And news that the federal government had negotiated with Arkansas to allow that state to use billions of dollars in Medicaid funds to buy private health insurance for the state's poorest residents -- seemingly unthinkable as recently as a few months ago -- has some Texas Republicans intrigued.
"From the standpoint of looking at how Texas could possibly expand coverage for this group of individuals, it fits very well with what my philosophy is," said state Rep. John Zerwas, R-Simonton, an anesthesiologist and former hospital executive who called the plan a "private sector remedy."
"I don't know if it's something the governor would particularly smile upon," he added, "but certainly from my perspective this would be something worth looking at."
Stephanie Goodman, a spokeswoman for the state Health and Human Services Commission, said the agency is anticipating a bill from state lawmakers directing them to "submit a major Medicaid waiver that would give the state more flexibility on Medicaid."
She said that would be the starting point for the agency's discussions with the Obama administration.
Perry, meanwhile, indicated it was "premature" to evaluate Arkansas' plan because the details are still being worked out.
"The bottom line is Medicaid as a whole is broken, and without fixing the entire system it will continue to consume a substantial and growing part of our budget, crowding out our ability to pay for other critical services," his spokeswoman Lucy Nashed said.
Sen. Bob Deuell, R-Greenville and a family physician, wrote a letter to Gov. Rick Perry on Thursday reaffirming his stance that Texas should not expand Medicaid. He offered a range of alternative ideas, including asking the Obama administration for a smaller block grant to assist poor Texans with access to health care, and for permission to let Texans who would be eligible for a Medicaid expansion under the Affordable Care Act participate in an Orbitz-style health insurance exchange.
He said the state could "negotiate for flexibility to form group or individual policies in conjunction with insurance companies and/or a health system," and should "work with the private insurance industry and various health care entities to establish a system of modest premiums, co-pays and deductibles based on income."
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