GOP Caucus Opposes Medicaid Expansion — With Caveats

House Republicans on Monday agreed not to expand Medicaid as called for under the federal Affordable Care Act — but left the door open to doing so if the Obama administration grants Texas enough flexibility.

“The current path as proposed is unsustainable from a fiscal standpoint,” said caucus chairman Brandon Creighton, R-Conroe. He said the caucus would continue to “propose solutions on the issue, which we’re formulating and will continue to do so throughout the session.” 

Several Republican-led states have in recent weeks reached compromises with the federal government to expand Medicaid coverage to poor adults. Arkansas, for example, has received permission to use Medicaid expansion financing to subsidize private health coverage for individuals who would qualify for Medicaid under the expansion. 

“State by state we’re going to study what every state proposes and compare it to what’s best for Texas," Creighton said. "We are Texas, so we are very different. We’re not making a blanket statement or a hard position on anything.”

So far, Gov. Rick Perry is standing firm on not expanding Medicaid, and has not expressed particular interest in any other states' compromises. 

“The governor’s position has not changed,” his spokeswoman Lucy Nashed said late last month. “It would be irresponsible to add more Texans and dump more taxpayer dollars into an unsustainable system that is broken and already consumes a quarter of our budget.”

Some of the solutions Creighton said GOP lawmakers are considering include implementing co-pays to hold Medicaid enrollees fiscally responsible for their care or using the expansion funds to help subsidize private health coverage for poor Texans — similar to what Arkansas is considering.

The state's health commissioner, Kyle Janek, served as a resource witness for the caucus and presented a variety of illustrations on the financial impact of the Medicaid expansion. Creighton said the caucus did not formally discuss other reports that have come out, including one by the state's former chief budget estimator, Billy Hamilton, on the beneficial financial impact Medicaid expansion would have on Texas.

“Instead of politicizing the issue, we’re analyzing it and we’re doing what we need to do to formulate the solutions that we will recommend,” Creighton said.

Progress Texas, a liberal nonprofit, has compiled a list of more than 50 organizations that support a Medicaid expansion in Texas. The list of supporters includes nine chambers of commerce, seven local government entities and more than 40 other organizations. Texas' two largest health trade organizations, the Texas Medical Association and the Texas Hospital Association, have also endorsed the expansion of Medicaid — as long as state lawmakers also implement reforms to improve the current system.