Starve a Cold, and Your Taxes

It's a well-known rule in journalism that when you don't want to write the story your editor assigned you, you suggest a new one—an equally good, if not better, alternative.

This rule, obviously, does not extend to politics, where several Republican governors have taken pains to assure people that they absolutely positively hate the Affordable Care Act—Maine Governor Paul LePage worried that under the law, the IRS would turn into the Gestapo. And Texas Governor Rick Perry went on Fox News Monday morning to explain just how intense his hatred was. But rather than offering any sort of alternative plan, Perry denied there was a health-care problem in the first place.

"We're not going to be a part of socializing health care in the State of Texas," he proclaimed. He said that the state would not participate in the subsidies states are supposed to set up to help the middle class buy policies, nor would the state expand Medicaid to cover those too poor for the subsidies. The former won't have much impact—the federal government will create a one-size-fits-all plan for states that don't set up their own exchanges. However, the Medicaid expansion is optional after the Supreme Court ruled that the federal government could not threaten to take away all funding if the state refused to comply. 

"People need to be free to make those decisions about their health care," Perry said. 

But in Texas, most people have little freedom or choice when it comes to health care. The state has the nation's highest percentage of uninsured people—around a quarter of the population. Public dollars must often help cushion the blow for hospital emergency rooms, which treat people who will likely be unable to pay their bills. That cost also gets transferred to those with insurance in the form of higher premiums. Even among the insured, things aren't great; last Thursday, the federal Agency for Healthcare Research and Quality ranked Texas last in the nation when it came to health services.

If Texas refuses to expand Medicaid services, as many as two million residents will be stuck without affordable health-care options. They'll be too poor to qualify for the subsidized policies but too wealthy to qualify for Medicaid. Furthermore, the state would hardly have to pay for the extra people—the federal government covers 100 percent of costs for the first few years, and states will never pay more than 10 percent. That means billions of dollars will be left on the table if the state chooses not to expand. It's not hard to figure out: It makes economic sense to expand.

But Perry was adamant, insisting that Medicaid is already a failure. "To expand this program is not unlike adding a thousand people to the Titanic. You're going to further drive this country into debt," he said. Instead he argued the funding should go toward allowing states to offer their own coverage, promising that "Texas and other states would find more effective, efficient ways to deliver health care to their citizens and do it in a way that preserves those individuals' freedom."

Medicaid is far from a perfect system, and even with the Obamacare reforms, many have legitimate concerns about the number of doctors who will see patients that rely on Medicaid. Government's reimbursement rates to doctors are often low, and doctors have difficulty making money when they see Medicaid patients. The Texas Medical Association released disturbing numbers Monday that less than a third of Texas doctors are accepting new Medicaid patients. However, Perry isn't offering alternatives to the problem of uninsured people—he doesn't even recognize that there is a problem.

"Every Texan has health care in this state, from the standpoint of being able to have access to health care—every Texan has that," he said on Fox.

That's simply not true. Millions of Texans don't have access to care—the state already has one of the stingiest Medicaid programs in the country. In some areas, people wait 24 hours to see emergency-room doctors. Perry can complain about the mandates, the federal expansion, and everything else, but to deny there's a problem in Texas is cruel to the many people who struggle to get care. 

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