Amendment Targeting Medicaid Expansion Unlikely to Stick

An amendment that blocks Texas from expanding Medicaid without legislative approval doesn’t seem likely to stick.

The House on Thursday knocked down a nonbinding motion to instruct conferees to keep the “anti-Medicaid expansion” amendment when they meet with Senate members to work out the final language of Senate Bill 7.

Added to SB 7 on Monday with an 87-57 vote, the amendment would prohibit the Health and Human Services Commission from providing “medical assistance to any person who would not have been eligible for that assistance and for whom federal matching funds were not available” under the state’s existing criteria for medical assistance.

The amendment “essentially ties the hands” of the commission and state health commissioner, said state Rep. Chris Turner, D-Grand Prairie, by preventing “any discussion with all of the federal government on how we may be able to reach some kind of Texas solution.”

“This amendment has nothing to do with this bill,” added state Rep. Richard Peña Raymond, D-Laredo and the sponsor of SB 7. He said the bill deals with individuals that have intellectual and physical disabilities, and he added that the author of the amendment, state Rep. Jeff Leach, R-Plano, chose not to push for a motion to keep the amendment.

This bill is “trying to move them in a very careful way to a system that we hope will provide better care and help people in our society that need the most help,” Raymond said.

The nonbinding motion was offered by state Rep. Giovanni Capriglione, R-Southlake, who argued that the House conferees should keep the amendment “to make sure that we do not expand” Medicaid. The motion was rejected by a 71-68 vote.

“The Leach amendment is problematic,” said Sen. Jane Nelson, R-Flower Mound and the author of SB 7. The specific language of the amendment would have unintended consequences, she said, but she is working on new language to add to the bill during conference “that would capture the essence of what those who supported the amendment want, but does not have unintended consequences.”

“We’ve got plenty of time, we’ll work it out,” she said. “Senate Bill 7 has to pass.” 

“Our whole intent behind the amendment is to have the Legislature be involved in any future expansion of Medicaid,” said Leach, adding that he’s spoken with Nelson, state health commissioner Kyle Janek and members of Gov. Rick Perry’s office on tweaking the language of the amendment. “My hope is that it passes with my amendment on it, the tweaked version of my amendment.”

State Reps. John Zerwas, R-Richmond; Jim Pitts, R-Waxahachie; Carol Alvarado, D-Houston; and Bennett Ratliff, R-Coppell, will join Raymond and Sens. Nelson; Bob Deuell, R-Greenville; Juan “Chuy” Hinojosa, D-McAllen; Joan Huffman, R-Southside Place; and Charles Schwertner, R-Georgetown, in conference to decide on the final language of SB 7.

Deuell said that he and his Senate colleagues had a brief chat about the amendment Wednesday night, but that he has not been able to examine the language closely enough to reach a final determination. Although he opposes Medicaid expansion under the Affordable Care Act, he raised concerns that the amendment could limit the state’s ability to request a block grant or other Medicaid waiver to reform the program as Texas sees fit.

Zerwas, who has pushed this session for the Legislature to weigh in on the Medicaid expansion debate by approving “a Texas solution” based on private-market reforms, raised similar concerns when lawmakers discussed the amendment on Monday evening.

He argued that the "broad stroke" of the amendment could handicap the state's ability to draw down federal financing for other programs. "This particular provision, in terms of restricting any ability to utilize matching funds for the provision of health care, is not the right amendment for this bill,” he said.