Network News

X My Profile
View More Activity

California vs. Texas: The Jekyll and Hyde of health-care reform

By Suzy Khimm

So Texas is making noises about ditching Medicaid, but on the other end of the spectrum, some blue states are rushing to embrace the program's expansion under the federal health-care reform law as quickly as possible. Take California, for example: Just last week, the Obama administration approved a plan that will give the state $10 billion to modernize and expand the state's Medicaid program. The plan -- which was passed by the state legislature and heralded by Gov. Arnold Schwarzenegger (R) -- will expand coverage to about 500,000 Californians who didn't previously qualify for Medicaid. All states will be required to undertake a similar entitlement expansion by 2014, but California is leading the pack.

Why is California so eager to get ahead, while red states continue to drag their heels? The state had already made an effort to insure poor residents who didn't qualify for Medicaid, requiring counties to take final responsibility for covering the poor, disabled and low-income seniors. As a result, county governments and hospitals for low-income residents have extended health-care services, if not full insurance coverage, to a larger swath of California's population. But county governments have struggled to come up with the funds for such services: The Los Angeles Department of Health, for example, is facing a $629-million deficit from last year and this year. California counties and hospitals will now receive federal funds to transition their low-income patients into a full Medicaid coverage program: Los Angeles County will receive $65 million more in revenue, for example, and California is expected to pay only 1.5 percent more for Medicaid, while the federal spending on the program will rise by 23 percent.

Earlier during the debate, Schwarzenegger had joined Texas and other states in protesting the Medicaid expansion as a budget-buster. Now he's outright celebrating some of the changes under health-care reform for providing an injection of new federal money. "This agreement is great news for the people of our state because we will be able to expand coverage, improve the delivery of care and build a strong bridge to federal healthcare reform with increased federal resources," he said in a statement Tuesday.

Having committed to extending health-care services to more of its population, California has decided that it's worth betting on health-care reform and reaping the benefits of federal dollars sooner than later.

Texas stands to receive even more bang for its buck in the Medicaid expansion -- at least partly because the state has restricted its Medicaid eligibility and skimped on its benefit packages for so long. As a Kaiser study points out, the federal government will be covering more than 95 percent of the costs of the state's Medicaid expansion: "If Texas sees a 46 percent increase in Medicaid enrollment by 2019, the study notes, it will still only see state Medicaid spending grow by 3 percent," reports the Texas Tribune. In essence, the residents of some states that have done the least to expand medical coverage are now poised to benefit the most from health-care reform.

On one side, you have states such as California that made expanding health-care to the poor a priority well before the passage of the federal health-care reform law -- and those states are now grateful to receive federal money to assist their efforts. On the other, you have states such as Texas that declined to make this commitment and now resent that the federal government is forcing them to do it.

By Suzy Khimm  | November 11, 2010; 6:17 PM ET
Categories:  California, Government, Health, Health Coverage, Health Reform, Obama administration, states  
Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati   Google Buzz   Previous: Waldman on the technocrats
Next: Wonkbook: Liberals push on taxes; G-20 agreement; Korea trade deal fails

Comments

But Ezra this is bad news for us even though it's good news for California! Read what you wrote, California can't pay for the financial decisions it made so it's good news that the Federal Government has to step in and bail them out!

"Los Angeles County will receive $65 million more in revenue, for example, and California is expected to pay only 1.5 percent more for Medicaid, while the federal spending on the program will rise by 23 percent."


This is the kind of totally insane fiscal policy that runs all through the HCR.

PLEASE, I beg of you, write a column on how this is anything different than bailing out Wall Street banks for the things they did. You have to leave out the "moral good" argument however because then we get into the murky waters of whether or not saving the financial system saved more people than it hurt.

Posted by: 54465446 | November 11, 2010 7:26 PM | Report abuse

Oops, sorry thought Ezra wrote this. Suzy, wow, can't even being to say how crazy this piece was.

" On one side, you have states such as California that made expanding health-care to the poor a priority well before the passage of the federal health-care reform law -- and those states are now grateful to receive federal money to assist their efforts. On the other, you have states such as Texas that declined to make this commitment and now resent that the federal government is forcing them to do it."

So in other words the fiscally responsible states resent sending bailout money to the fiscally irresponsible states.

Who could have predicted that??????????

