Last month, Gov. Rick Perry (R-TX) took to the airwaves to suggest that Texas — which has the highest uninsurance rate in the country — would be better off if it sent back the matching fund it receives from the federal government to fund its Medicaid program and instead developed a new more efficient alternative to cover lower income residents. “We understand that’s our money,” Perry explained to CNN’s Candy Crowley on November 9th. “We send hundreds of billions of dollars to Washington, DC, and generally don’t get much of it back. We’d just as soon not send as much money to Washington, DC. Let us come up with the idea. I can promise you Pawlenty and Jindal and Barbour and some Democrat governors across this country as well will come up with really good ideas about how to deliver health care.”

Well now, a report by the Texas Health and Human Services Commission and the Texas Department of Insurance has panned the “good” idea, causing Perry to also back away from “his call to leave the federal system.” According to the findings, if Texas opted out of Medicaid:

- Texas would lose $15 billion (SFY 2009) in federal matching funds for client services and hospitals.

- At the same time, Texas residents and businesses would continue to pay federal taxes in support of other states’ Medicaid spending.

- Up to 2.6 million Texans could become uninsured.

- Hospitals still would be required by federal law to treat medical emergencies of uninsured former Medicaid and CHIP clients, potentially adding billions to uncompensated care costs each year.

- The Legislature could preserve benefits for some current Medicaid and CHIP clients using the state share of funding while shielding the state budget from significant losses, but it will be difficult to accomplish these two goals without shifting costs to county governments and public hospitals.

In a statement issued following the release of the report, Perry again called for greater state flexibility in the Medicaid program, but did not mention the idea of opting out entirely. He asked Congress to change the Medicaid funding structure to provide the state with “block granting funds to the states, so we can tailor Medicaid dollars to best serve the needs of Texas patients, families and taxpayers.” But that idea is almost as bad as his old one.

Jennifer Haberkorn has the scoop on a pending deal to pay for a one-year extension of the so-called doc fix, a legislative patch that would prevent scheduled pay cuts of 25% to physicians participating in Medicare:

The deal pays for the must-pass patch to prevent a deep cut in Medicare doctors’ payments with changes in the tax subsidy program that some consumers will use after 2014 to buy health insurance on the new exchanges.

Staff members representing Majority Leader Harry Reid, Minority Leader Mitch McConnell, Finance Chairman Max Baucus and Ranking Member Charles Grassley agreed to the deal, according to two Congressional aides and lobbyists familiar with the proposal….

The deal on the table would change how much money consumers would have to repay if their income status changes mid-year, pushing them out of the eligibility bracket. For instance, someone who qualified for a subsidy because he was unemployed in the first half of the year may have to repay a large portion of that subsidy if he finds a job. Few additional details were available Monday night.

In other words, individuals who qualified for subsidies at the beginning of the year (that is, they earned below 400% of the federal poverty line), but experienced an income boost that took them out of the eligibility levels, would have to repay more of the subsidy. The CBO estimates that this would raise about $19.2 billion that could be used to pay for the one-year fix.

The final details of the detail are still emerging and there are scattered reports that lawmakers are also looking to squeeze savings from the Medicare Improvement Fund and other tweaks to the health reform law’s exchanges. And while news of a doc fix is certainly reassuring, it is somewhat troubling to see lawmakers taking money out of the health care law and focusing on provisions that have not yet gone into effect.

In fact, with premiums only increasing and the economy still in recovery, changing the affordability standards — even in this relatively innocuous manner — is certainly not the best way to find pay-for dollars. Republicans will be eager to raid the ACA for savings in January and here are the Democrats helping them get started.

ThinkProgress is devastated and heartbroken to hear that the health of our dear friend and colleague Elizabeth Edwards has deteriorated, as she wages her courageous battle against breast cancer. A long-time advocate of universal health care, Elizabeth transformed a personal medical tragedy into an instrument for social and political change after her initial diagnosis in November 2004. In the process, she gave voice to the millions of Americans who were left behind by our health system.

With her trademark courage, activism, and strong sense of justice, Elizabeth directly confronted the inequalities of the American health care system and the politicians who perpetuated them. During the 2008 presidential campaign, Elizabeth — a regular contributor to the Wonk Room throughout the health care reform debate and a senior fellow at the Center for American Progress — took to our blog and challenged conservatives for releasing a health care plan that would have excluded millions of Americans who suffered from pre-existing or chronic conditions. “Why are people like me left out of your health care proposal,” Elizabeth asked Republicans, pointing out that market-based proposals would leave millions of Americans “outside the clinic doors” and allow insurance companies free reign to continue excluding sicker beneficiaries.

Through congressional testimonies, public speeches, blog posts, and countless television appearances, Elizabeth emphasized the human and moral dimension of the health care debate. She pressed lawmakers from both sides of the aisle to pass a law that not only offered insurance to those who went without it, but did so at affordable rates. After all, nine out of every ten people who sought individual coverage in the current system “never got it,” Elizabeth reminded the protectors of the status quo. “People who have had cancer are denied coverage and those who get cancer run the risk of simply being dropped by their insurer for any excuse that can be found.” Elizabeth also highlighted the inequality facing women, who pay more for health insurance than men because they can potentially become pregnant.

Elizabeth was indispensable to the Democratic push for health care reform not only because of her persuasiveness and breadth of knowledge, but also because of her dedication to extending the health benefits she herself enjoyed to every American. In spite of her ailing condition, she inspires a sense of strength in all of us. She has viewed access to health care as an urgent issue that every American could agree on. And as she wrote in the aftermath of the death of her friend Tony Snow, “lots of people who valued the same things Tony did — a family well-loved and work well-done — have died and will die of colon cancer, those who have preceded Tony and those who will follow him.” But “can’t we start with something easy on which we can agree?” she asked, suggesting “that no one should die of a disease we can find and stop?” Thanks in part to her tireless efforts, that vision will become a reality.

You can read an archive of her work at the Wonk Room here.