It’s a truism—yet also true—that collectivism discourages innovation. If one size fits all, as the Affordable Care Act and its proponents insist, then we need not search for other fits—or other solutions.
Yet a federal judge in Tyler, Texas has now sided with Texas and innovation in his ruling on a Medicaid waiver program that Texas has used to find new ways to connect uninsured Texans with real health care (not just meaningless coverage).
Last week, U.S. District Judge J. Campbell Parker granted Texas a preliminary injunction that blocked the Biden administration’s attempt to cancel a Trump-era agreement. The Centers for Medicare and Medicaid Services (CMS) had demanded that Texas renegotiate its “1115 Waiver” that allows it to use $3.87 billion in federal funding each year to “pay for innovative health care projects that serve low-income Texans, often for mental health services,” as the Texas Tribune reports.
It’s a 10-year deal that the Biden administration affirmed in January before denying in April. CMS was attempting to strongarm Texas into expanding Medicaid—despite the budget-busting price tags and lack of demonstrable improvements in health outcomes seen in other states. What’s more, adding an estimated 1 million Texans to the rolls would swamp a poorly performing system and crowd out the neediest families.
That’s why the 1115 waiver is important. Texas Attorney General Ken Paxton sued in May to reinstate it, noting at the time, “This would be a disaster for our state, and yet President Biden seems intent on thrusting his bloated model of government on everyone — including Texas.”
Meanwhile, the Texas Legislature is improving access to health care—as well as its quality—with innovative measures that go far beyond what simple (and simplistic) Medicaid expansion could hope to achieve.
Lawmakers began by demonstrating to their colleagues that Medicaid expansion alone won’t fix health care in Texas.
According to the Kaiser Family Foundation, 57% of the uninsured in 2018 were eligible for financial assistance through Medicaid or marketplace subsidies. In Texas, 662,000 could have signed up for Medicaid (or another public insurance, such as Medicare). And some 2.17 million Texans qualify for some level of subsidy. But they don’t—a plurality (45%) says the cost of premiums is too high, even with the subsidies. The Affordable Care Act is a clearly diagnosable failure.
That’s why Texas lawmakers brought out the innovative “Healthy Families, Healthy Texas” slate of reforms, which will help far more Texans than just expanding an ineffective federal program. And that 1115 waiver is key to allowing Texas to innovate. As Paxton’s lawsuit explains, “But Federal law provides CMS several ways to grant States additional flexibility. Section 1115 of the Act is one such process.”
“Healthy Families, Healthy Texas” actually strengthened Medicaid in Texas for vulnerable children by streamlining the eligibility process and ensuring continuous coverage for up to a year past eligibility. Another section addressed maternal health and mortality by expanding Medicaid eligibility to new mothers for up to six months after their child’s birth.
It established a prescription drug savings program for uninsured Texans. And another bill allowed certain member organizations—like The Farm Bureau and Texas Mutual—to create customized health benefit programs for individuals and families. These programs are an alternative to the Affordable Care Act—not an expansion of its fatally flawed mandates.
CMS is sure to challenge Judge Parker’s ruling in the Fifth Circuit Court of Appeals, but that court should acknowledge the wisdom of his ruling. Texas’ 1115 waiver allows the Lone Star State to seek new and innovative solutions that are best for Texans—without the ill-fitting strictures of the Affordable Care Act.