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How the Election Will Affect Health Care in Texas

Lawmakers will take up Medicaid funding when the Legislature convenes next year. But the first test comes on Election Day, when who becomes president could determine the fate of the program.

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If President Obama wins a second term and the Affordable Care Act stays in place, the debate will likely turn to whether Texas will join an expansion of Medicaid.

Gov. Rick Perry says Texas will opt-out of that expansion. But Anne Dunkelberg of the Center for Public Policy Priorities, a liberal state policy think-tank, says the state’s largest counties — which have the most to gain monetarily from joining the program — may band together to force the expansion.

Audio: Ben Philpott's story for KUT News

“I don’t see them doing an end run,” Dunkelberg said. “I do see them potentially coming together and trying to figure out if there is a way outside of the basic state budget general revenue system that they can come up with the rather modest, less than a billion dollars a year, that the state would need to do this expansion.”

Conservatives hope a victory for Mitt Romney would be the end of federal health care reform. But it could be the beginning of new Medicaid block grants. Arlene Wohlgemuth of the conservative Texas Public Policy Foundation says multiple states have asked the federal government for the freedom to spend Medicaid dollars as they wish.

“Governors are saying, ‘We can do a better job for our population than what you’re doing with this straightjacket that we have coming from Washington,’” Wohlgemuth said. “Our research shows that we can deliver better care for more people if we were just given the flexibility to design a program for Texas.”

She says one example of block-grant savings would come from instituting a sliding scale in which families would make modest co-pays for coverage based on their income.

“We can save so much money and get the most money to those who need it the most,” Wohlgemuth said. “It’s so common-sense that everywhere except Medicaid we’re using it. So it’s time for Medicaid to catch up with that public policy.”

No matter who wins, you can bet any future health care debates will include discussions of abortion. It is a topic not directly tied to the Affordable Care Act, but one that Dunkelberg says can hamper policy discussions.

“When arbitrary issues become these enormous, symbolic, philosophical, hot-button issues in the political debate, policy stops being made in the middle where it probably belongs,” Dunkelberg said. “And you stop having practical discussions about how you really govern and how you really create good public health policy.”

But first, lawmakers will need to pass a supplemental budget in early 2013. Without an infusion of about $4 billion, the Health and Human Services Department is expected to run out of money for its Medicaid programs by April.

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