On April 1, Texas’ most powerful elected officials gathered at the state Capitol to rail against Medicaid. In a packed press conference room with protesters shouting outside the door, Republican Gov. Rick Perry, Lt. Gov. David Dewhurst, and U.S. Sens. John Cornyn and Ted Cruz made clear to reporters that Texas—the state with the nation’s largest uninsured population—wouldn’t expand the program that provides health insurance to the poor and disabled.
Under the Affordable Care Act, the federal government would have largely paid for Medicaid to cover an additional 1.5 million Texans. But the state’s Republican leaders instead called for the federal government to “block grant” Medicaid, giving them a lump sum of money to run the program as they see fit. Dewhurst compared expanding the current Medicaid system to drug addiction. “Would you consider expanding a broken system? Of course not, of course not,” Dewhurst said. “It’s like a drug dealer. You give them their first hit free and then they’re hooked for years and years.”
The group that organized the press conference and supplied the policy prescription was the Texas Public Policy Foundation (TPPF), an influential think tank funded largely by right-wing foundations, corporations and wealthy Texans. TPPF has been instrumental in preventing increased spending on Medicaid and other social welfare programs in Texas. Perry, Cruz, Cornyn and other politicians frequently turn to TPPF to help make the intellectual case for reducing government involvement in health care. The press conference was part of TPPF’s multi-year strategy to remake Medicaid in accordance with free-market principles. The think tank would later claim credit for helping block Medicaid expansion in Texas under Obamacare.