Harris County Judge Ed Emmett on Monday called on Gov. Rick Perry to support the expansion of Medicaid under the federal Affordable Care Act, and encouraged state leaders to invest in transportation and mental health care.
Emmett, using the bully pulpit of his sixth annual State of the County speech to the Greater Houston Partnership, drew widespread applause when he said he agrees with recommendations from the Texas Hospital Association, Texas Medical Association and Legislative Budget Board on expanding the federal health care program for the poor.
“While the political debate over the Affordable Care Act continues, poor people will continue to get sick and they’ll continue to need care. Harris County taxpayers should not have to foot the bill while our federal tax dollars are going to other states,” Emmett said. “We are already paying those dollars into the federal government, and for us to say, ‘Well, we don’t want your $4 billion in exchange for $50 million that we put in,’ frankly is just nonsensical.”
Texas could draw down $100 billion in federal funds over 10 years if it puts up $15.5 billion under Medicaid expansion, analyses show. For the 2014-2015 budget cycle, the Legislative Budget Board reports Texas would need to spend $50.4 million to receive $4 billion in federal funds. Texans with incomes up to 133 percent of the federal poverty line would be eligible for Medicaid under the expansion, up from 26 percent of the poverty line now.
Mental health care
Rapidly growing Harris County has a strong balance sheet, Emmett said, praising its hardworking officials, employees and appointed volunteers. However, the speech chiefly was a call for prudent public investment in areas Emmett said would allow continued future growth. He also drew applause by calling for increased funding for mental health care, to divert those in crisis from county jails, and when he called for immigration reform.
Perry spokesman Josh Havens said the governor remains opposed to the expansion of Medicaid, which already makes up a fourth of the state budget.
“If we expand Medicaid, that percentage will drastically increase and eclipse other important priorities like education, infrastructure and public safety,” he said. “The fact of the matter is, Medicaid is unsustainable and it would be irresponsible to add more people to (an) already broken system.”
The Texas Medical Association’s views on expansion also are not clear-cut. Its president, Houston neonatologist Michael Speer, said in a statement Thursday that the program must be reformed to allow a flexible solution that limits red tape and adjusts reimbursement rates to allow more doctors to participate and more patients to be treated.
“We must look beyond the federal government’s expansion solution to design one especially for Texas and for Texans,” Speer said. “The physicians of the Texas Medical Association are confident that state leaders and lawmakers … can design a comprehensive solution that is healthy for patients and taxpayers.”
An appeal to logic
Ron Cookston, executive director of Gateway to Care, a health care education and outreach group, called Emmett’s announcement “oustanding.”
“Leaders in Fort Worth and Bexar County and other counties across Texas are beginning to step up and recognize the importance of moving forward with the expansion,” Cookston said. “That’s just huge in terms of the working poor that would have access to adequate health care resources.”
Emmett, like Perry, a Republican, said after his speech that his address was not meant as an appeal to political moderation, but to logic. No one has accused Republican governors Rick Scott of Florida, John Kasich of Ohio or Jan Brewer of Arizona of being liberals, he said, but each has decided to support Medicaid expansion.
“To me, it is conservative to spend $50 million to get $4 billion,” he said. “When things are going well, that’s when we need to spend money to make sure things keep going well in the future. If I got that across, then I accomplished my purpose.”