AUSTIN — Texas leaders were left licking their wounds and weighing their options Thursday after a decision by the U.S. Supreme Court upholding most of President Barack Obama's historic health care overhaul.
Gov. Rick Perry called the ruling a “stomach punch to the American economy,” while state Attorney General Greg Abbott interpreted it as somewhat of a victory for states' rights. In the aftermath, it's unclear how Texas will address the creation of insurance markets, or whether the state will expand Medicaid after the ruling stated the federal government can't withhold states' entire Medicaid allotment if they don't expand the program.
Perry spokeswoman Lucy Nashed said the governor's office will work with Abbott and the appropriate state agencies to “determine the impact” of the court's decision. The governor gave few specifics, but did blast the ruling on Fox News Channel, saying that “freedom is under assault.”
“I kind of feel like I'm watching that old movie The Godfather and the American people looked the Godfather in the face and he said, 'I'm going to make you an offer you can't refuse.,'” Perry said. “And that offer is, 'you're going to buy my insurance, and if you don't, I'm going to tax you.' That is just unconscionable.”
About 6.2 million Texans — a quarter of the state's population — are uninsured.
Texas Health and Human Services Executive Commissioner Tom Suehs said he is pleased the ruling “gives states more ability to push back against forced expansion of Medicaid.”
“The court clearly recognized that the Affordable Care Act put states in the no-win situation of losing all their Medicaid funding or expanding their programs knowing that they would face billions of dollars in extra costs down the road,” Suehs said in a statement.
Erin Daly, spokeswoman for Texas House Speaker Joe Straus, R-San Antonio, said the speaker has charged the House Committees on Insurance and Public Health with monitoring implementation of the law, which will guide legislators work once they are back in session.
“The findings from those committees will offer the Legislature guidance heading into the 2013 session,” Daly said.
Texas was one of more than two dozen states that sued, claiming Congress did not have the authority to enact the health care overhaul. Abbott traveled to Washington for the decision. Later, he spoke to reporters on a conference call, saying that whether or not the Medicaid program is expanded will be a policy decision lawmakers will have to make when legislators reconvene in January.
“The state is going to have to consider several options. One is whether or not they want to expand the state Medicaid system consistent with the parameters set out in Obamacare. Or if the state wants to exempt itself from that expansion,” he said. “That will be a policy decision for the policymakers in Austin to make.”
Chief Justice John Roberts cast the deciding vote, and Abbott said that, upon close examination of dissenting Justice Anthony Kennedy's opinion, “it looks as though Chief Justice Roberts may have seemingly engaged in some judicial activism as opposed to strict construction in order to reach a result.”
Roberts was “quite literally reaching to uphold the validity of the law,” the attorney general said.
The Texas Health and Human Services Commission estimated that the Medicaid expansion would cost the state $27 billion in the first 10 years, agency spokeswoman Stephanie Goodman said. The agency has estimated that the expansion would add about 2 million people to the Texas Medicaid rolls in the first two years, making 21 percent of the uninsured eligible for coverage.
Abbott says a decision on creating an insurance market will be “hammered out in the coming weeks and months.”
Texas has not yet implemented the exchange where individuals and small businesses can shop for private coverage from a range of competing insurers. States face Nov. 16 deadline to submit a plan to the federal government for an exchange. Regardless, the federal government will implement the system by 2014 if Texas doesn't comply in time.
Abbott said that even though the court's ruling went against Texas, it was still a victory for individual liberty and states' rights.
He said that “despite the outcome of this case, the federal government is more restrained than it was yesterday,” noting that the court sided with Texas and other states that filed suits claiming the law violated congressional powers under the federal Commerce Clause. But Abbott acknowledged losing the case because of the court's “novel application” of federal taxation authority.
The attorney general said Texas was planning further legal action to “continue to try and legally dismantle Obamacare” but said he wasn't prepared to discuss specifics yet.
Health care advocates said it was time for the state to move forward with implementing the changes called for in the act.
“Starting today, there's no real excuse for dragging your feet,” said Bee Moorhead, executive director of Texas Impact, a statewide religious grassroots network with a focus that has included health care for all people. “It's time to go ahead and roll up your sleeves and get to work and stop thinking up a way to circumvent this ruling.”