Friday, July 13, 2012

Editorial: Passing on Obamacare’s Medicaid Expansion and Exchanges is the Right Call for Texas

Sen. Deuell, MD
Rep. Schwertner, MD
Rep. Shelton, MD
Rep. Zerwas, MD

As the four physicians currently serving in the Texas Legislature, each of us brings firsthand experience to the challenges facing our health care system, as well as a unique perspective on the profoundly detrimental effect Obamacare will have on the citizens of Texas. That is why we stand shoulder-to-shoulder with Governor Perry and support his decision not to expand the state Medicaid program or implement a federally controlled health insurance exchange in Texas.

Medicaid is a jointly-funded state and federal program intended to provide health care to some of our most vulnerable citizens: pregnant women, children, the disabled, and the truly indigent. Over the years, this broken but well-intentioned program has drifted progressively further from its intended purpose and further still from those it was designed to assist. The unprecedented expansion of Medicaid proposed under Obamacare will not fundamentally improve patient access to care, and as a greater number of physicians withdraw from the system entirely, will only make it more difficult for these individuals to seek the medical help they need.

In 1987, Medicaid accounted for roughly 11% of the state budget. Today, this entitlement consumes over 22% of our state budget – diverting funds that could otherwise be used to support public safety, build new roads, or educate our children. State spending on Medicaid has grown two and a half times faster than the rest of the budget, and will balloon even more rapidly under the Obama Administration’s proposed eligibility standards, which would place one out of every five Texans on the rolls of Medicaid by 2014. Our present course is clearly unsustainable, and expanding Medicaid coverage to over a million new able-bodied adults does nothing to repair a broken system that’s already groaning under the weight of those it serves.

While the federal government will claim to pick up the tab for this expansion, their share of funding is designed to diminish progressively over time, creating an ever-greater burden on our own state budget. Eventually, this situation will create a substantial budgetary crisis for Texas, forcing us choose between raising taxes and diverting increased resources from other areas of government just to keep Medicaid afloat. Funding an expanded Medicaid program under even the best of circumstances will mean higher taxes, increased federal debt, and reduced government services for the citizens of Texas.

The Obama Administration has also asked Texas to implement a new health insurance exchange controlled entirely by federal rules and regulations, many of which have yet to be written. Even those among us who have supported similar proposals in the past realize that instituting a health care exchange at this point would yield little or no benefit to the state of Texas. Washington has essentially presented us with a false choice – either we can do it their way, or they will do it their way – but ultimately, they are the ones calling the shots. Any input or control on behalf of Texans is negligible and largely illusory.

The best solution to ensure the long-term viability of our state's ailing Medicaid program is to seek a federal block grant which would allocate funding to the state directly, thereby providing Texas with the freedom to design its own Medicaid system without burdensome federal regulations and one-size-fits-all mandates. Such a grant would provide us with the independence and flexibility to devise the best and most cost-effective solutions to the specific health care needs of Texas, while preserving the critical doctor-patient relationship and ensuring continued access to care.

The health care solutions proposed under Obamacare are simply wrong for Texas, and Governor Perry is right to reject them. As physicians, each of us has taken an oath which states that, first, we will do no harm. That is why we cannot in good conscience support these measures which threaten to reduce quality of care, place further barriers between doctors and patients, and do irreparable harm to the people of Texas.

State Senator Bob Deuell, MD
State Representative Charles Schwertner, MD
State Representative Mark Shelton, MD
State Representative John Zerwas, MD

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