If Texas withdrew from Medicaid

IF TEXAS WITHDREW FROM MEDICAID…. Despite assertions that Texas’ conservative governance is a model for the nation, the state government is facing a drastic budget mess. After more than a decade of conservatism, Texas suddenly finds itself in a $25 billion hole.

To address the shortfall, a growing number of Texas Republicans are interested in simply withdrawing from the Medicaid program altogether. Suzy Khimm explains why that’s a very bad idea.

The underlying rationale is that sacrificing the health coverage of poor people would be a worthwhile move if it solves the state’s budget crisis. If you’re a purist in opposing the welfare state — even at significant human cost to the most vulnerable — it’s a logical argument to make. But even if we all agree the goal is fiscal solvency, there’s also a chance that gutting Medicaid could end up backfiring.

The uninsured poor have already been resorting to hospital emergency rooms for care, and hospitals, in turn, have relied on state governments to cover the costs. If Medicaid coverage were pared back, the hospital ER would likely become the de facto safety net: The number of uninsured ER visits would invariably rise, and the state government would end up paying the price anyway. Texas’s own comptroller, Susan Combs, has admitted as much: In a 2005 paper, she proposes that the state’s Medicaid should be slashed and hospital reimbursements upped instead. But ER visits are extremely expensive, and they won’t serve as a particular cost-effective solution to eliminating insurance, which at least gives patients other options for care.

Khimm added that the “uninsured poor will continue to get sick,” even if Texas eliminates Medicaid coverage altogether. And as they do, and they seek care in emergency rooms, the costs for the state will still be enormous (arguably even higher than the status quo they’re inclined to abandon).

This is awful, of course, but it’s worth remembering that it’s not especially surprising — Republicans have made no secret of their love of emergency rooms as an alternative to a system of Americans with health insurance.

As for Texas, which already has the highest rate of uninsured residents in the country, dropping out of Medicaid would take the total from 26% of the state to 40% of the state.

I guess “compassionate conservatism” didn’t last?