News Column

As GOP Ponders Medicaid Expansion, Hispanic Support Hangs in the Balance

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For Republicans nationally, the big takeaway from the 2012 presidential election was that, as a party, they have to get right -- or at least do better -- with Hispanic voters.

With the opening of the 83rd legislative session, the lessons of the 2012 election seemed to have taken here as well.

No provocative emergency items like in the last session, on sanctuary cities or voter I.D., issues that roused the Republican base but lacerated Hispanic sensibilities.

But on one issue, Gov. Rick Perry did draw a line in the sand.

"We have made it clear Texas will not expand Medicaid under the Affordable Care Act," he declared. "Texas will not drive millions more into an unsustainable system, and that stance has not changed an iota."

Perry's resistance to expanding Medicaid did not stir comment that he was being insensitive to the needs of Texas Hispanics.

But beneath a flurry of recent activity at the Capitol to find a "Texas solution" on Medicaid lurks an obvious, if mostly undiscussed, fact that the Hispanic community has the most to gain from expanding Medicaid, and that Republicans have the most to lose politically in their long-term relationship with Hispanic voters if they are seen as having denied so many Hispanics coverage just as it was within their grasp.

"Medicaid may have quietly eclipsed immigration reform as the major campaign issue standing in the way of the GOP drive to woo Hispanic voters. Hispanics, especially children, are disproportionately dependent on Medicaid, especially in Texas, the state with the greatest percentage of uninsured residents and with one of the largest Hispanic populations," said Frederick Lynch, a government professor at Claremont-McKenna College, who explored the nation's changing political demography in his 2011 book, "One Nation under AARP: The Fight over Medicare, Social Security, and America's Future."

"When it comes to the way Latinos are received by any political party, with regard to Republicans there is always that sort of anti-Latino sentiment, that's 1.0 -- that's the anti-immigrant, sanctuary cities, deport-them-all. And then you sort of have the anti-Latino sentiment that's 2.0, which is lack of support for public policy initiatives that disproportionately impact minority communities -- in this instance, Latinos, said state Rep. Trey Martinez Fischer, D-San Antonio, the chairman of the Mexican American Legislative Caucus.

"Everybody knows Texas is the poster child" for having the largest percentage of uninsured people in America, he said, and "3.6 million of the Texans who are uninsured are Hispanics."

According to the Kaiser Family Foundation's state health facts, those 3.6 million constitute 60 percent of the uninsured in Texas, and nearly a quarter of the 15.5 million Hispanic uninsured in the entire country.

"We're one of four states in the union that's majority-minority," said Texas GOP chairman Steve Munisteri, who said it's hardly surprising that in a state with such a large Hispanic population, Hispanics make up such a large share of the uninsured.

Gov. Perry has described Medicaid as a "broken" system that needs to be reformed, not expanded, and that to open its rolls to a huge new population in perpetuity would expose the state to crushing costs in the long term, even if the federal government kept its commitment to pay the lion's share.

"Everybody is in agreement that it should be a goal in the United States to ensure that people have access to affordable health care," said Munisteri, who said that Obama could have done much to contribute to that end if he had, as promised, driven down the price of premiums instead of driving them up.

An analysis by Rice University demographers Michael Cline and Steve Murdock forecast that without Medicaid expansion, the new health care law will reduce the number of uninsured in Texas from 6.1 to 4.5 million. With Medicaid expansion, that number of uninsured would plunge another 1.5 million to 3 million.

The power of health care as a motivating issue -- and not in a way most Republicans had hoped -- was evident in Obama's re-electon.

In separate recent election post-mortems, both Mitt Romney and David Plouffe, who managed the Obama campaign, agreed health care was at the heart of Obama's 71 to 27 percent victory over Romney among Hispanics, in what, just as importantly, was a record turnout.

"The weakness that our campaign had and I had, is we weren't effective in taking our message primarily to minority voters, to Hispanic Americans, African Americans, other minorities," Romney said in an interview with FOX. "We did very well with the majority population but not with minority populations."

