AUSTIN, Texas (AP) — Texas Republicans have made it clear they hate the idea of expanding health care for the poor under the Affordable Care Act, but a key leader pledged Friday to work on a state alternative to accomplish the same goal and bring in the same federal matching funds.
House Appropriations Chairman Jim Pitts said lawmakers from several committees will work together to try to come up with a home-grown solution to providing more poor people with health care. A Gallup poll released Friday showed 28.8 percent of Texans lacked health insurance in 2012, which Gallup called the highest rate in the nation and highest ever recorded in the United States.
"I think we owe Texans an obligation to discuss this plan during the legislative session and get something done this legislative session," Pitts said in the most unequivocal statement yet on expanding Medicaid.
Lawmakers heard three hours of testimony about how Texas could provide 1 million people with health care coverage and better reimburse doctors by spending $18 billion and earning $100 billion in federal matching funds over 10 years. State officials, hospital representatives and county leaders said the state might even save enough money at the local level to cover its $18 billion investment.
Billy Hamilton, a former state revenue estimator who now works as an economic consultant for Methodist Healthcare Ministries of South Texas, said counties and hospital districts spend $2.5 billion a year on indigent health care, and private hospitals provide $1.8 billion a year in charity care. Expanded Medicaid would reduce much of those costs, he said.
"I don't really think you're going to see a more overwhelming fiscal opportunity" than Medicaid expansion, he said.
Dallas County Judge Clay Jenkins said expanded health care coverage would allow him to lower county and hospital district taxes. He said the mentally ill also would gain coverage, reducing the likelihood they end up in the county jail.
"If we can get behavioral services for those people outside of our jails ... that's a much better way of doing it," he said.
The only person to speak against expanding health care coverage was John Davidson, a policy analyst with the conservative Texas Public Policy Foundation. He said expanding the number of people who rely on government-funded health care means ever-growing costs for taxpayers.
"We believe Medicaid spending is on an unsustainable trajectory," he said.
Twenty-seven states and the District of Columbia have agreed to Medicaid expansion, with most states developing unique methods for spending increased funding to make sure everyone who earns less than the federal poverty level gets health coverage. In Texas, that's $11,170 a year for an individual, or $19,090 a year for a family of three.
Democrats agree with Republicans that Texas should develop its own program to meet the state's unique needs.
Rep. Sylvester Turner, D-Houston, expressed surprise when Health and Human Services Commissioner Kyle Janek said he had not developed a Texas proposal to take to Washington for consideration.
"Y'all are driving me nuts! The state of Arkansas has come up with a plan! This is not funny," Turner said, referring to Arkansas' plan to provide private health insurance to the poor by using federal and state money.
Janek said he was awaiting instructions on what lawmakers want a Texas plan to look like.
House Republicans started the week by rejecting Medicaid expansion under current Affordable Care Act provisions. But Speaker Joe Straus said Thursday it was time for Republicans to start looking for a conservative solution to Texas' high uninsured rate.
Gov. Rick Perry has roundly rejected expanding Medicaid "under current conditions" and is believed to be open to an alternative.
Ideas floated include requiring co-payments from those who enroll, setting up a defined network of providers and offering a menu of services rather than a set package.
Concerns include how much Medicaid reimburses doctors, and whether there are enough doctors to absorb the expected influx of new patients. Doctors complain current reimbursement rates set by the Legislature only cover 52 percent of actual treatment costs.
The Texas Medical Association reports only 30 percent of doctors are accepting new Medicaid patients because of low rates. The group has recommended Texas expand health care for the poor, but only if reimbursement rates improve.
Reimbursement rate increases are included in the $18 billion state price tag of the plan lawmakers considered Friday.