The Medicaid legislation getting the most attention in the Legislature this session are companion bills filed by Johnson in the House and state Sen. Nathan Johnson, D-Dallas, modeled after programs in conservative states like Ohio and Indiana.
The identical bills offer incentives for recipients to achieve self-sufficiency and independence through health savings accounts, employment assistance and healthy behavior rewards, rather than cultivating an attitude of state dependency, said Nathan Johnson, whose Senate Bill 117 is awaiting a committee hearing. The legislation would also increase provider reimbursements to encourage physicians to accept more Medicaid patients.
Medicaid expansion would also potentially generate hundreds of thousands of jobs and bring in billions in additional tax revenue to the state and to local governments, according to a recent analysis by The Perryman Group, an economic research firm in Waco.
“I’ve got to ask my colleagues, ‘How much are you willing to reject, in order to not provide health care to people for free? In order to not have people healthy enough to go to work?” Nathan Johnson said. “There’s a narrative that says, ‘We created the Medicaid program to help the truly vulnerable, the elderly, the disabled, the children. We’ve taken care of everything. Everybody else, you’re on your own.’ And that just refuses to look at reality.
Better reimbursements for doctors and the personal responsibility incentives are the two biggest reasons why House Republican Rep. Steve Allison, a San Antonio freshman and co-author of House Bill 3871, said he signed on to the legislation after years of skepticism.
“In the past, we just talked about expanding coverage and didn’t talk about care. I’ve always been stuck on care,” he said. “The incentives, too, are so important. … I think that’s what’s starting to move some of the Republicans, because that’s been a legitimate concern in the past. That we’re just further promoting welfare.”
But first it needs to reach the House floor. Frank, a Wichita Falls Republican, said he has not decided whether to allow a hearing on the House bill.
“I remain convinced that there are better ways for Texas to improve access and affordability of health care for all Texans than Medicaid expansion,” Frank said, adding that he worries Medicaid expansion could drain the state budget over time and lead to fewer private employers offering health benefits to workers.
Earlier this month, Phelan, Frank and other House members from both parties championed a set of bills called “Healthy Families, Healthy Texas” that Frank said would improve quality of care and health care access “for all 29 million people in the state.”
They include measures to reduce the cost of some prescription drugs for uninsured people, make it easier for children on Medicaid to continue coverage during income verification processes, require transparency in medical billing, expand availability of telehealth and broadband services, and increase insurance plan options through small businesses, agricultural nonprofits and associations, among others.
They also supported a bill expanding Medicaid coverage for new mothers to 12 months after the birth of a child, up from the current two months.
In Canyon Lake, what the politicians do at the Capitol could have a big impact on Trish, whose son inherited the same blood disorder and does have Medicaid coverage. If they expand Medicaid, she could stop having to make the difficult choice between paying for her own health care or putting food on the table and keeping the lights on.
“It’s not like we’re going to go see a doctor every chance we get,” she said. “It’s just to have that card in your back pocket to go get a physical or see a doctor if there’s an emergency. It means a lot to people like us. We exist, and we matter, and we don’t deserve to be treated like trash on the bottom of someone’s feet.”
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Correction, April 21, 2021: A previous version of this story gave the incorrect number for Sen. Nathan Johnson’s Medicaid expansion bill. It’s Senate Bill 117, not Senate Bill 118.
Clarification, April 23, 2021: An earlier version of this story said the 1115 waiver that was rejected by the federal government does not cover Medicaid services. The uncompensated care funds in the waiver help Texas hospitals cover costs of caring for the uninsured but does not pay for health care coverage or drug coverage for patients.