Posted by: 54465446 | November 11, 2010 7:39 PM | Report abuse

so how much of others revenues are paying for California's expansion. And typical around here no talk of how providers are reacting in California towards expanding its medicaid rolls at low payment schedules.

I think its time for another graph when Ezra returns comparing by state what funds are sent to the federal treasury and corresponding graphs as to what is taken out of it.

Posted by: visionbrkr | November 11, 2010 9:28 PM | Report abuse

Sounds good. Let's ship Texas's Medicaid population to california and leave it there.

Posted by: krazen1211 | November 11, 2010 10:59 PM | Report abuse

"Why is California so eager to get ahead, while red states continue to drag their heels?"

Yeah, it's all about "getting ahead", isn't it? Not at all about free riding on other states via federal largess...

"Earlier during the debate, Schwarzenegger had joined Texas and other states in protesting the Medicaid expansion as a budget-buster. Now he's outright celebrating some of the changes under health-care reform for providing an injection of new federal money."

So in other words, Schwarzenegger can be bought.

"the federal government will be covering more than 95 percent of the costs of the state's Medicaid expansion"

Okay, but this isn't a free lunch. The state taxpayers will pay, one way or another (particularly by 2014).

Posted by: justin84 | November 12, 2010 1:31 AM | Report abuse

You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check http://bit.ly/bandYw .If you have health insurance and do not care about cost just be happy about it and trust me you are not going to loose anything!

Posted by: eastony12 | November 12, 2010 3:37 AM | Report abuse

I wonder how many of the people ranting that is fiscally irresponsible to expand Medicaid are without insurance coverage. What do they plan to do in Texas with the people without coverage when they get sick? Do we let people die because treating them is "fiscally irresponsible?" Also what do they plan to do when epidemics break out and they get sick? Or their kids keep coming home from school with strep infections or lice because the next kid's parents couldn't take their kid to the doctor?Preventive care is a lot cheaper than treating disease. Sharon Angle said that health care under the Obama plan should not cover mammograms or colonoscopies. Hers are covered by her husband's plan. People should spend a little time imagining themselves in someone else's shoes before mouthing off.

Posted by: Lauri2 | November 12, 2010 4:17 AM | Report abuse

Mr Klein.
OF COURSE California is all for it - they're a state full of leaches and moochers led by a RINO. They keep voting in the same twits who got them in their mess, so they should have to live with it - don't give them a nickel, quit feeding the moochers and looters.

Posted by: Mjarcana | November 12, 2010 9:02 AM | Report abuse

So bankrupt CA is able to suck more Federal Taxpayer Money in lieu of being able to pay for the freebies themselves.
This is the same CA that drives business, jobs and tax revenue out of the state with its wildly destructive regulations and business taxes.
We may have to give CA back to the Mexicans.

Posted by: NeoConVeteran | November 12, 2010 9:17 AM | Report abuse

You have to understand a few things to understand what's going on in Texas. When Bush rolled into the Governership and we had our big redistricting the republicans swept into power. Texas lost a huge amount of seniority in the Senate and Government, but Bush took the White House shortly after that and Texas never had to deal with not having the seniority in the government we were used to. Now it's caught up with the state. The texas Delegation is not the most senior and the president isn't inclined to cover our antics. So Texas is acting like any long spoiled child it's acting out and making a scene. It'll take us awhile to accept our new reduced role in things. Hopefully the temper tantrums don't hurt our state too badly before it adjusts to the new reality.

Posted by: galfax | November 12, 2010 9:18 AM | Report abuse

Judging from these comments, and so many others I read, we're becoming the Ebeneezer Scrooge society. A bunch of wizened, bitter, lonely old men pecking away at their keyboards and railing against any efforts that might deprive them of a few coppers in order to help the less fortunate lead decent lives. And most of these misers probably think they're true Christians!

Posted by: Virginia7 | November 12, 2010 9:26 AM | Report abuse

I live in Texas and I am ashamed of what it is trying to do with Medicaid. There are poor senior citizens and children who rely on Medicaid to live. Have we become so hearless that we don't care about our neighbors? Do we want to go back to the days when seniors had to resort to eating cat food to survive? I am heartbroken over what has happened to this country, it is going in the totally wrong direction and the voices of reason are being drowned out by the insane! I hope the people who are so gung ho over cutting services to the poor and elderly, never become either one. These same people hate the government until they need the government to help them put food on the table and a roof over their heads. Texas is a disgrace!

