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greater burden on our own state budget. Eventually, this situa- tion will create a substantial budgetary crisis for Texas, forcing us to choose between raising taxes and diverting increased re- sources from other areas of government just to keep Medicaid afloat. Funding an expanded Medicaid program under even the best of circumstances will mean higher taxes, increased federal debt, and reduced government services for the citizens of Texas.”

The physicians said the best way to “ensure the long-term viability of our state’s ailing Medicaid program is to seek a federal block grant which would allocate funding to the state directly, thereby providing Texas with the freedom to design its own Medicaid system without burdensome federal regulations and one-size-fits-all mandates. Such a grant would provide us with the independence and flexibility to devise the best and most cost-effective solutions to the specific health care needs of Texas, while preserving the critical doctor-patient relation- ship and ensuring continued access to care.” State Sen. Jane Nelson (R-Flower Mound), chair of the Senate Health and Human Services Committee, is dubious about expanding a program that she says is “financially un- sustainable.”

“I have serious concerns about the long-term consequences of adding millions to an inefficient system that — despite our repeated efforts to gain flexibility — severely restricts our abil- ity to contain costs, root out abuse, and encourage personal responsibility.”

While state lawmakers worry about the price tag for PPA-

CA, so do some hospitals because the law makes steep cuts in supplemental Medicaid payments to facilities that serve large

numbers of poor and uninsured patients. The law was sup- posed to add some 16 million people to the Medicaid rolls nationwide, meaning hospitals would no longer need the sup- plemental payments to help cover uncompensated care. But hospitals in states that reject the Medicaid expansion will suf- fer the payment cuts and still see large numbers of uninsured patients walking through their doors, experts say. Even if Texas implements the Medicaid expansion, some

lawmakers question whether it would really improve patients’ access to care. Representative Shelton says physicians simply cannot afford to see Medicaid patients because the payment rates do not cover the cost of providing care. “When you think about that, who is going to see these pa- tients?” he asked.

CREATING AN EXCHANGE While state decisions to reject Medicaid expansion could signif- icantly cut the number of newly insured people under PPACA, the decision to forego a state-run health insurance exchange likely will have less impact. That’s because PPACA gives Sec- retary Sebelius authority to create a federally run exchange in those states that fail to create one. According to the Kaiser Family Foundation, the exchanges

will offer patients a choice of different health plans, certify those plans that participate, and provide information to help patients understand their options. Set to begin in 2014, the exchanges will target individuals buying insurance on their own and small businesses with up to 100 employees, though states can choose to include larger employers in the future. There seems to be some



Are your patients asking you questions about the Patient Protection and Affordable Care Act and how it affects them? To help you answer their questions, TMA created a brochure for

patients, “Because Your Doctor Cares: What You Need to Know About Health Care Reform” (see insert between pages 24 and 25). TMA members may order free copies of this brochure to hand out or

place in waiting rooms. Call the TMA Knowledge Center at (800) 880- 7955 or email with the number of brochures you need and your mailing address.

16 TEXAS MEDICINE September 2012

disagreement, even among Republican lawmakers, about whether Texas should create its own exchange. Representative Zerwas

sponsored legislation in the 2011 session that would have authorized state agencies to move forward with an ex- change, and he still thinks Tex- as should take the reins on one. “I have a lot of discomfort in ceding this to the federal gov- ernment, even if it’s only on a temporary basis, because I think the federal government ultimately will remedy this with a one-size-fits-all solution and, perhaps, a single-payer model, which obviously is what this administration would love to do,” he said. But Representatives King and Shelton say it really doesn’t matter who sets up the

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