They've been bandying this consideration around for several months now but as Texas looks at its looming budget shortfall the idea is gaining steam. It would not be an easy move. Dropping out of Medicaid, a voluntary program, would mean forfeiting the federal contribution to the program which equates into a chunk of sizable change for Texas coffers.
For Texas, the problem lies partly in the fact that the state has narrow eligibility rules for enrollment. Under ObamaCare, that threshold would change; by 2014 there could potentially be millions more Texans enrolled in the Medicaid program adding to the state's financial woes; that number varies; conservative estimates of new enrollments hovers around 1.5 million.
One obstetrician in Texas spoke to The Dallas Morning News in July about his currently limited coverage of Medicaid patients:
"They're going to try to expand the rolls of Medicaid ... and at the same time they want to reduce the reimbursement to doctors," he said, noting tensions between the priorities of federal and state officials. "With the [pay] trend going downwards, I don't see additional physicians signing up. It's just not going to happen."
Physicians across the nation already limit their acceptance of Medicaid patients, if they accept them at all, and the upcoming mandates for coverage will increase Medicaid rolls across the nation.
Texas is considering, along with some other states, forming their own insurance exchange and then basically waiting to see if the government challenges them on it. There are problems with this and we all know how well it's worked in Massachusetts, but the options are looking very narrow to legislators struggling to reconcile state budgets. Oklahoma has hinted it may consider dropping the program as has Nevada, although the idea would get tough play by legislators there. Indiana is also giving the thought some play.
The Heritage Foundation suggests that most states would be better off for dropping Medicaid.
It may all be moot at this point as Republicans are now poised to begin dismantling this monstrosity.