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torneys general to challenge the law, bemoaned the decision. “Although the individual mandate was found to exceed

Congress’ authority to regulate commerce, the court allowed Obamacare to stay intact by ruling that the mandate is a tax. We will continue our work to fight this unworkable and un- popular law,” he said. “It is time for Congress to step in and end the Obamacare nightmare by repealing this unprecedented tax on all Americans.” President Obama, however, declared the law is here to stay

and urged states to move forward with implementation. That, apparently, is not going to happen in Texas and several other states.

NEW NUMBERS Then-Texas Health and Human Services Commissioner Tom Suehs told a state House of Representatives appropriations subcommittee on July 12 that implementing the new health care law in Texas would cost the state about $11 billion less over 10 years than previously estimated. He said the cost is now estimated to be between $15 billion and $16 billion over 10 years, compared with the original forecast of $26 billion to $27 billion if the law is fully implemented, including the Medicaid expansion. He based his revised estimate on “new information and spending estimates,” but said the Supreme Court ruling makes it difficult to know exactly how much the law would cost. The new information includes a reduction in the projected case- load growth from 2 percent to 1.2 percent and a medical cost increase forecast of 4 percent instead of the original 6 percent. He also told the subcommittee that the reduced caseload re- sulted in a lower cost of primary care provider rate increases. Commissioner Suehs added that “expanding Medicaid with-

out reforming it only multiplies the tremendous budget pres- sure the program puts on states.” Anne Dunkelberg, associate director for CPPP, says expand- ing Medicaid would have been a “great deal for Texas” because the federal government would have picked up 100 percent of the cost from 2014 to 2016, with the federal government’s share gradually declining to 90 percent by 2020. Even at 90 percent, that is substantially higher than the

roughly 60 percent the federal government contributes to cur- rent state Medicaid programs.

“Expanding Medicaid will save Texas money in other ways, especially by reducing the money it spends providing health care in emergency rooms and health clinics to people without insurance,” she added. “Texas could even end up saving more on these costs than it spends on the expansion, easing the strain on property taxes.” But several Texas lawmakers question the wisdom of ex- panding a program that already is in the red. In 2011, lawmakers failed to fully fund Medicaid for 2012–

13. State Rep. Susan King (R-Abilene) says the state faces a shortfall in the program of somewhere between $3.8 billion and $5.1 billion. “We’re going to have to have a supplemental appropriations bill to pay that tab when we walk in the door for the 83rd ses- sion,” said Representative King, a member of the TMA Alliance. In a letter posted on TMA’s MeandMyDoctor blog (www, one senator and three House members who are physicians supported Governor Perry’s decision not to expand the state Medicaid program or implement a federally controlled health insurance exchange. Sen. Bob Deuell, MD (R-Greenville), and Reps. Charles Schwertner, MD (R-Georgetown), Mark Shelton, MD (R-Fort Worth), and John Zerwas, MD (R-Richmond), said they have “firsthand experience to the challenges facing our health care system, as well as a unique perspective on the profoundly det- rimental effect Obamacare will have on the citizens of Texas.” In 1987, they wrote, Medicaid accounted for about 11 per-

cent of the state budget but now totals more than 22 percent of the state budget, thus diverting funds the state could use for public safety, new roads, or education. They added that state spending on Medicaid grew two- and-a-half times faster than the rest of the budget and would increase more rapidly under the Obama administration’s proposed eligibility standards, placing one out of every five Texans on Medicaid by 2014. “Our present course is clearly unsustainable, and expanding Medicaid coverage to over a million new able-bodied adults does nothing to repair a bro- ken system that’s already groaning under the weight of those it serves,” they wrote.

Even though the federal government “will claim to pick up the tab for this expansion,” they said its share of funding “is designed to diminish progressively over time, creating an ever-

Gary Floyd, MD

Sen. Bob Deuell, MD

Rep. Charles Schwertner, MD

Rep. Mark Shelton, MD

Rep. John Zerwas, MD

Sen. Jane Nelson September 2012 TEXAS MEDICINE 15

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