By State Sen. Charles Schwertner MD
(such as blood pressure cholesterol and blood sugar levels) showed no statistically significant improvement when compared to the control group. More puzzling still the study found no decline in emergency room visits and a 30 increase in overall hospital admissions.
Clearly this counterintuitive outcome has raised a number of questions.
The study would seem to suggest that in spite of increased access to preventative care and improved identification of individual health risks the Medicaid group didnt take advantage of that knowledge to make the kind of lifestyle changes needed for any lasting improvement to ones health.
Personal choices left to the individual plays a far greater role in determining individual health than insurance coverage ever will. This may come as a surprise (or at least a disappointment) but there is no magic bullet to improving ones health… it requires commitment diligence and self-control.
If providing comprehensive preventative health care in Oregon resulted in increased utilization and cost but no corresponding improvement in actual health then why would Texas expand its Medicaid program as well?
However the news isnt all bad. Despite showing no measurable improvement in overall health those covered by Medicaid suffered almost no catastrophic out-of-pocket medical expenses over the studys two-year timeframe.
Which gets to the heart of what health insurance was originally intended to be: not all things to all people but a safety net to guard against the crushing expense of a truly catastrophic medical emergency.
Lets think about this another way.
All drivers in the state of Texas are required to carry automotive insurance. These plans are relatively affordable generally carry high deductibles and are designed as a financial safeguard against only the most serious auto accidents. 
Most Americans would never dream of billing their car insurance company for routine low-cost auto maintenance such as an oil change or tire rotation but thats precisely what weve come to expect from our health insurance.
If Oregon has anything to teach Texas its that Medicaid expansion really shouldnt be a comprehensive gold-plated health plan but rather a low-cost high-deductible system of emergency health coverage that focuses on the one thing weve actually proven we can change…keeping patients who suffer from a serious medical event from going broke as a result.
Try as it might government will never be able to legislate personal responsibility. But what it can do and should do is form the kind of health care system that rewards personal responsibility and puts patients back in charge of their health care. Options such as variable benefit packages copayments health savings accounts and high-deductible emergency care plans have a far greater potential to keep costs under control and keep patients out of bankruptcy.
However the federal government wont allow Texas the flexibility to implement these solutions in our states Medicaid plan. Rather than forcing a poorly-conceived expansion of our overburdened Medicaid program Washington should give Texas the freedom to use these kinds of innovative approaches to provide real sustainable relief to our states uninsured.
We can solve the challenges facing our health care system but a one-size-fits-all Medicaid solution just doesnt fit Texas. We should learn from the lesson of Oregon and realize that the governments role in health care should be as 
limited as possible and narrowly focused on improving the things we can change rather than throwing more and more money at the things we never will.
Senator Charles Schwertner is a medical doctor serving his first term in the Texas Senate. Schwertner represents the citizens of Senate District 5 a 10-county region of Central & East Texas which includes Brazos Freestone Grimes Leon Limestone Madison Milam Robertson Walker & Williamson counties.
