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Monday, March 18, 2013


In a letter to the Texas congressional delegation — followed up by a speech to the Conservative Political Action Conference (CPAC) — Gov. Rick Perry firmly rejected a one-size-fits-all Medicaid expansion and staked out the “Texas Medicaid Solution” negotiation parameters. Specific Medicaid reforms the governor mentioned in the letter include:
  • Cost sharing: establish copays, deductibles, and premium payments on a sliding scale;
  • Asset testing: ensure care is there for those who need it most;
  • Health savings accounts: improve patients’ control over health care spending; and
  • Promote the use of existing private coverage and employer-sponsored coverage.
The Senate Finance Committee attached a rider to its version of the 2014-15 state budget bill that says Medicaid expansion cannot come until the Texas Health and Human Services Commission “develops a plan to create more efficient health care coverage options for all existing and newly eligible populations.” It enumerates 11 principles with which the plan must comply, including reducing uncompensated coverage, promoting existing private coverage, wellness initiatives, cost-sharing, pay for performance, reducing nonemergency visits to the emergency department, and “creation of customized benefit plans for defined populations within Medicaid.” Both Governor Perry’s position and the Finance Committee’s incorporate portions of TMA’s. As TMA President Michael Speer, MD, wrote in a widely disseminated blog post, “Reform first, then expand only with a state-specific plan that targets the unique health care needs of our state’s population and that Texas taxpayers can afford.”

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