The Lege This Week: Texas House Passes Budget, Republicans Again Reject Medicaid Expansion

Welcome to the 87th Legislative Session. Since the last session came to a close in June 2019, Texas has been hit by an unrestrained pandemic and a crippling economic crisis—and now the fallout from deadly blackouts. Under unprecedented circumstances, lawmakers are faced with a number of urgent challenges. The Texas Observer is following along every step of the way. 

Go here for last week’s dispatch from the state Capitol.

What We’re Following:

House Republicans Reject Medicaid Expansion

Texas has the highest rate and number of uninsured people in the country, by far. Hundreds of thousands more Texans lost their coverage during the pandemic. Rural health care is in crisis across the state, with the most rural hospital closures in recent years anywhere in the county—in large part because they can’t continue footing the bill for uncompensated care of uninsured people. Yet Texas lawmakers again rejected a proposal on Thursday to draw down billions in federal funds to expand insurance coverage to more than 1 million Texans. 

After just a few minutes of debate on the House floor on Thursday, Republican members voted down a budget amendment from Representative Garnet Coleman, a Houston Democrat, to accept the federal funds available under the Affordable Care Act and create a version of Medicaid expansion modeled after plans in other conservative states. 

It’s not surprising that Texas Republicans would again reject the coverage expansion. A more than decade-long political grudge against former President Barack Obama and his sweeping health care law has made it a nonstarter for many state conservatives, even as other red states have opted in. Texas is one of just 12 states that continues to decline the expansion. But there were signs that this session could be different. For one, a majority of House members had publicly signed on to an expansion bill, including nine Republicans. (The measure has not gotten a committee hearing, prompting Coleman to join with the bill author, Democrat Julie Johnson, to try to pass it as a budget amendment.) But just one Republican, San Antonio Representative Lyle Larson, voted with all Democrats in favor of the measure on the House floor. 

“Unfortunately we are stuck in a decade old narrative that has forced the closing of many rural hospitals and less access to physician care,” Larson tweeted after the vote. “Fiscal conservatism was denied today.”

All major medical groups in Texas ask the lege to increase federal healthcare dollars coming to Texas. Unfortunately we are stuck in a decade old narrative that has forced the closing of many rural hospitals and less access to physician care. Fiscal conservatism was denied today pic.twitter.com/EYbIuFSQnw

— Lyle Larson (@RepLyleLarson) April 22, 2021

About 75 percent of the estimated 1.4 million Texans who would become eligible for coverage under Medicaid expansion are people of color, according to the Kaiser Family Foundation. Large populations who would gain coverage live along the Texas-Mexico border and in parts of East and Central Texas and the Panhandle. Hospital administrators, physicians, and health care advocates have long said expanding Texas’ extremely narrow Medicaid income eligibility is critical for rural areas in particular—often Republican strongholds—where there are many uninsured residents and hospitals struggle to pay for their care.  

Raising the stakes, the Biden administration announced late last week that it would revoke the Trump administration’s last minute approval in January of Texas’ 10-year $100 billion Medicaid waiver, saying that it was a rushed process. Absent renewal, federal funding under the current Medicaid waiver would expire in September 2022, before the next legislative session. The waiver is meant to be a temporary stopgap measure, but because Texas has refused Medicaid expansion, it’s been used to help pay for uncompensated care for the state’s uninsured population. Conservative state leaders and the Texas Hospital Association slammed the Biden administration for the move. 

But health care advocates, who have long said the waiver was a bandaid that didn’t do enough, hoped it would prompt more serious consideration of Medicaid expansion, especially after the Biden administration added billions of dollars in extra incentives this year. That had appeared to be the case earlier this week, with bipartisan support for expansion and a letter from nearly 200 Texas medical, advocacy, and government groups urging state leaders to expand coverage. “Texans cannot wait. Many continue to reel from the ongoing health, economic, and social impacts of the COVID-19 pandemic,” the letter stated. Of the state’s massive uninsured population, the groups wrote: “All Texans pay the price.” —Sophie Novack

“Smarter Justice” 

On Wednesday, the day after a Minneapolis jury convicted the police officer who murdered George Floyd, Texas House leaders outlined a bipartisan plan for reforming the criminal legal system, an initiative they dubbed “Smarter Justice, Safer Texas.” The announcement by Republican House Speaker Dade Phelan and Democratic Speaker Pro Tem Joe Moody listed more than a dozen bills filed by members on both sides of the aisle that aim to improve police training, bolster protections for defendants, limit the death penalty, eliminate financial barriers for people returning from prison, and reform sentencing for juveniles.