Posted by: susanmdabney | November 12, 2010 9:41 AM | Report abuse

So, the great american socialist experiment on the left coast is being bailed out by the federal government because they decided to spend too much money. Being broke and electing some of the same people who broke them is rather idiotic in my opinion. Oh well, the federal government will just print more money to save California.

Posted by: gfafblifr | November 12, 2010 9:54 AM | Report abuse

Ebenezer Scrooge, after he had his change of heart, was giving out his own money, not the government's.

Also California is the most fiscally irresponsible state in the union. They are already techincally insolvent. Their most recent budget would put any accoutant who signed off on it in jail if this were private industry. They don't have to worry though because we are going to be bailing them out in the next year or two, guaranteed. Medicaid is just the beginning.

Posted by: 54465446 | November 12, 2010 9:58 AM | Report abuse

"Texas lost a huge amount of seniority in the Senate and Government, but Bush took the White House shortly after that and Texas never had to deal with not having the seniority in the government we were used to. Now it's caught up with the state."


Until Rick Perry takes office.

Posted by: krazen1211 | November 12, 2010 10:05 AM | Report abuse

Texas receives more money from the Federal Government than it sends in Taxes. California receives only 81 cents for every dollar it sends to the Federal government. (this was from a report of the Tax Foundation). If the same group who screams about giving federal money for health care, showed half the passion to reduce agricultural subsidies, or corporate welfare for oil and gas companies, than you would be taken seriously.

Posted by: ChicagoIndependant | November 12, 2010 10:32 AM | Report abuse

I it really that surprising that the states run by liberal Democrats such as New York and California are the states in the worst financial situation and are the ones the most eager to line up at the federal trough to suck up more money from the taxpayers who live in the more financially responsible states run (mostly) by Republicans? Heck New York and California voters just strenghthened the hand of the party that has flushed their economies down the toilet. Isn't it one of the definitions of insanity to keep doing the same thing over and over and expect different results? Also, Ezra it would be good if you pointed out that the federal largess to subsidize the expansion of Medicade runs out at some point and then it will be up to the states to pay for the gigantic expansion of their Medicade rolls.

Posted by: RobT1 | November 12, 2010 10:39 AM | Report abuse

RobT1,

that's 2019 btw (when the medicaid burden shifts). You see we can talk about theoretical deficit reduction in the second 10 years of the PPACA but we dare not speak of medicaid transfer payments to states at that point. It wouldn't help us make our argument.

Posted by: visionbrkr | November 12, 2010 11:08 AM | Report abuse

Trace back the rise in health care costs and behind it you'll find the Federal Government (read a Democrat controlled Congress). Of course, prices rose and the Congress was outraged. Now they're exporting their insanity to the states. Just look at the states that are in major financial trouble and you'll find three things in common: unions; an entrenched Democrat Legislature; and huge budget deficits. Oh yeah, the bigger the Democrat majority in the state legislature, the bigger the deficits. Please Ezra, spare us this nonsense that this is good for California. It's not and it's not good for the country either.

Posted by: WriterDude | November 12, 2010 1:08 PM | Report abuse

None of these proposals address the actual primary cause of rising health care prices to individuals.

The cause is fairly straightforward: the market for health care is not a free market, but a heavily-regulated and controlled one, in which providers have far greater market power than their customers.

For example: government delegates to the AMA (a physicians trade group) the power to set all standards for admission to practice medicine, even to get into medical school. The doctors trade group, predictably, exploits this power to keep the number of practicing physicians artificially low, and their incomes artificially high. The customers pay whatever they demand, because they MUST pay... the providers are protected from competition, and patients are hostages to their demands.

Posted by: Iconoblaster | November 12, 2010 1:18 PM | Report abuse

Post a Comment

We encourage users to analyze, comment on and even challenge washingtonpost.com's articles, blogs, reviews and multimedia features.

User reviews and comments that include profanity or personal attacks or other inappropriate comments or material will be removed from the site. Additionally, entries that are unsigned or contain "signatures" by someone other than the actual author will be removed. Finally, we will take steps to block users who violate any of our posting standards, terms of use or privacy policies or any other policies governing this site. Please review the full rules governing commentaries and discussions.




characters remaining

 
 
RSS Feed
Subscribe to The Post

© 2010 The Washington Post Company