Texas Battles Health Law Even as It Follows It

2010-07-29

AUSTIN, Tex. — There are more uninsured residents of Texas — 6.1 million and counting — than there are people in 33 states. The state’s elected officials might be expected, therefore, to cheer a federal health care law that is likely to deliver billions of dollars from Washington to Austin and cover millions of low-income Texans.

Instead, the Republican political leadership has greeted the law and its anticipated costs with open hostility, leaving policy makers to move forward with a complex set of changes even as the governor, attorney general and ranking legislators rage against it. The same awkward dichotomy exists in many of the 21 states that are challenging the health reform act’s constitutionality, but are nonetheless required to follow it while their lawsuits meander through the courts.

In Austin, legislative hearings and agency planning sessions proceed despite Gov. Rick Perry’s vow to fight “on every front available” against a law that he characterizes as “socialism on American soil.” Bureaucrats apply for federal grants and collaborate with the Obama administration at the same time that Attorney General Greg Abbott strategizes to eviscerate the law in court.

“Sometimes it seems a little schizophrenic,” acknowledged State Representative John M. Zerwas, a Republican who favors the law’s repeal but also leads a House committee that seeks to maximize its benefits to Texas. “There are plenty of laws out there that I might not agree with. But if the law of the land says we have to do it, the last thing I want is for Texas to not be prepared or not put things in place to comply.”

The antipathy toward the law in Texas is rooted in deeply conservative politics that have been further stirred up in a gubernatorial election year. Because one in four Texans is uninsured, the highest ratio in the country, the law’s advocates argue that Texas stands to gain as much as any state. But leaders in Austin are focused on the fiscal threat it poses, which they estimate could cost the state $27 billion in the 10 years beginning in 2014.

“You can say a chicken in every pot, a car in every garage and health care for all, if taken in isolation,” said Mr. Abbott, a leader among the Republican attorneys general who are suing the federal government in Florida. “But none of those are good things if it requires breaking the Constitution and breaking the bank to do it.”

States share in the cost of Medicaid, the government insurance program for the poor, and the new health law will vastly expand eligibility by offering coverage to childless adults

State agency leaders said politics had not interfered to date with that task, or with new requirements to create a health insurance exchange and oversee strict regulations on health insurers.