Janek Awaits Direction From Lege on Medicaid Expansion

Texas Executive Health Commissioner Kyle Janek clarified on Thursday why negotiations between the federal government and the Health and Human Services Commission on whether to expand Medicaid are at a standstill: He's waiting on the Legislature.

“It makes more sense to me as an unelected official to wait for the Legislature to finish its work,” Janek, who oversees five state health agencies, told Evan Smith, the Tribune’s CEO and editor-in-chief, at a health care symposium in Austin.

Janek explained that even without intervention from the Legislature, it’s already within his purview to negotiate with the federal government on a way to expand or reform Medicaid in Texas. But the Legislature could pass a law dictating the terms of what those negotiations could look like, he added, so “it would be a waste of my time to start negotiating pieces when I don’t know what the Legislature will decide.”

Lawmakers are debating whether to pass a bill or include a rider in the state budget detailing how lawmakers would prefer the state reform Medicaid and approach negotiations with the federal government to draw down federal dollars to expand coverage for poor adults.

The House has approved a nonbinding motion to prevent budget conferees to include any language that would expand Medicaid in the state budget, and it’s unclear whether House Bill 3791, a conservative alternative to Medicaid expansion, would win legislative approval.

Gov. Rick Perry, who appointed Janek, remains adamantly opposed to expanding a “broken” Medicaid program, and has advocated that the state should request a block grant to reform the program without federal intervention.

In response to Smith’s question “Who do you work for — the citizens of Texas or the governor?” Janek responded, “If he’s not in charge, then who?” He added that the debate on Medicaid expansion is not just about politics, but rather, “it’s politics based on policy.”

Janek also clarified a text message exchange with state Rep. Garnet Coleman, D-Houston, on potentially visiting Washington together to discuss health reform with the federal government. The exchange was published by The Dallas Morning News this month. Despite reports that the trip was to discuss Medicaid expansion, Janek said that that wasn’t necessarily on the agenda and that the governor’s office did not intervene to cancel the trip. 

As for his personal opinion on whether Texas should expand Medicaid, Janek said he’s not sure whether it’s “the right thing to do.” Even though it would expand coverage and free up general revenue in other areas of the state budget, he said, expansion would put Texas on a trajectory for greater spending on health care down the line.