When U.S. President Lyndon B. Johnson signed into law Medicare 45 years ago, Title XIX was included in the legislation. Title XIX was known as Medicaid and introduced as a welfare program for states to administer to citizens in need. In 1996, U.S. President Bill Clinton separated Medicaid from the welfare status and today, many working Americans qualify for Medicaid reimbursement. In the near future, Medicaid may in fact cover 25 percent of the population and be one of the largest payers for health care coverage.

Rather than approach Medicaid as a problem, let’s look at potential opportunities to position the program as an insurance product rather than welfare health coverage. Texas has intelligent professionals who could sit down in a bipartisan and collaborative meeting. They could look at a truly state-based Medicaid insurance product with fair and equitable payment levels. Perhaps we could place state employees within this plan, have sound actuarial assumptions and place this qualified health plan (QHP) on the state health insurance exchange.

This QHP would have tremendous purchasing power, allowing the state to shape the landscape of rates, coverage and payment methods. This would help Texas to examine state staffing shortages in the Health and Human Services Commission. Our state could clearly define coverage, including mental health, and control its own destiny when administrating the Medicaid program.

No plan is perfect. Utilizing funds from the Affordable Care Act, increasing coverage through Medicaid expansion and the qualified health plan on the insurance exchange would provide a solid foundation to help many of the six million uninsured Texans.

This approach to reform would include the Medicaid 1115 waiver, patient payment responsibility, long-term sustainability and a state-controlled payer to help Texas pave the way to health care delivery reform.