Health Reform Roulette

One House Republican wants to create the state health insurance exchange required by the federal health care reform law for fear the feds will do it for Texas.

Another has filed a bill that would make his colleague’s efforts — really, those of anyone trying to implement “Obamacare” in Texas — illegal.

Meanwhile, early versions of the Republican-written state budget include cost-saving pilot programs like medical payment reform, with little mention that they are key components of the much-maligned federal health care law.

It is an uncomfortable balancing act: Republican lawmakers hate few things more (perhaps the Environmental Protection Agency) than the federal Patient Protection and Affordable Care Act, which became law in March. But even as the state pursues a suit attacking the law’s constitutionality, and Gov. Rick Perry and other top Republican politicians assault it with the relentless enthusiasm of 9-year-olds hitting a birthday piñata, some state officials are reluctantly laying the groundwork to implement parts of the law.

“Playing politics is one thing. Hampering the state from moving forward is another entirely,” said Tom Banning, CEO of the Texas Academy of Family Physicians. “When the health plans, doctors, hospitals and business community get behind them saying, ‘This is something we need to do,’ it gives lawmakers the political cover to defeat the partisan effort not to do anything that touches health care reform.”

To be sure, most of the legislation filed thus far is an effort to halt federal health reform in its tracks. State Reps. Wayne Christian, R-Center, and Ken Paxton, R-McKinney, are among several lawmakers proposing a state constitutional amendment to preserve Texans’ right to go without health coverage, free of penalty.

Rep. Leo Berman, R-Tyler, takes it a step further. He has filed a bill to nullify federal health care reform entirely. Under his legislation, any state or federal government official who attempts to implement any aspect of the Patient Protection and Affordable Health Care Act could be charged with a crime — and face a fine and even jail time. Berman said his measure would even apply to his colleague, Rep. John Zerwas, the Simonton Republican who has drafted legislation to create one of the key elements of the law, a health insurance exchange.

“We’ll just have to see which one passes,” Berman said. “The Obamacare bill is unconstitutional and must be declared null and void.” 

Zerwas, a staunch conservative, is no fan of the federal reform effort. He believes Congress exceeded its authority by passing it. But he said that if Texas lawmakers do not design their own health insurance exchange — effectively a clearinghouse for consumers looking to purchase small-employer and individual health insurance plans affordably — the feds will do it for them.

Plus, he said, the proposed Texas Health Insurance Connector, which could operate as a kind of Travelocity or Orbitz for buying health insurance and has the support of the state’s most vocal health care organizations, would be beneficial even if federal health reform is repealed or overturned by the courts. (Court challenges are pending. The U.S. House voted to repeal the measure two weeks ago, but the Senate is unlikely to take up the issue — and President Obama’s veto pen would be at the ready in any event.) 

“In the spirit of our 10th Amendment rights, I don’t want to cede anything to the federal government,” said Zerwas, who is also an anesthesiologist. Still, he said, the insurance exchange “would have value even beyond Obamacare.”

Some elements of federal health care reform are even evident in the state’s proposed 2012-13 budget — though not under that name. The federal law awards incentives to states and health care providers that try creative payment and delivery models to cut costs. The state budget includes these types of pilot programs, too. And both the House and the Senate are drafting legislation to address the high cost of health care through so-called “quality-based payment reforms,” with Lt. Gov. David Dewhurst’s office giving it much attention. 

“With how much it affects patients, and how much of our budget it makes up,” Banning said, “to get caught up in the partisan nature of health care does no good for Texas.”