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Garnet Coleman: The TT Interview

The Democratic state representative from Houston on his Republican colleagues' quest for a federal Medicaid waiver, the problem with block grants and what realistically the feds could do to help Texas and other states.

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Texas Republican lawmakers and right-leaning think tanks are considering ways to secure flexibility — read: exceptions — from the federal Medicaid program. Their best bet may be right under their nose: a House Democrat headed to Washington this week for meetings with the Center for Medicare & Medicaid Services

Rep. Garnet Coleman, D-Houston, doesn't often agree with the House's Republican supermajority. But while some of those lawmakers hold a press conference today with the conservative Texas Public Policy Foundation on their suggestions for meeting the state's Medicaid crunch — everything from asking for block grants to creating a program to let Medicaid patients buy into the private insurance market — Coleman will have the Obama administration's attention, or at least the ear of its deputy Medicaid administrator.  

TT: What do you want out of this meeting with CMS? 

Coleman: Two things. One, it’s important that we extend the enhanced FMAP (the Federal Medical Assistance Percentage, or the percent of Medicaid expenses the feds cover — which was enhanced with stimulus dollars to meet the national recession). That would help every state accomplish its goals in terms of dealing with what a recession causes, and the ability to balance their budgets, and it’s a simple fix. [The FMAP ratio is] still 70-30, federal to state, with the enhanced match. The goal is to continue the enhanced match past when it expires in June.

TT: How much would that help Texas alleviate its budget shortfall, estimated at between $15 billion and $27 billion?

Coleman: I worked really hard, and so did other members from across the country, to get that enhanced match, which gave Texas $850 million in real general revenue savings the first time around. If we had that for another year, we would get approximately $2.5 billion in savings. If we had it for another two years, we'd have approximately $5 billion in GR savings. And so this is extremely important. The other piece is, in terms of Medicaid in general, and the use of Upper Payment Limit, or UPL funds (federal funds paid to hospitals to bring Medicaid reimbursements up to Medicare levels), under the current rules, you can’t have a statewide managed care program and get UPL. And then if you did have that managed care system, you'd have to carve out hospitals. The question is whether the federal government will approve [allowing managed care programs to participate in UPL]. I went up in December to have a conversation about that, and I'm going to revisit it with [Deputy Medicaid/Medicare Administrator] Cindy Mann in her office about that. 

TT: What's your concern with the Medicaid waiver ideas — including a flat-out block grant — some of your Republican colleagues have suggested? 

Coleman: The waivers people are proposing don't really have a shot if they curb expansion. Look, the Bush administration did not even approve the original waiver attempt by Rick Perry [in 2008]. And all of this talk about block grants — none of that’s going to happen. It’s just political rhetoric. The things I'm talking about are real solutions. And I don’t want to see Texas penalized because people would rather play politics than solve problems. I'm going to advocate on behalf of my constituents, of the people who have need in this state. But also, because I have a good relationship with the White House, I will be critical of things I think are not good for my constituents. What I do know is this: Block grants are bad public policy, bad fiscal policy. We’re a growing state, a low-benefit state. The problem I have is, [Texas' Republican leadership is] not even asking [for a waiver]. They’re just riding on the back of some other governor, or lieutenant governor or the National Governors Association. They're riding on the back of those government associations.

TT: What's your overarching message, to Washington, and to your colleagues in Texas?

Coleman: It's this: Really, without new revenue of some sort, the only way Texas can solve any of its budget problems is if the federal government is a part of that solution. This is no different than in 2003, when [then-President] Bush gave an enhanced FMAP and a grant of dollars to every state and the state of Texas got $1.2 billion. And it created even more money. What has changed from 2003 to now is one thing: Now, it's President Obama.

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