Leaders of TMA and the Texas Hospital Association met with U.S. Sen. John Cornyn on July 3 to work out a better solution for the Medicaid provisions in the Better Care Reconciliation Act (BCRA), the Senate’s bill to repeal and replace the Affordable Care Act.
Senator Cornyn, the Senate Majority Whip, didn’t return to Texas for the July 4 recess. He stayed in Washington to work on the bill after a planned June 27 vote was cancelled. He met with the physician and hospital leaders via teleconference.
San Antonio pediatrician Ryan Van Ramshorst, MD, chair of TMA’s Select Committee on Medicaid, CHIP, and the Uninsured, and other members of the committee, participated in the meeting along with TMA Board of Trustees member David Fleeger, MD, of Austin. They explained to the senator how the BCRA’s Medicaid provisions would affect their practices and their patients.
In a joint letter signed June 28, both organizations offered their help in rewriting the bill.
“If enacted as drafted, the Medicaid provisions of the BCRA will have significant negative consequences for Texas, for Texans, and for the Texas state budget,” the joint letter said. “We welcome the opportunity to work with you to devise improvements that keep Medicaid costs low, reduce Medicaid’s administrative challenges, and preserve Medicaid’s important role in the health care delivery for all Texans.”
Compared to other states, the letter said, the proposed changes would punish Texas’ lean, efficient Medicaid system, which already underpays physicians and hospitals by as much as 60 percent and requires that enrollees must join a managed care organization. TMA and THA pointed out that:
- Medicaid funding is the financial lifeline for rural, border, and urban safety-net hospitals and physician practices upon with all Texans rely;
- Four million, or 15 percent, of Texans benefit from Medicaid directly;
- Texas Medicaid is the cord that binds the state’s health care safety net, covering 40 percent of low-income children and 50 percent of births; and
- If the federal government shifts costs to the states, Texas will be forced to shift costs to counties, which in turn will increase property taxes and/or services to compensate.
“Undoubtedly, Medicaid is imperfect. We agree reforms are necessary,” the letter said. “However, in lieu of the BCRA’s Medicaid proposals, we strongly encourage you to examine other sensible and fiscally sound options. Texas hospitals and physicians stand ready to help you develop pragmatic reforms that will preserve a high-functioning, efficient, and fair Medicaid program that supports quality health care for Texans.”
TMA also signed on to a separate letter on the same issue, sent to Senate leaders from the Coalition of State Medical Societies. That letter offers the assistance of the Coalition’s 10 member societies to “craft a better bill that will engender broader support from your colleagues and the American public.”
“We are concerned that the Medicaid per-capita cap and block grant growth index will not keep pace with rising costs beyond our control,” the Coalition’s letter said. “The proposal places an untenable burden on state budgets and an uncompensated care burden on physicians who are on the front lines caring for these patients every day. We need Congress’ help to better care for our patients.”
Per policy the TMA House of Delegates adopted earlier this year, TMA is committed to preserve guaranteed, uncapped federal Medicaid funding for at least all Texas Medicaid populations covered by the program as of Jan. 1, 2017.
Action, July 5, 2017