The State of Texas has created more jobs over the last 10 years than any other state, and it has weathered the Great Recession better than other states of comparable size. But out-of-control growth in the Medicaid program threatens the future prosperity of our state – and our nation.

Under current law, Medicaid is projected to consume 46.6 percent of the 2014-15 Texas state budget. The Texas Public Policy Foundation has developed recommendations for reforming Medicaid, but these reforms cannot be enacted unless Texas can recapture our freedom and our federal tax dollars.

This week U.S. House Budget Committee Chairman Paul Ryan released his 2012 budget proposal. This proposal would restrain the level of federal spending, but more valuably, it would provide pass-through funding for Medicaid in the form of a block grant. Texans should enthusiastically support Chairman Ryan’s approach.

Block grants are essentially a pot of money given directly to the states with a minimal number of requirements for their use. Block grants offer considerable flexibility for states to innovate and adapt to the unique needs of their citizens – flexibility that does not exist under current Medicaid rules.

For Texas, this could mean a subsidy program that expands access, lowers cost, and provides budget certainty. On the other hand, Vermont could use these grants to implement the single-payer system its politicians prefer. We can then see which policy approaches work best for which groups.

The debate over block grants for Medicaid is both economic and philosophical and leads to the fundamental question at the heart of the health care debate: who controls your health care?

ObamaCare was written to give authority to the federal government to determine what benefits you need, what you should pay for them, how health care companies operate, and the like. Fundamentally, ObamaCare centralizes decisions in Washington, D.C. bureaucracies and trusts that they will fix health care.

In answering the question of who controls your health care, ObamaCare gives the same tired answer that has yielded poor results for decades – more regulation and higher taxes.Block grants offer a new solution.

A block grant gives the state and its citizens control of their own health care by removing the federal strings attached to the Medicaid program.

Block grants offer hope for a Medicaid program that has languished in rising costs and declining quality for decades.

Skeptics say these are just a means to cut benefits to individuals by giving clients funds and throwing them into the private market. This is why the federal government must maintain control of the program.

But what makes a federal official more capable of determining needs than the individual involved? Why is their understanding of a person’s needs and wants more valid than the person in question? In fact, is there anyone more invested in the quality of their health care than the individuals themselves?

Government programs are among the most inefficient endeavors on earth, and, after years of ineffective operations, a politician will pass a law requiring the bureaucracy to complete a study listing the inefficiencies. This is a slow, conventional process, and it has yielded poor results historically.

The system of health care that is run by consolidated management in Washington, DC has not worked and will not work. If we are going to get health care right, the states must have the freedom to innovate and the return of taxes paid by Texans going to Medicaid. Texas needs Congressman Ryan’s block grant proposal.

The Honorable Arlene Wohlgemuth is the Executive Director and Director of the Center for Health Care Policy at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin. She served 10 years in the Texas House of Representatives, specializing in health care issues.