Abbott blasts Biden administration decision to block health care safety net for uninsured Texans

Madlin Mekelburg
Austin American-Statesman

Gov. Greg Abbott on Friday said the Biden administration is “obstructing healthcare access for vulnerable Texans” after officials rescinded approval for a waiver that delivers billions in federal dollars to hospitals in Texas.

In a letter to the state, federal Medicaid officials said the Trump administration’s decision to fast-track approval of the $100 billion waiver in January was made in error, without enough time for public comment.

The 1115 Medicaid waiver serves as a federal funding agreement that reimburses hospitals in Texas for expenses they incur when treating patients without health insurance. It also funds innovative health care initiatives geared towards low-income patients who might not have insurance.

Texas received an initial waiver from the federal government in 2011, and it was renewed again in 2017. In January, the Trump administration agreed to extend the state’s waiver for 10 years, but the state also requested an exemption from federal requirements for public comment periods.

More:Texas House OKs Medicaid coverage expansion for mothers until one year postpartum

Gov. Greg Abbott greets President Donald Trump and first lady Melania Trump after they arrived in El Paso on Aug. 7, 2019,  to meet with law enforcement and victims of the mass shooting there. U.S. Sen. John Cornyn, R-Texas, is at left. Abbott might face an easier path to reelection in 2022 with a Democrat in the White House.

Biden officials cancel Texas waiver
 

Elizabeth Richter, acting administrator of the Centers for Medicare and Medicaid Services, said the agency is rescinding approval issued by the Trump administration because the application did not go through the full rulemaking process.

“Additionally, considering the existence of the COVID-19 public health emergency and the financial pressures that many providers across the nation have experienced as a result, the state did not identify any circumstances that constituted a genuine emergency with respect to its request for an exemption from the public notice and comment requirements,” Richter wrote.

Richter said the state can resubmit its application for a waiver after holding the required public comment period.

One portion of funding available under the waiver approved in 2017 is set to expire in September, and another portion is set to expire next year.

Abbott said the federal government’s dismissal of the agreement is a betrayal of uninsured Texans who rely on the federal dollars to receive medical care.

“The State of Texas spent months negotiating this agreement with the federal government to ensure vital funds for hospitals, nursing homes, and mental health resources for Texans who are uninsured," Abbott said in a statement. “With this action, the Biden administration is deliberately betraying Texans who depend on the resources made possible through this waiver.”

More:Texas health officials say COVID-19 vaccine demand continues, despite Johnson & Johnson pause

Uninsured rates in Texas

U.S. Rep. Lloyd Doggett, D-Austin, said Republican leaders in Texas have used the waiver as a means of avoiding expanding Medicaid eligibility, which could reduce the state’s uninsured rate.

Texas has more uninsured residents than any other state and is one of 12 states in the country that has not expanded Medicaid coverage under the Affordable Care Act. 

Federal health officials told The Washington Post that Friday’s decision to rescind the state’s waiver is part of an effort to push Texas towards expanding the program.

“Today’s rejection of Trump’s last-minute, premature gift to Abbott is an encouraging development for all of us seeking to overcome the deplorable distinction of having more uninsured citizens in Texas than any other state in the nation,” Doggett said in a statement. “Excluding reasonable public participation, this rushed Trump waiver represented an attempt to lock us in to a decade of minimal progress toward reducing the number of uninsured Texans.”

Ted Shaw, president and chief executive officer of the Texas Hospital Association, said revoking the waiver's approval in an abrupt manner could create uncertainty for the health care industry.

“With an ongoing pandemic and millions of uninsured Texans, Texas hospitals have been stretched like never before and clearly have a critical role in protecting the health and wellbeing of all Texans,” Shaw said in a statement. “This action undermines the safety net and hospitals’ ability to protect people."

But Ann Dunkelberg, associate director of Every Texan, previously the Center for Public Policy Priorities, said the waiver approval that was revoked Friday would not have taken effect until October, as funding under the prior agreement is slated to continue at least until September.

That means the "critical need" felt by hospitals for this funding will continue to be met, she said. 

"The federal requirement to invite input on the Medicaid waiver process from all Texans is an important right that should not be overlooked," Dunkelberg said in an email. "All Texans deserve a voice in the future of Medicaid."

Other Texas officials joined Abbott in his criticism of the Biden administration. Texas Attorney General Ken Paxton said Biden "grossly betrayed those who rely on our assistance the most."

Texas Comptroller Glenn Hegar called the decision irresponsible and said "the Biden administration is recklessly working to undermine our fragile recovery by holding hostage the critical funding Texas needs to support its rural hospitals, nursing homes, mental health and other crucial care facilities."