Texas counties seek Medicaid help

Governor Perry opposed to aid from Obama law

SAN ANTONIO — Local officials in Texas are discussing whether to band together to widen Medicaid coverage in some of the state’s biggest counties, making an end run around Governor Rick Perry’s opposition to the expanded program included in President Obama’s health-care law.

For years, Texas’s six most populous counties, as well as some smaller localities, have offered free or low-cost health care for uninsured residents with incomes as much as three times the federal poverty level, or about $57,000 for a family of three. The cost of the programs is about $2 billion a year.

If some of the patients were enrolled in Medicaid, the state-federal health-care program for the poor, it could be salve for cash-strapped county budgets and a boon for local taxpayers.


George Hernandez Jr., chief executive of University Health System in San Antonio, came up with the idea of the alternative, county-run Medicaid expansion and said he has been discussing it with other officials in his county, Bexar. ‘‘They are all willing,’’ he said. He added that he has also been talking up the proposal with officials in other big counties, such as those including Houston and Dallas, and is optimistic they’ll support the idea.

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Robert Earley, chief executive of JPS Health Network, the public hospital system serving Tarrant County, which includes the Fort Worth area, said he could see the idea catching on.

The Medicaid expansion is a key part of the Obama health-care law, but its fate was thrown into question when the Supreme Court in June ruled that states could refuse to take part without being penalized by the US government. Half a dozen Republican governors, including those in Florida, Louisiana, and Texas, have declared their opposition to the expansion, while several other governors, including some Democrats, have remained noncommittal.

The county-led effort would require the consent of both the White House and the Texas legislature. Federal officials would have to waive requirements that states apply the same eligibility standards statewide.

Whatever the plan’s fate, it shows that frustrated local officials don’t necessarily want to give the governor the last word on whether to accept millions of dollars in federal health aid that could ease local burdens.


In Bexar County, about half of the 55,000 people who get county-paid health care would be eligible for the Medicaid expansion, saving the county up to $53 million per year, said County Judge Nelson Wolff, the county’s top public official.

‘‘That’s a pretty big chunk of money,’’ said Wolff, a Democrat. ‘‘We could cut taxes. Or we could expand some of our existing services. Either way, it has a big impact on us financially in terms of taking the pressure off.’’

The novel alternative floated by county officials is a stark indication of the Lone Star State’s often-contradictory approach to health care for the poor.

On the one hand, Texas’s prevailing culture of distrust of Washington and emphasis on personal responsibility has resulted in one of the most restrictive Medicaid programs in the country. Working parents are eligible only if their incomes are at or below 26 percent of the federal poverty level. That’s one reason Texas has an uninsured rate of 24 percent, the highest in the country.

On the other hand, major urban counties have been stepping into the breach for years to cover the uninsured, creating hospital districts with taxing authority to fund not only public hospitals but also generous charity care programs.


Such a program was a welcome surprise for Alexandra Riojas, a 44-year-old mother of four who has stage IV colon cancer, no health insurance, and who is not poor enough to qualify for Medicaid in Texas, even though her income is practically at the federal poverty line. ‘‘It’s such a blessing. . . . I just had no idea how I was going to pay for everything,’’

Riojas, who was working in an embroidery store when she was diagnosed in November 2010, said, ‘‘I thought, if I can’t pay, I’m going to die even sooner from this than I have to.’’

More than half of the state’s population lives in one of the large hospital districts offering generous health care programs. Some of the counties, such as Bexar, cover illegal immigrants.