the next couple of months on the effects of ending the state’s Medicaid participation, and the Heritage Foundation has already weighed in with a study estimating that Texas could save $60 billion between 2013 and 2019 by withdrawing from Medicaid and the Children’s Health Insurance Program.

This isn’t a step that Texas can take lightly.  If a state-run alternative is a smaller, leaner version of Medicaid, hospital emergency rooms in the state could see an escalation in the number of Texas using the ER as a healthcare access point.  Yet, the fact the debate is occurring shows the concerns states have about the Medicaid expansion that is a centerpiece of the Affordable Care Act.  Texas legislators said that, with the federal government tying their hands on the ability to change eligibility or benefit structures, the program will become increasingly unaffordable.

And with Republicans taking over more governorships and state legislative bodies in 2011, it’s very likely that the GOP will flex its muscles on state-level implementation issues, such as those affecting the creation of health insurance exchanges.  This was the subject of a discussion on CNN’s State of the Union program this weekend with outgoing Minnesota Governor Tim Pawlenty (R) and re-elected Texas Governor Rick Perry (R).  They made it clear that Republican leaders beyond the Beltway won’t stand on the sidelines when the health reform fight re-ignites.

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