| Perspectives on Texas

I get the sense that it’s tough to be an elected state official in Texas and deal with health care issues. Just as shouts of “amnesty” have crippled pragmatic conversations about immigration reform, shouts from Texas’ fringe have also derailed wise health policy decisions.

The Texas Legislature has known for years that 6 million uninsured Texans — and the highest uninsured rate in the nation — is bad for Texas, and has in the past worked creatively to try to expand health coverage. In all four previous legislative sessions, the state House and Senate have passed bills authorizing key health care items. Since 2011, however, shouts of “Obamacare” have caused Texas leaders to stumble and forget that we’re actually the state that led health reform innovation. In fact, red states moving ahead with alternatives to Medicaid expansion are using the accountable Medicaid managed care model that Texas innovated.

It’s time for us to regain the lead. Texas-style health care reform is good for Texans and good for business.

To regain our place as smart conservative leaders, here’s what we should do this session:

1. Implement the improvements recommended for Texas’ Health and Human Services Commission (HHSC) and the Medicaid program as outlined in the legislative Sunset report.
2. Adopt principles to cover all eligible Texans including:
   • personal responsibility through copayments or other mechanisms
   • a global, risk-adjusted, per-capita funding mechanism
   • flexibility by recipient type and/or region
3. Charge HHSC officials with negotiating expanded Medicaid reform with the federal government as part of the existing 1115 waiver program, which has produced innovative and successful health outcomes across Texas. Other conservative states have modeled programs based on Texas’ leadership with the waiver. And though our current agreement expires soon, HHSC can negotiate not only the continuation of our successful leadership but also health care reform similar to the “Texas Way,” advocated by the Texas Hospital Association, or TxRx, advocated by the Code Red Task Force.
4. Enact legislation adopting the federally facilitated marketplace as the state-sponsored health coverage exchange, and let the feds continue to run it at their cost (but protect the subsidies for Texans that our Texas tax dollars are paying for).

We believe in private marketplace solutions, and our Texas-style reform is just that. We’re committed to wise financial stewardship — it’s our money we’re sending to Washington, and we need to get it back. Plus, we’ll get our funds back in a way that gives us the flexibility we need. Reform enables responsible local control: Many of our local hospitals, urban and rural, need these funds to stay open. If we do nothing, not only will we not be able to reduce local property taxes, but taxes will rise. In the end, local authorities will move to protect their medical providers and hospitals. Local voters will demand it, and they have to — by state law, counties are responsible for indigent health care.

We’ll continue to work with Texas’ congressional delegation in Washington to amend and replace the unworkable parts of the Affordable Care Act even as we maximize our opportunities in the short term. That’s smart leadership.

We need only talk to county judges across the state and groups like the Texas Association of Business to know that the vast majority of pragmatic Texans want health reform. More than that, we need health reform. Almost all state leaders believe we can and should reform our health coverage policies, and many already know the policies can be fixed with no new state spending.

This is the year our state leaders must stand up against uninformed ideological shouting and stand for smart health reform. We have the know-how, and we see the path forward. Let’s get it done, Texas.

Disclosure: The Texas Association of Business and the Texas Hospital Association are corporate sponsors of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.