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Is Rick Perry’s Rejection of the Affordable Care Act Political Posturing or a Portent of What’s to Come?

Texas Governor Rick Perry

Texas Governor Rick Perry (Photo: Ed Schipul / Flickr)

Written by Andrea Grimes for RH Reality Check

On Monday, Texas Governor Rick Perry publicly rejected two major tenets of the Affordable Care act, saying the state would not participate in the individual state exchanges nor in the federal Medicaid expansion. In a letter to U.S. Health and Human Services Secretary Kathleen Sebelius released yesterday, Perry wrote that the “Orwellian-named PPACA” would “make Texas a mere appendage of the federal government when it comes to health care.”

Texas, which has the highest rate of uninsured people in the country — about one in four Texans currently have no insurance — could receive over a hundred million dollars from the federal government over the next few years, enabling the state to dramatically expand Medicaid overage to low-income adults who are not currently eligible. But, instead, Perry wrote that he believes the Medicaid expansion would “exacerbate the failure of the current system, and would threaten even Texas with financial ruin.”

Texas is already in serious financial trouble, and Perry’s dedication to rejecting any help, or dipping into state reserves, has put it in ever more dire straits. The state notably grappled with its multi-billion dollar budget shortfall during last year’s legislative session; Perry has repeatedly refused to tap into the state’s “Rainy Day Fund” to address the state’s health and education needs, opting instead to cut public services. Perry also turned down millions in federal Medicaid funding for the Women’s Health Program in order to exclude Planned Parenthood from participating in the program in Texas.

Perry’s claims in the Sebelius letter are woefully misinformed, according to one public health policy expert at Houston’s Rice University. Elena Marks, a Baker Institute Scholar in Health Policy at and former director of health and environmental policy for the City of Houston, says it’s a “shame” that Perry can’t see the good a state-run insurance exchange could do for Texas, because if Texas doesn’t set up its own exchange, the ACA ensures the federal government will do it for the state instead.

“If the state doesn’t set it up, the Feds will,” said Marks, “and that would be a shame for Texas.” Instead of Texas experts on Texas soil deciding what the exchange would look like according to federal rules — especially since, says Marks, federal “parameters still give you a lot of opportunity to tailor an exchange to meet the unique needs for yourself” — the federal government will set up a one size fits all program.

“I’m sorry that we Texans who know the Texas population and health care needs and provider community the best will not be the ones designing the exchange and all the things that go with it,” said Marks. As for the Medicaid expansion, she said it’s simply good public policy to accept the federal money — not least because of the 3.25 multiplier effect, which means that every dollar spent on Medicaid and CHIPgenerates 3.25 times that amount in economic activity.” [cont’d.]

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