If Republican vice presidential hopeful Paul Ryan's controversial plan for reforming Medicaid and Medicare sounds familiar in Texas, it should. The Wisconsin congressman’s proposal bears strong similarities to bills that Texas Republicans advocated for — and eventually passed — during the last legislative session.
Ryan’s congressional budget plan — so far trumped by Senate Democrats and the Obama administration — would replace Medicaid, the joint state-federal health insurance program for the disabled and impoverished children, with block grants to allow states to run the program as they see fit. And it would dramatically alter Medicare, offering the elderly who qualify for it “premium support” to purchase subsidized private insurance plans instead of directly paying for their medical costs.
In Texas, legislation Gov. Rick Perry signed into law after the 2011 session directed state officials to request a waiver from the federal government to operate Medicaid with a federal block grant. Another measure grants the state permission to partner with other states to ask the federal government for control — both fiscal and administrative — over both Medicaid and Medicare.
That proposal, called the Health Care Compact, is not likely to gain traction with a Democrat-controlled U.S. Senate or with Obama in the White House, though several Republican-leaning states have endorsed it. But with a Romney presidency, state Rep. Garnet Coleman, D-Houston, said, Medicare vouchers and Medicaid block grants could be the new reality.
Coleman said there is "no difference at all" between Texas' plan and Ryan's plan, which he has called "a backdoor way to cut off services for populations Americans care about."
The key difference between Ryan’s plan and what Texas Republicans have endorsed is in Medicare. Though they’re aligned on block-granting Medicaid, state lawmakers have steered clear of saying how they’d overhaul Medicare; state Rep. Lois Kolkhorst, R-Brenham, a staunch proponent of the Health Care Compact, said last session that Texas would start with Medicaid, and that its plan for Medicare would probably look far different from Ryan’s.
“It would be wisest for Texas to do Medicaid first,” said Arlene Wohlgemuth, executive director of the conservative Texas Public Policy Foundation. “If we could get Medicaid working in Texas, then if Medicare fell apart, we’d have the ability to protect Texas seniors by having a plan already in place, and just fold Medicare into it.”
Not surprisingly, the Medicare portion of Ryan’s plan is where some of his allies in Congress have also wavered in their support, particularly when they take into account walking the tightrope that is senior voters. For his part, presumptive GOP presidential nominee Mitt Romney has defended the ingenuity of Ryan’s plan, saying it’s about “providing people greater choice in Medicare,” and asserting that it wouldn’t apply to current seniors or those within a decade of retirement. But he has stressed that he will produce his own proposal for the health safety net programs in the lead-up to the November election.
On Fox News on Monday, Perry said Ryan's Medicare plan starts the right conversation, but added that the "idea that we're going to draw up a piece of legislation here in August of 2012 is not correct."
Wohlgemuth said that although Texas may not be ready to overhaul Medicare yet, Ryan's plan for it — providing "premium support" and establishing a sliding scale for what it costs to buy in — is what she'd like to see Texas do for Medicaid.
Medicaid "is totally unsustainable, and state budgets cannot handle it, whether they're red states or blue states," she said. "If we’re looking at providing a true safety net … we need to do something different. Ryan’s plan would put decision-making back with the state government."