I sort of favor Texas secession from the United States of America, but nevertheless it bugged me to see Texas Governor Rick Perry randomly prattling over the weekend about his alleged desire to opt-out of Medicaid “rather than this one size fits all mentality that comes out of Washington, DC with string attached.”
You see, though there are a lot of problems with Medicaid’s hybrid state/federal nature, one virtue that structure has is that doesn’t have a one size fits all mentality. Any governor who thinks he has a more cost-effective way of meeting Medicaid’s coverage goals is free to apply for a waiver to restructure the program. Perry’s problem, as my colleague Igor Volsky explains, is that he doesn’t actually have a way to do this:
But of course, if Perry believes that Medicaid is such a bad deal, he can continue petitioning the government for a waiver that would allow the state to alter some of the rules of the program — so long as he can demonstrate that his ‘Texas solution’ is comparable to Medicaid’s coverage standards. Perry hasn’t proposed anything remotely plausible during his first term as governor and while he talked a lot about states acting as “laboratories of innovation” in the above CNN interview, but didn’t list a single “good idea” for how Texas would provide care more efficiently than Medicaid.
The fact of the matter is that governors generally don’t want flexibility over this sort of thing. What they want is the ability to do what Perry did — to go on television and tell people they have a double super secret way to accomplish the goals of federal programs more efficiently if only the jackbooted thugs in Washington would get out of the way. But nobody is standing in Perry’s way. He just doesn’t have a proposal that works.