As someone who has advocated for Medicaid expansion from the very beginning, I applaud TMA’s statement that we need to find a way to implement the expansion here in Texas. It’s a great start, and I agree with their position that denying care to over 1 million disabled and low-income Texans is ‘unconscionable.’
However, the devil is in the details. TMA’s proposal that Texas should have more ‘flexibility’ in the Medicaid program is worrisome because of its vagueness. ‘Flexibility’ has long been a code word used by those who only want the ‘flexibility’ to reduce Medicaid services, beneficiaries, or both. Further, it’s unclear whether TMA wants more flexibility in the entire Medicaid program or just the expanded portion. Finally, the federal government already allows for Medicaid flexibility through the 1115 Waiver process, most recently seen in the 1115 Transformation Waiver that allows Texas health providers to continue to receive federal UPL funds after the switch from fee-for-service to managed care.
TMA correctly points out that the low reimbursement rate of Medicaid in Texas has resulted in only 30% of Texas physicians accepting new Medicaid patients, but I want to remind everyone that Medicaid reimbursement rates are set by the Texas State Legislature and the Governor through the appropriations process, not by Washington. We could simply pass a budget that raises them. I’d vote for it. Also, physicians are not the only providers who see Medicaid patients. Advanced practice nurses, physician assistants, and entities such as Federally Qualified Health Centers, county hospital districts, and Accountable Care Organizations will all help fill the gap. Our primary goal should be to ensure that all Texas have access to care, and this is something we can do.
Finally, Texas, not Washington, will decide whether or not we expand Medicaid in this state. Governors across the country of each party are realizing that expanding Medicaid is important and the best policy for their populations; we need to do the same. The bipartisan solution that TMA calls for is already on the table. We just need to take it.