Perry Rejects PPACA Mandates

Railing against "brazen intrusions into the sovereignty of our state," Gov. Rick Perry told federal officials he opposes expanding Medicaid in Texas or creating health insurance exchanges, two key provisions of the Patient Protection and Affordable Care Act (PPACA).

"I stand proudly with the growing chorus of governors who reject the PPACA power grab. Thank God and our nation's founders that we have the right to do so," he said in a letter to Health and Human Services Secretary Kathleen Sebelius.

"Neither a 'state' exchange nor the expansion of Medicaid under the Orwellian-named PPACA would result in better 'patient protection' or in more 'affordable care,'" he said. "What they would do is make Texas a mere appendage of the federal government when it comes to health care."

Meanwhile, the share of Texas physicians who will take new Medicare or Medicaid patients has dropped to an all-time low, according to a TMA physician survey. Low-income Texans who rely on Medicaid for their care are the hardest hit.

TMA President Michael E. Speer, MD, said the association is already at work developing an alternative approach to present to Governor Perry and the Texas Legislature. "I do not know what that system looks like … yet. But I do know we need to fix the system so poor patients can receive care. We need to win realistic payment rates, we need to reduce the stifling state bureaucracy, and we need to eliminate the fraud-and-abuse witch hunts."

The governor wrote that PPACA "does not truly allow states to create and operate their own exchanges. Instead, it gives the federal government the final say as to which insurance plans can operate in a so-called 'state' exchange, what benefits those plans must provide, and what price controls and cost limits will apply. It leaves many questions to be answered later through federal 'future rulemaking." In short, it essentially treats the states like subcontractors through which the federal government can control the insurance markets and pursue federal priorities rather than those of the individual states.

Secretary Sebelius responded to Governor Perry and other governors opposed to the Medicaid expansion that she hopes state leaders "will take advantage of the opportunity provided to insure their poorest working families with the unusually generous federal resources while dramatically reducing the burden of uncompensated care on their hospitals and other health care providers."

The Supreme Court upheld PPACA in June but said the law cannot force states to relinquish their current federal Medicaid funding if it does not expand Medicaid. The health insurance exchanges are not optional. If Texas does not implement one, the federal government will.

The September issue of Texas Medicine will have more information about what PPACA means to Texas physicians.

The TMA survey found Texas physicians available to treat new Medicaid patients plummeted from 42 percent in 2010 to 31 percent, less than half the 67 percent who reported they would take all new Medicaid patients in 2000. The number of Texas physicians accepting all new Medicare patients dropped from 66 percent in 2010 to 58 percent in 2012. That's part of a steady decline from 78 percent in 2000.

"All the bureaucratic red tape and administrative burdens only serve to increase the cost of running a practice while diverting a physician's attention away from patient care," Dr. Speer said. "Every business has a breaking point; physicians' practices are no different."

The survey also found that if health care reform were to increase the number of patients covered by private insurers and Medicaid, one in five doctors (and one in 10 primary care physicians) cannot serve any more patients than they do today. More than half of physicians (51 percent) report their practice could take more privately insured patients, but not more Medicaid patients.

TMA recently published its strategic roadmap, titled Healthy Vision 2020. It outlines the association's state and federal recommendations to ensure patients have the right care, at the right place, and at an affordable price.


 Action, July 16, 2012


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