AUSTIN, Tex. — Hundreds of activists and uninsured Texans plan to rally at the steps of the Capitol here Tuesday, increasing the pressure on Gov. Rick Perry and other Republican leaders to switch their stance on expanding Medicaid, a major provision of President Obama's health care overhaul.
Mr. Perry has told federal officials that Texas has no intention of expanding Medicaid, the government health insurance program for low-income and sick people, saying he would not take part in socializing health care and admitting millions of Texans into an unsustainable program at a cost of billions to taxpayers. When Mr. Perry made his decision official in July, he wrote of standing "with the growing chorus of governors who reject the Obamacare power grab."
In recent weeks, however, that chorus has diminished, as several Republican governors who had resisted the expansion — including Chris Christie of New Jersey and Rick Scott of Florida — said they would accept federal money to expand the program. Meanwhile, the number of state organizations and individuals who vocally support an expansion in Texas has grown.
Several cities and counties have passed resolutions calling for expansion of the program — including the City Councils of Austin and Waco — as have health care and financial experts, including Elena Marks, former director of health policy for the City of Houston, and Ray Perryman, an influential economist in Waco. The Texas Medical Association, which represents more than 47,000 physicians and medical students, asked state leaders to expand the program while instituting reforms. The Chambers of Commerce in Dallas, Fort Worth, San Antonio and other cities also support expansion.
Texas has the highest rate of uninsured residents of any state, 24 percent of the population, officials said. Supporters said the Medicaid expansion would provide coverage to more than one million low-income Texans and ease the burden on local taxpayers, who help support the public hospitals now providing much of the care to the uninsured.
The federal law covers 100 percent of the costs for the first three years of the state's Medicaid expansion, and in the years that follow, Texas would not pay more than 10 percent. From 2014 to 2023, about $100 billion would be available to the state in an expansion, with Texas having to pay about $15 billion in that time, supporters said.
"If you have a chance to provide that coverage and improve health care, then in the long run, you're going to have a healthier, more productive state," said Dr. Roland A. Goertz, the chief executive of the Waco Family Health Center, which treats thousands of Medicaid and uninsured patients annually.
A spokeswoman for Governor Perry, Lucy Nashed, said his position had not changed.
"It would be irresponsible to add more Texans and dump more taxpayer dollars into a broken and unsustainable system that already consumes a quarter of our budget, making it harder to pay for other things like public safety and education," Ms. Nashed said. "Medicaid should transform into a system that gives the states flexibility to tailor the program to serve the needs of their specific and unique challenges."
Critics of Mr. Perry's stance have grown increasingly brazen. In January, protesting activists interrupted Mr. Perry's State of the State address at the Capitol. One of the most significant developments for Medicaid advocates came the day before, however, when a report by the state's former deputy comptroller, Billy Hamilton, described expansion as smart, affordable and fair.
The report found a substantial impact on the Texas economy. In fiscal years 2014 to 2017, the injection of $27.5 billion in new federal Medicaid money would increase the state's economic output by nearly $68 billion, said the report, which was sponsored by two religious-based advocacy groups, Texas Impact and Methodist Healthcare Ministries.
Some leaders, including State Senator Tommy Williams, a Republican and chairman of the Senate Finance Committee, have insisted that the state needs flexibility to administer a "Texas solution," like requiring co-pays and deductibles for Medicaid recipients and enrollment in private or employer plans if available.
The likelihood of a compromise remains unclear. Officials with the federal Department of Health and Human Services said they were not currently in talks with Mr. Perry's office, but welcomed conversations with him and other governors.
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