Texas is still reluctant to expand the Medicaid program as part of the Affordable Care Act, but the federal government is offering flexibility in how the Lone Star State may proceed.
According to the Texas Tribune, Secretary of the Department of Health and Human Services Kathleen Sebelius wants to open discussions with Texas about an alternative to straight Medicaid expansion.
"We are eager to have discussions with Texas about a program that could look uniquely Texan," Sebelius said. "But as far as I know, those conversations, at least with the state officials, are not taking place right now."
Sebelius did note that members of the Texas Congressional delegation who voted for the ACA have expressed support for discussions, as have mayors and county officials, according to Texas Public Radio.
Among the proposals that have been floated is a tax on health insurance policies that would help pay for Texas' share of paying for Medicaid expansion, and the use of co-payments, deductibles and other cost-shifting methods to patients. Such alternative proposals are being discussed in other states, such as Arkansas and Iowa, FierceHealthFinance previously reported.
A quarter of Texans--6.5 million--lack healthcare insurance, including one-third of all adults, the highest rate of uninsured in the nation.
Yet the Texas Legislature, which meets in only limited sessions every other year, would likely not convene again until 2015 to debate Medicaid expansion, according to the Tribune. And public officials in Texas have been harshly critical of the ACA.
"It's not that Americans don't understand Obamacare; it's that we understand it all too well," Texas Gov. Rick Perry, a Republican, told the Tribune. "We're all too aware Obamacare will still cause our state immense budgetary challenges in the years ahead just like it will to families and small businesses across our country."
The state's business community appears equally skeptical. "What this legislation--now law--has done is dramatically driven up the cost to small business owners and business owners who had been providing health insurance benefits to their employees are faced with ever-escalating costs to their business and are likely to drop care or eliminate employees in order to afford it," Will Newton, executive director of the Texas branch of the National Federation of Independent Business, told Texas Public Radio.