Texas Starts the Debate Whether to Take Obamacare's Medicaid Money

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Texas faces Medicaid, and Obama.
Advocates of Medicaid expansion -- part of Obama's Affordable Care Act -- continue to ply Texas lawmakers with economic numbers, making the point that the expansion of the program is not a cost, but a benefit, to taxpayers.

Like Sisyphus eternally pushing his boulder up the hill, advocates for Medicaid expansion like Texas Impact and the Center for Public Policy Priorities are vigorously working the Capitol on the Medicaid issue, luring staffers to free breakfast briefings, walking the halls for supporters and, today, issuing a breakdown, legislative district by legislative district, as to the cost benefits of expansion. The tabulated gain is $2.1 billion in new revenue across the state.

Harris County spends around $1 billion dollars in indigent care each year, whether it's the hospital district, the charity care of local hospitals or the indigent health care picked up by the county. Put more people on the expanded Medicaid rolls, pull down more federal dollars and the collective benefit in "freed up" local tax revenue is around $411 million over four years.

"The point here is it's not just an issue of defraying costs that local taxpayers currently are paying," said Texas Impact Executive Director Bee Moorhead. "There's actually a net benefit to the county that will give county commissioners and hospitals more local money to meet their mission."

Here's the breakdown by legislative district that is being circulated in Austin.

Two Houston-area Republican lawmakers -- Tommy Williams in the Senate and John Zerwas in the House -- could play a key role in deciding whether the state will put the dollars aside to provide a local match for Medicaid expansion. Williams, who chairs the Senate Finance Committee, has called Medicaid "broken." Zerwas, who chairs the Appropriations subcommittee on health care issues, says he agrees with Gov. Rick Perry that Medicaid expansion is a mistake.

The only mistake, from Moorhead's point of view, is that Texas could forego its share of the $100 billion the federal government already has set aside for Medicaid expansion.

"The federal government has piped up and said they will kick in $100 billion over the next 10 years to fix the situation, and the only thing our legislators are going to say is, 'No, no, let our own taxpayers continue paying for it'?" Moorhead said. "By passing up this money, you've also locked out all those people right above the poverty level who could now afford insurance because Medicaid will supplement their premiums. Their benefit is gone."

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