Both Phelan and Moody are members of the House Criminal Justice Reform Caucus, which Moody formed after many similar proposals failed last session. In a statement introducing the roster of bills, Phelan urged lawmakers to consider “bold and innovative ideas.” “After years of over-incarceration, we now realize that a compassionate, common sense approach to criminal justice can keep Texans safe, save lives, and save money,” he said.

Perhaps the most significant reform on the list is a bill limiting arrests for fine-only offenses, a proposal that reformers have been pushing in Texas for years and that is also part of a larger omnibus police reform package this session named after Floyd, a Houston native. But some reforms are notably absent from the bipartisan coalition’s list of “Smarter Justice” bills. Pot decriminalization, for instance, has been a priority of Moody’s for several sessions and is even part of the state Republican party platform, yet it didn’t make the cut. And key planks of the George Floyd Act that prohibit chokeholds, restrict use of force, enact a duty for cops to intervene when they see other officers doing harm, and end qualified immunity aren’t on the list either, although some related standalone bills have moved in the Senate. The bipartisan list of reforms also doesn’t include any changes to Texas’ toothless system of police oversight, let alone address the many crises inside the state’s aging and understaffed prisons. 

Some advocates warn the bail reform bill on Phelan and Moody’s list could even increase pretrial detention and further entrench an inherently inequitable cash bail system in the state. A similar bill that would keep more people in jail who can’t pay bail has already cleared the Senate. 

Not surprisingly, some were underwhelmed by the list of “Smarter Justice” reforms. Scott Henson, with the Austin-based reform group Just Liberty, said in an email, “It’s hardly transformative and little of it represents the main demands of the [criminal justice reform] movement.” Phelan told the Dallas Morning News that he plans to add more bills to the plan this session, saying, “We need to normalize conversations around this.” While not transformational, whatever the coalition can pass this year will likely set a new bar for bipartisan criminal justice reform in a state that’s seen very little of it in recent years. —Michael Barajas

Peril for Permitless Carry?

After the House passed a bill last week that would allow almost all adult Texans to carry a handgun without a permit, Lieutenant Governor Dan Patrick pledged his commitment to the measure, while acknowledging that there currently are not enough votes for passage in the Senate. “If we have the votes to pass a permitless carry bill off the Senate floor, I will move it,” he said. “I plan to meet with law enforcement who oppose permitless carry and with the [National Rifle Association] and [Gun Owners of America] who support it to see if we can find a path that a majority of senators will vote to pass.”

In order for it to pass, all 18 Republican senators would need to vote for the measure. But Amarillo Republican Kel Seliger, a relative moderate, has hinted that he may not support the bill. Since Patrick’s statement, some Senate conservatives have come out in support of the bill. 

After @DanPatrick said Mon there aren't enough votes, some Senate Republicans are starting to publicly declare their support for #HB1927 (permitless carry):
– @DrewSpringer (author of similar Senate bill): https://t.co/25UmY6Id1V
– @DrBuckinghamTX: https://t.co/1goAiU1kVN #txlege

— Patrick Svitek (@PatrickSvitek) April 21, 2021

Meanwhile, Governor Greg Abbott—ever the political weathervane—has declined to weigh in on the matter. When asked by reporters if he wanted the bill to pass and if he would sign it if it reached his desk, Abbott only said that “we’re looking at all of these bills.” Despite growing pressure from gun groups to pass the measure, many Texas police chiefs have gone on the record opposing permitless carry. That puts Abbott in a tight situation as he prepares for a primary challenge from the right in 2022 while also trying to cast himself as a champion for law enforcement this session. 

