Committee, says he might favor an ex- pansion so long as it does not break the state budget or flood emergency de- partments with Medicaid patients who turn out to be underinsured because not enough doctors will treat them. “We [lawmakers] have got to consid- er the fact that there is a lot of money out there the federal government wants states to use for the purpose of providing coverage to people who aren’t insured right now, and Texas leads the nation in that,” he said. “But I agree with the gov- ernor: If we are going to continue to do the same old thing and add a couple of million more patients to the mix, we are going to see the whole thing fall apart.” Representative Zerwas agreed the time is now for the state to consider a Medicaid waiver, block grant, or other options, including those put forth by TMA. “Let’s talk about these things that might make a difference for Texas, and let’s see if we can get our leadership comfortable with the idea that there is a place for doing this.”
Senator Nelson also said she agrees with TMA that “there must be more flex- ibility and certain conditions met before we consider expanding Medicaid. We need to improve access to care and en- courage more providers to participate in Medicaid, but expanding the program as directed by the Affordable Care Act is not a realistic option for Texas. Especially for our seniors and dual-eligible population, our Medicaid services need to be of the highest quality, and part of that is ensur- ing those services are delivered by pro- viders who are adequately compensated.” Rep. Garnet F. Coleman (D-Houston),
an early proponent of expansion, says the bipartisan solution TMA calls for is “already on the table. We just need to take it.”
While he expressed concern that a so- called “flexible” approach could trans- late to a reduction in Medicaid services, Representative Coleman also added his support for other reforms, like raising Medicaid payment rates and promoting ACOs.
As for other changes, physicians are seeing progress on some fronts. Dr. Cardenas pointed to one health
plan that helps South Texas physicians manage difficult populations, for exam- ple, by helping provide asthma patients with certain medical supplies. Many HMOs have begun implement- ing systems to reward physicians for reducing nonurgent emergency depart- ment use, and HHSC has supported sim- ilar policies, according to the congress’ report. Meanwhile, TMA representatives on an HHSC-appointed Quality-Based Payment Advisory Committee are devel- oping ways for Medicaid HMOs and fee- for-service plans to engage physicians in new payment models that reward im- proved costs and patient outcomes. Representative Zerwas also highlight- ed a 2013 LBB Government Effective- ness and Efficiency Report that recom- mends a legislative oversight committee for Medicaid managed care operations to make sure health plans live up to their contract requirements and ensure appro- priate use of state funds.
The report is available at www.tex
med.org/MedicaidLBB.
“Those concerns have been heard, and we [lawmakers] are looking at some leg- islative ideas that might help,” he said. The Medicaid Congress’ recommen- dations are by no means exhaustive, Dr. Holcomb says. “But now there is pick and shovel work that has to be done so we can fix this. The bottom line is we need a more physician-friendly Medicaid program in order to get doctors to come back or get them into the program for the first time.”
Making the case
Texas Republicans argue that without flexibility, expanding the current Med- icaid program as prescribed by the Pa-
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