There is broad agreement that the glitch-filled rollout of Affordable Care Act enrollment was awful. Some have compared it to the botched response to Hurricane Katrina by the administration of President Obama’s predecessor, Republican George W. Bush.

With this difference: Bush and company had a few days to plan for Katrina. The Obama administration had three years to plan enrollment for Obamacare.

It probably would have been a lot easier to just lower the Medicare eligibility age from 65 to zero. But trying to accommodate private insurance companies and lots of other folks around the healthcare process made that politically infeasible.


However, no less embarrassing than the Obamacare rollout has been the performance of those in charge in states like Texas.

Republican Gov. Rick Perry refused Medicaid expansion, despite the fact that all the funding for the first three years, and 90 percent for the next several years, would come from the federal government. Rather than trying to help implement the Affordable Care Act, Perry and others — including the leading Republican candidate to replace Perry, Atty. Gen. Greg Abbott — have done everything they can to oppose and sabotage the effort to expand health coverage to millions of Texans who don’t have it.

The argument of Perry and others is that Obamacare, including the Medicaid expansion, borders on socialism and creates an entitlement. (This is different from the governor collecting more than $92,000 a year in retirement pay from the state on top of his $150,000 salary, free house, free car, etc. That’s “retirement,” not an “entitlement.”)

Medicaid expansion would allow about 2 million more Texans without healthcare coverage to get it. Over 10 years under the largely federally funded program, Texas would get about $100 billion from the feds, while putting up about $15 billion.

Many local governments support it because it would provide much of the funds they now must raise from local property taxes for hospitals providing care to the indigent.

The argument is appropriately made that the federal money has to be collected from somewhere. It does.

But the problem for taxpayers in Texas and other states whose governors have refused the expansion is they will still pay federal taxes. The money just goes to other states that do accept the Medicaid expansion.

(A professor in New York wrote a tongue-in-cheek column for the Austin American-Statesman a few weeks ago, applauding Texans for their selfless generosity: sending money to support Medicaid expansion for New Yorkers, while declining it for Texans.)

Dozens of local chambers of commerce, medical organizations like the Texas Medical Association and Texas Hospital Association, nonprofit and for-profit groups, and newspaper editorial pages urged Perry to accept the Medicaid expansion. It would provide not just healthcare for a couple of million people, but also lots of jobs, they point out. Others just called the refusal of that money borderline crazy.

Perry was unmoved. Not just no, but hell, no. He compared Obamacare to “putting a thousand more people on the Titanic when you knew what was going to happen.”

You can be forgiven if you suspect the governor might be polishing his conservative credentials for another run for the Republican presidential nomination.

One of the wisest commentaries on the situation came from Ross Ramsey in the Feb. 22, 2013, Texas Tribune.

Some of the combatants in the Medicaid expansion fight in Texas “regularly tell voters that government should be run more like a business,” Ramsey noted. But if the feds will pay all of the cost for the first three years, and most of it for the next several years, “Here’s the business question: Why leave that kind of money on the table, especially if it’s going to be spent elsewhere if Texas opts out?”

It’s possible the Medicaid expansion’s federal support might dry up down the road, Ramsey says. But Texas can always quit if that happens. In the meantime, the citizens would have healthcare support that they don’t have now, and the state could save several billion dollars.

Better to have part of something than all of nothing — while paying taxes to help others get the benefits your state is passing up.


Veteran Texas political journalist Dave McNeely can be reached at


  1. Republican politicians “for life” in the state should be looked at. The whole Medicaid program under Sen Jane Nelson (R) Flower Mound (under whose committee funding is handled) has been a major debacle. consider the $51 million dollars of tax payer money which went to unnecessary glamour Orthodonture (the offending dentists have yet to be prosecuted). Sen. Nelson has been busy with the reportedly “pay for play” $40 billion dollar CPRIT legislation providing “grants” to the scientifically naive but politically well connected. (now being looked at by the Travis County DAs office and questioned by Sen-now Dem Gov candidate Wendy Davis (D) Tarrant County). My problem with Medicaid is that so much of it gets caught in the grasp of “not for profit” hospital CEOs (whose 5 million dollar annual salaries are breathtaking) with little trickle down to the actual patients.

    • My problem with Medicaid is that it is ABUSED by people who should be footing their OWN bills instead of bleeding the hard working taxpayers!!!

  2. why would Perry or anyone for that matter want to support a horrible program like odumbocare? it’s not about health care to start with. if it was created to insure people who had no insurance, why didn’t they just do that and leave all the millions who had acceptable coverage alone? lib’s should realize what an idiot idea this was but no they keep on supporting anything that their dear leader does, even when it harms them. they just can’t seem to be able to admit what a mess the adm has turned out to be.

  3. Rick Perry knows what he is doing. I would vote for him again if he would run. People should study and know all the facts about the so called Oboma Care before they comment.

  4. That’s what the program was originally going to do Loyd but because of the incredibly selfish and self-serving efforts of Republicans and the Insurance lobby what would have been a much more streamlined possibly single payer system became something much more complicated than it never needed to be. I do not understand why so called fiscal conservaties want us to continue to pay the high cost of emergency room care for people who do not have insurance rather than help them get the insurance they need so that, like those of us fortunate to have it, they can take most of their medical problems to the doctors office.

    • Re:Emergency room use. Two years ago very liberal Oregon instituted a broad expansion of its state Medicaid program as a form of state govt financed “single payer” coverage. Almost everyone in Oregon is now covered by insurance. Data (gathered by the Kaiser Foundation) from the first two years shows no decline in over-utilization of the state’s hospital ERs, in spite of the availability of insurance and outpatient providers. The rates of morbidity from HTN, heart disease, obesity, DM and other preventable illnesses also did not decline. People “felt” better about it evidently, because rates of depression decreased.

    • It was “selfish and self-serving . . . Republicans” that derailed single payer? How does the liberal Kool-Aid taste? Obama had both houses of congress and the presidency for the first two years of his presidency. He could have passed anything he wanted. Quit with the misinformation and ignorance. Your name is fed up, well get fed up with the liberal lies.

    • I work around these patients…..they will NEVER go the route of the doctor’s office like the rest of us due to they don’t make appointments or schedule anything in their lives. If they were MADE to PAY out of THEIR own pockets for healthcare, they would learn the reward of going to the doctor’s office when it is not an emergency….since that would cost them more. As long as there is no penaltly for them to go to the ER, they will continue to use it! One local children’s hospital has opened an urgent care center next to their ER and the non_emergencies are triaged over to it, which is a cost savings and frees up the ER for emergencies.

  5. Perhaps you should write Perry and recommend that to him Doyle. Why would you want to subject our state to another 4 year term of office by someone who is all hat

    • You should read the Washington Post article today about how the ACA cost blue state Maryland millions (and they -WP) supported Obama’s health care initiative.