To expand Medicaid or not. That's the question for Texas lawmakers now that the Affordable Care Act is law.
Gov. Rick Perry has made it clear that he doesn't support expansion.
With changes at the federal level and a bill to the state of Texas for nearly $5 billion, the question to expand Medicaid is only tip of the iceberg.
"As it stands now I agree that expansion is not right for this time at this moment with the unknowns that we have in regards to the program," State Rep. Susan King said.
Part of the Affordable Care Act allows states to provide more health coverage through Medicaid.
King said that doesn't mean states will do it.
"As a nurse, and I've been a nurse, and a practicing nurse for over 30 years, I think it's important for people to receive healthcare, but I also think it's important that there's individual responsibility," she said.
She believes a co-pay or some cost sharing program would be fair.
Officials at hospitals, like Hendrick Medical Center in Abilene, said preparations are being made to deal with lower payments.
"You still have the pressure of those payment reductions from the federal government, but we're not going to get that expanded coverage on the Medicaid in the state," said Hendrick CFO Stephen Kimmel.
That's if Texas doesn't expand Medicaid.
According to King, the talk in Austin is another priority.
"They have to do with transportation costs, so there's the question , what's more important healthcare or transportation," she said.
King met with members of the Appropriations Committee to discuss healthcare.
Here's a statement from Rep. Jim Keffer (R) TX - District 60:
Eastland, Texas - July 23, 2012 - The Texas State Legislature needs to fully scrutinize the impacts of the Patient Protection and Affordable Care during the upcoming session. The legislature is already managing a Medicaid system with soaring costs. Furthermore, I have grave concerns about the federal government fulfilling their end of the obligation when they have failed to balance a federal budget, continue to run deficits and grow debt.
Here are the facts on Medicaid in Texas:
The Houston Chronicle reports of a potential shortfall of $10 billion if no change is made to the program which makes up a fifth of the state's budget.
More than 60 percent of those served by Medicaid are low income children, yet they only make up a third of the cost.
The majority served are the disabled and the elderly, who can't pay for Medicare.
For every dollar Texas spends on Medicaid, Washington matches it with $1.47.