Texas GOP Chair Allen West—a potential challenger to Abbott—has launched a coalition with national gun rights advocates to ratchet up the pressure on tentative Republican lawmakers. He lashed out at Abbott and Patrick, accusing them of “actively running away from this legislation. You’d think they’d be proud to whip the Legislature to get it done.” —Justin Miller

 

What We’re Reading:

Wikimedia Commons/Larry D. Moore

Texas House passes cautious $247B budget, rejects more health care for working poor

The House unanimously passed its budget for the next biennium Thursday night while opting to further delay the appropriation of $35 billion in federal pandemic relief aid. Legislators approved an amendment that would require a special session for the Legislature to approve all federal relief spending, striking a blow to Abbott, who has kept a tight grip on those purse strings. / Dallas Morning News

Texas lawmakers advance bills blocking access to gender-affirming health care despite opposition from LGBTQ Texans, medical associations

Republican legislators have filed more anti-LGBTQ bills this session than any other state in the country, according to Equality Texas. Many of those bills specifically target trans children and their parents’ ability to access gender-affirming health care services. If Republicans get their way, transgender children would be barred from receiving puberty blockers, hormone treatments, or surgery for gender-confirmation purposes. / Texas Tribune 

Texas Legislature renews fight over removing Confederate monuments, other historical markers

Led by Dallas State Representative Rafael Anchía, Democrats are pushing legislation this session that would remove seven Confederate monuments that are on display in the Texas Capitol, including a portrait of Confederate president Jefferson Davis that hangs in the Senate chamber and the hulking confederate soldier statue on the Capitol’s south side. In 2019, state leaders finally removed a plaque in the Capitol that asserted the Civil War was not fought over slavery—and only after protracted public pressure. Some Republicans, meanwhile, are renewing their attempts to stop the removal of Confederate monuments from government property. / Dallas Morning News 

‘A Failure of Texas-Size Proportions’—State Debates How to Overhaul Its Power Market

Two months after blackouts paralyzed Texas, most participants in the state’s Wild West electricity market agree: The freeze wasn’t a one-off event and the state’s power market needs to change. But how far are lawmakers willing to stray from laissez-faire orthodoxy and how much are Texans willing to pay to prevent future grid failures? “All eyes are on Texas, and they should be, as it relates to electricity-market reforms,” said Curt Morgan, CEO of Vistra Corp., the state’s biggest power generator. “If they just put a Band-Aid on a mortal wound…we’re not going to make it.” / Wall Street Journal

 

All Hat, No Cattle

The Texas Legislature is known for its outlandish members, ludicrous antics, and right-wing flare-ups. Here’s your weekly dose.

Nothing brings out the Texas Legislature’s zeal for right-wing performance politics quite like Budget Day in the House. When the floor opens up for amendments, legislators get the opportunity to throw hunks of the choicest red meat at the budget bill and see what sticks. Whether it actually sticks isn’t so important, so long as they are seen offering it up. In a marathon proceeding Thursday, the House considered more than 100 amendments to Senate Bill 1, the budget passed by the upper chamber earlier this month. Within that pile of proposals was a menagerie of right-wing theatrics. 

Representative Tom Oliverson filed an amendment that took aim at corporate foes, such as the meddling “Mr. American Airlines,” that oppose the GOP’s attempts to further restrict voting this session. The amendment would prohibit state agencies from administering grants to a business unless the company certifies that it “has not publicly opposed any legislation” in Texas or any other state related to “election integrity.” Facing a gauntlet of opposition, Oliverson quickly withdrew the amendment. 

Representative Mayes Middleton wins the award for the most niche amendment: prohibiting the Texas Department of Transportation from using any of its appropriated funds to enforce mask mandates on any ferry it operates. Middleton, too, withdrew the amendment before it could be considered.

Representative Jeff Cason authored an amendment that would prohibit state funds from being used to teach “critical theory” in public schools. The proposal did not define what that theory is, although it’s possible that he meant “critical race theory,” which conservatives believe to be the latest method of communist indoctrination in public schools. Cason’s amendment was promptly killed by a point of order.

Representative Bryan Slaton, a first-term Republican, filed a proposal to zero out the Commission on the Arts’ $10 million in appropriations and use that money to fund construction of the “President Donald J. Trump Wall” along the Texas-Mexico border. He also filed the latest in a series of amendments attacking trans children. This one would prohibit the use of public school funding “to ffirm certain perceptions of biological sex.” Both amendments were killed.

While the most outlandish amendments were clearly political stunts, Republicans still managed to pass a few. One was Representative Matt Krause’s amendment to raid $20 million in appropriations over the next two years to the state health commission that were dedicated to help administer programs like Medicaid, CHIP, and SNAP, and funnel that money into “Alternatives to Abortion,” which funds faith-based pregancy centers. The anti-abortion program lacks transparency, but Republicans continue pumping in more and more money—its budget has increased at least 16-fold since 2006—with these sorts of maneuvers.