I laughed out loud the first time I read Perry's letter. It seemed calculated to appeal to the anti-big government crowd. But as I write this, I wonder if Perry didn't make a brilliant political move.
Is Secretary Sebelius really going shrug her shoulders and let Texas off the Medicaid hook? Is Perry really going to walk away from an estimated $70 billion in federal money? It's doubtful.
With 6.2 million uninsured individuals in Texas, the state has some clout in terms of negotiating with the federal government. In his letter, Perry says he "looks forward to implementing healthcare solutions that are right for the people of Texas" and asks Sebelius to support him in that effort.
On the flip side, Perry and the Texas legislature face a $6 billion shortfall in the state's current Medicaid program. That bill comes due in 2013. The legislature has never been shy about reducing Medicaid benefits. Only pregnant women, children, and disabled adults quality for the program now, so there's not much that can be cut there.
Texas just trimmed physician reimbursements by 2%, which reduced the number of physicians willing to take on new Medicaid patients.
Remember, the PPACA goal is to get more people under the insurance umbrella. A little give and take could be all the Perry needs to jump into the Medicaid expansion fold.