Romney's explanation: "Obamacare was very attractive, particularly to those without health insurance," he said. "And they came out in large numbers to vote."

Or, as Plouffe put it in a recent interview with The New York Times Magazine, "the bigger problem they've got with Latinos isn't immigration. It's their economic policies and health care. The group that supported the president's health care bill the most -- Latinos."

"Latinos believe in a strong safety net," said Antonio Gonazales, president of the William C. Velasquez Institute, a Latino public policy and research organization, who said that health, like education, has long been a top-tier issue.

It's too soon to say how powerful an issue Medicaid expansion will prove to be for Hispanic voters, but, he said, "Texas is the place you would find intensity because access to health care is so bad for Latinos."

But George Antuna Jr., a co-founder with George P. Bush of Hispanic Republicans of Texas, sees no evidence of that.

"I have my ear on the ground and I'm not hearing Latinos clamoring, 'I need more Medicaid.' I think what they are saying is, I need a good job, a secure backyard and a good education for their kiddos. The same as every ethnic group," said Antuna.

The Texas Lyceum Poll in October found that about half of all Texans supported expanding Medicaid in the state, with 40 percent opposed. More than half of non-Hispanic whites, but only a little more than a third of Hispanics, were against expansion.

In a way the Obama administration could not have anticipated, the Supreme Court's decision last year on the constitutionality of the Affordable Care Act baited a political trap for Republican governors. The court found the act constitutional, but ruled that it could not punish states that didn't want to go along with expanding Medicaid.

If that potentially blew a big hole in the administration's ambitions to dramatically reduce the numbers of uninsured, it offered Democrats in states like Texas a potentially potent political issue by letting millions of citizens in those states know that under Obamacare they would be newly eligible for Medicaid coverage, unless their governor chose not to go along with expansion and turned down the big pot of federal money that comes with it.

Under the terms of Medicaid expansion, the federal government picks up 100 percent of the cost of adults added to the program for the first three years, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and no less than 90 percent thereafter.

One by one, prominent Republican governors -- Jan Brewer in Arizona, John Kasich in Ohio, Rick Scott in Florida, Chris Christie in New Jersey -- have announced they would go along with Medicaid expansion (though Scott faces fierce resistance in the Florida House).

Even now, Texas is hardly alone in resisting Medicaid expansion. According to tracking by The Advisory Board Company, a research and consulting group, as of last week, 24 states have agreed to expansion, and four are leaning that way, while 14 states -- including a band of Southern states from Texas to North Carolina -- are not participating, and three are leaning against participating. Five states are undecided.

But, because of its size, its numbers of uninsured, its politics, and its governor, the eyes of the nation on this issue are now fixed on Texas.

While Perry may have drawn a line in the sand on expansion, House Speaker Joe Straus, while seconding the governor's critique of Medicaid and praising his negotiating skills, said in an interview Wednesday with The San Antonio Express-News that it was time to "get our heads out of the sand," and "put forth a good-faith effort to find a Texas solution."

The political stakes for Perry are high.

He will speak Thursday at the Conservative Political Action Conference outside D.C., the premier national event of its kind, and his performance and reception there will be an important bellwether of whether he has any really hope of mounting a second presidential campaign. Christie was not invited to speak after he said he was gong to go along with Medicaid expansion. When Scott in Florida did the same, a tea party leader was quoted on the front page of The New York Times as blogging, "I'm trying to determine how the Medicaid expansion is going to pay for the surgery to remove the knife planted in my back."

But Jerry Pollinard, a political scientist at the University of Texas-Pan American, said that should Perry somehow found himself the GOP nominee in 2016 and needing a decent share of Hispanic votes to get elected president, his singular identification with this issue could come back to haunt him.

"It begins to isolate him," said Pollinard. "Standing in the spotlight is one figure: Gov. Oops."