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Agenda Texas: An Update on Medicaid Expansion

On the latest Agenda Texas, from KUT News and the Tribune: Efforts to include Texas in the Affordable Care Act's expansion of Medicaid have come down to a single budget rider.

Rep. John Zerwas, M.D. (R-Simonton) talks with a colleague about the sonogram bill HB15 on March 2, 2011.

We’ve highlighted Medicaid expansion in Texas a couple of times during the legislative session, from those hoping to pick up Medicaid coverage to lawmakers for and against Texas joining in the Affordable Care Act program.

State Rep. John Zerwas, R-Simonton, worked this session to pass legislation that would let the state negotiate with the federal government on expansion. His final bill got out of committee but didn’t get to the House floor before last week’s deadlines.

“The question is, is it worth trying to find a vehicle to attach it to as an amendment?" Zerwas said. "It’s not really well suited for that, frankly."

So what happened? You could say Gov. Rick Perry set the tone for the session months ago. When the U.S. Supreme Court ruled states had the right to opt out of Medicaid expansion, Perry immediately, loudly and repeatedly said Texas would not be joining.

“Expanding Medicaid is not a solution; it’s not even a Band-Aid for what ails us. In short, it’s a prescription for failure," Perry said at an April press conference reiterating his position on expansion.

That had a chilling effect on lawmakers and activist groups that would have normally worked to pass some kind of expansion. 

“What didn’t happen was a year ago, people didn’t seriously start talking about [how] it may be difficult for Texas to move forward on this, so we should have a game plan," said Bee Moorhead, executive director of Texas Impact, a group that favors expansion.

That delay led to a late start in pushing for expansion and the late inclusion of a grass-roots effort to get people involved.

“The people who really should care the most about the expansion are local taxpayers, who are currently having to subsidize care for low-income people who would qualify," Moorhead said. "Those are the people who would see real, immediate, direct savings."

With less than two weeks left in the session, expansion isn’t dead, but it's hanging on by a thread — a rider stuck in the Senate’s version of the state budget that instructs Texas Health and Human Services to negotiate Medicaid expansion.

Zerwas tried to include similar language in the House version of the budget, but that ultimately failed.

"We at least have something that reflects what the attitude of the Legislature is towards negotiating something," Zerwas said.

He said Texas wants to create its own version of expansion, which includes getting a waiver for how it delivers health care with the additional Medicaid billions. And he’s optimistic an agreement could be reached.

"I think they’re very interested in Texas somehow participating in what they call the Medicaid expansion," Zerwas said. "And I think that they would at least receptive to hearing what our thoughts are on that."

So far, the rider has survived negotiations between the House and Senate while reconciling the two different versions of the budget. The rider was added by Senate budget writer Tommy Williams, R-The Woodlands, and has the backing of House budget writer Jim Pitts, R-Waxahachie. Throw in Zerwas, who is also on the budget conference committee, and the rider just might make it.

Moorhead said that without that rider, it could be another two years before Texas starts looking into expansion.

“It doesn’t mean they couldn’t move forward, but in the current environment, where there’s clearly a lot of legislative skepticism about whether the state ought to engage in covering low-income adults with Title 19 money, it would be hard to see how the agency would feel like they could freelance to that extent with no direction," Moorhead said.

The final version of the budget is expected any day now. It then heads to the House and Senate for a final vote.

Thanks to the people who have sent in questions for our upcoming segment on the session. We still need to hear from a few more people, so send in your questions to or on Twitter: @AgendaTexas.

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