Medicaid

The state of Texas is turning down billions of federal dollars that would have paid for health care coverage for 1.5 million poor Texans.

By refusing to participate in Medicaid expansion, which is part of the Affordable Care Act, the state will leave on the table an estimated $100 billion over the next decade.

Texas' share of the cost would have been just 7 percent of the total, but for Gov. Rick Perry and the state's Republican-dominated Legislature, even $1 in the name of "Obamacare" was a dollar too much.

When the sun rises over the Rio Grande Valley, the cries of the urracas — blackbirds — perched on the tops of palm trees swell to a noisy, unavoidable cacophony. That is also the strategy, it could be said, that local officials, health care providers and frustrated valley residents are trying to use to persuade Gov. Rick Perry and state Republican lawmakers to set aside their opposition and expand Medicaid, a key provision of the federal health law.

When the Senate voted Tuesday to make Marilyn Tavenner the official administrator of the Centers for Medicare and Medicaid Services, it was the first time the world's greatest deliberative body had approved someone to head the huge health agency since 2004.

That's right, you have to go way back to the Bush administration to find Dr. Mark McClellan, the last person to be officially put in the post.

The federal health care overhaul makes some notable improvements in insurance coverage for young adults.

They can now stay on their parents' health plans until they turn 26. Next year they can also look for subsidized coverage on the state-based insurance marketplaces, also called exchanges. And they may qualify for Medicaid, if their income are less than 138 percent of the federal poverty level ($15,856 in 2013).

So far, so good.

Two years ago, a landmark study found that having Medicaid health insurance makes a positive difference in people's lives.

Backers of the program have pointed to that study time and again in their push to encourage states to expand the program as part of the federal health law.

OK, the conventional wisdom about the budget President Obama sent to Congress yesterday is that's irrelevant.

It's two months late, after all, and the House and Senate have already approved their own spending blueprints for fiscal 2014.

But here's why it matters when it comes to health.

Since the Supreme Court made the Medicaid expansion under the federal health law optional last year, states' decisions have largely split along party lines. States run by Democrats have been opting in; states run by Republicans have mostly been saying no or holding back.

Cash-strapped states are coming up with an appealingly simple fix for soaring Medicaid costs: Don't pay for emergency room visits for people who aren't sick enough to be there.

There's a problem, though. It's almost impossible to figure out who's sick enough and who isn't at the moment they walk in the door, researchers say.

Poor adults who live in states that don't go along with the federal health overhaul's expansion of Medicaid face a double whammy.

When the nation's governors gathered in Washington, D.C., over the weekend for their annual winter meeting, the gathering's official theme was about efforts to hire people with disabilities.

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