Honestly, is there anyone less qualified to manage Medicaid than the Texas Legislature?
When Lieutenant Governor Dan Patrick took to the mic on Texas Independence Day in March, he did so with the air of a man rallying his people before an alien invasion. “On March 2, 1836, a group of patriots gathered at Washington-on-the-Brazos to declare Texas’ independence as a nation standing on its own two feet,” he said defiantly. “That proud and independent spirit has animated the Texas character for the last 179years.” But it was now under threat, he said. By immigration? By Jade Helm?
Patrick, flanked by a platoon of Republican senators, had come to consider a much more potent threat to the state’s liberty: Medicaid, the program that provides life-sustaining health care to more than 4 million Texans. For many, Medicaid is the difference between getting treatment for diabetes and losing a limb to amputation; between receiving physical therapy and using a wheelchair; between a healthy pregnancy and a catastrophic one.
But to Patrick and the Republicans in the Texas Senate, the program was an “unsustainable, irresponsible” burden, a parasite on the state’s finances at a time when money had to be found to pay for tax cuts. Patrick and the chair of the Senate Committee on Health and Human Services, Senator Charles Schwertner, R-Georgetown, were demanding that the federal government relinquish control of Medicaid to the state.
Medicaid’s “long-term viability” was threatened, Schwertner warned, in part because of a “rapidly declining pool of health care providers.” If the feds removed the “gold-plated handcuffs that stand in the way of common-sense, conservative reforms,” Schwertner said, the state could “more effectively manage its Medicaid program and better serve its citizens.”
The feds declined to unlock the handcuffs. But lawmakers succeeded in putting into practice at least one of their ideas. At the last minute, the budget bill was modified, partially at the behest of Schwertner himself, to lop $350 million from the Medicaid Acute Care Therapy Program, which pays for therapy services for severely disabled children, many of whom need the treatment simply to continue living.
The backlash has been a dramatic story all summer, and it now seems as if the cuts will be at least partially rolled back. But the saga calls into question lawmakers’ claims that they care about health care for the needy. Honestly, is there anyone less qualified to manage Medicaid than the Texas Legislature?Among the arguments Patrick, Schwertner and others make for state oversight of Medicaid is that waste and fraud diminish Texas’ ability to care for those who are truly needy, and that the state is best able to find and detect that fraud.
And yet the Legislature’s cuts, by failing to distinguish between wasteful and necessary spending, treated the neediest as collateral damage. And in justifying deep cuts to therapy services, the Legislature relied on background research that was riddled with factual errors and faulty premises.
Worse, the Legislature’s shaky hand has contributed to the mounting uncertainty about Medicaid’s future, even exacerbating the provider shortage Schwertner emphasized in March. Dena Dupuie, who brought suit against the state on behalf of her special needs child, told the Observer in September that a therapist who helped her adopted daughter cope with severe psychological trauma stopped taking Medicaid even before the cuts went into effect.
Is there waste and fraud in Medicaid? Certainly. But the state has not proved itself exceptionally competent here, either. Over a recent five-year period, Texas says it was wrongfully charged $823 million for orthodontic care for kids who didn’t qualify under Medicaid guidelines. But in court, the state struggled to prove its case. Myriad lawsuits against the providers allegedly responsible for the fraud were settled this year for a pittance. On top of that, the state recently awarded a $110 million contract to a company promising to detect Medicaid fraud — a company that was, itself, fraudulent.
Few programs are as critical as Medicaid. Texas’ stewardship has been consistently ham-fisted, and yet lawmakers want more control. Maybe the feds should click those handcuffs a little tighter.