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January 15th, 2013:

Expanding Medicaid is about more than money

It’s a matter of life and death

Not to Rick Perry it doesn’t

If Texas doesn’t expand Medicaid, it will reject more than $100 billion in federal money the first decade, according to the state’s own figures. To get that sizeable federal reimbursement, the state would have to spend about $16 billion over 10 years. The governor’s refusal to take the federal government’s billions puts him in an awkward position opposite some of the state’s most powerful economic players: hospital chains, local governments and chambers of commerce. Given that political pressure, Perry might strike a deal with the Obama administration, or the Texas Legislature could push for a Medicaid expansion.

Beyond the economics and politics, lives are at stake. Lack of insurance will certainly mean more deaths. How many more? Approximately 9,000 a year, according to Dr. Howard Brody, director of the Institute for Medical Humanities at the University of Texas Medical Branch in Galveston. Brody calculated that figure by extrapolating from a recent Harvard University study published in The New England Journal of Medicine that found that states that expanded Medicaid saw a 6.1 percent reduction in the death rate among adults below 65 who qualified for the program. In a recent op-ed in theGalveston Daily News Brody wrote, “This means that we can predict, with reasonable confidence, if we fail to expand Medicaid . . . 9,000 Texans will die each year for the next several years as a result.”

Too often the political debate around Medicaid expansion is about dollars and cents, Brody told me recently. “It’s presented as if it weren’t about life and death,” he said. Brody teaches ethics to medical students at UTMB, so for him, the issue of Medicaid expansion, when you cut through the rhetoric and endless policy discussions, is a deeply moral question: Should Texas allow people to die simply because they can’t afford health insurance? “Whose life and death are we talking about?” said Brody, who treated Medicaid patients for decades before becoming a professor at UTMB. “Politically, the Medicaid population are simply invisible folks. Most Americans may not care very much, because they think, ‘I’m not in that group of people and that’s somebody else and so it’s somebody else’s problem.’”

Perry has contributed to this attitude by arguing that uninsured Texans can receive health care in emergency rooms. “Everyone in the state of Texas has access to health care, everyone in America has access to health care,” Perry said at a New Hampshire campaign event in November 2011, according to the liberal website ThinkProgress. “From the standpoint of all people in this country, our government requires that everyone is covered.” Perry is correct that anyone can get treated in an emergency room—but it’s expensive. And not everyone in Texas has access to health care. People with chronic conditions—especially those with cancer—face a bleak future without health insurance. They are among the thousands of Texans whose lives could be saved by Medicaid expansion.

[…]

Medicaid expansion would help people like Mario Reyes, said [Kevin Moriarty, CEO and president of Methodist Healthcare Ministries], who is frustrated by Perry’s rejection of the program in Texas. “We’re talking 1.5 to 3 million people around the state who are going to get late care or no care,” he said. “They’re going to suffer, they’re going to be in pain because we can’t make a better policy decision.”

Sure is a good thing Rick Perry is pro-life, huh? Read the whole thing.

Point of disorder

New House, new rule.

"Objection Overruled", by Charles Bragg

The Texas House’s Democratic minority was dealt a blow Monday when the House passed an amendment to the chamber’s rules to limit legislators’ ability to derail a bill based on clerical errors. Calling “points of order” on such errors is a strategy lawmakers have often used to block measures they oppose.

State Rep. Phil King, R-Weatherford, authored the amendment to the House rules to limit abuse of typographical mistakes to kill legislation. Points of order on those types of mistakes send bills back to committee to be corrected before they can return to the floor to be voted on.

“The practice has been to allow bill after bill after bill to be defeated because a clerk at midnight, a sleepy and tired 25-year-old, made a typographical error,” King said. “That’s just not appropriate.”

Several Democrats and one Republican spoke against the provision, arguing that it weakens minority power. Rep. Armando Walle, D-Houston, said the amendment takes “tools out of the toolbox” for the minority party.

Since Republicans became the House majority in 2002, Democrats have often called points of order on the paperwork, including committee minutes and reports, that accompanies legislation. Under the new rule, a point of order may be overruled if it is “substantially fulfilled and the violation does not deceive or mislead.”

You can see the amended rule here. This is potentially a big deal, because Democrats have indeed been very adept at using points of order, known colloquially and amusingly as POOs, to stymie, delay, and sometimes kill outright bills they don’t like. Not just Democrats, of course, as anyone familiar with the oeuvres of Robert Talton and Arlene Wohlgemuth can attest, but it’s certainly been the main arrow in their quiver these past few sessions. Limiting their ability to wield this weapon will limit their ability to influence the outcomes. Having said that, I do have some sympathy for what Phil King says. There’s not really a principle behind POOs, and as they say about holding in the NFL, you could probably find such errors on every bill if you wanted to. It’s a matter of how much sway the minority is allowed, and how much authority the majority thinks it ought to have to enact its agenda. How you feel about these things is almost certainly directly proportional to your feelings about the majority and minority parties in the legislative body in question.

It occurs to me that this is also a potential trap for Speaker Straus. If he takes this rule to heart and regularly slaps down POOs he deems to be non-worthwhile, that could galvanize Democrats to abandon him and coalesce around a future challenger like David Simpson, who by the way was one of three Republicans (Jim Keffer and Gary Elkins were the other two) to vote against this amendment. If he continues to let Democrats knock bills down – and note that as a general rule, POOs only delay bills by a few days, so except in deadline situations they can be fixed and re-introduced; this happened several times last session – he’s unlikely to endear himself to his Republican critics. I think Straus is smart and slick enough to walk the tightrope, but it will be a challenge. BOR, Rep. Mike Villarreal, Trail Blazers and Texas Politics have more.

UPDATE: More from the Observer.

What they’re saying about transportation

So far in all the stories I’ve read about the beginning of the legislative session, education and transportation are two of the biggest items everyone talks about. Here’s a sample from the Chron.

Story #1:

[Rep. Ed] Thompson said funding for transportation is another high priority going into the session.

“The gas tax has not been visited since the early 1990s,” he said. “It’s not generating enough money. We’re going to have to figure out a way to fund highways going forward.”

[Sen. Larry] Taylor agreed. “Transportation is a huge issue particularly in our area,” he said. “We have to get more dollars to our roads and highways, and how we do that is up for debate.”

He said fuel taxes and increased registration fees are possible options.

“To build roads and maintain what you have, you need to have funds,” Taylor added. “And the system we have is not doing the job. We need additional funding.”

I cited that article in my earlier post about education discussion. I wanted to revisit it after I saw what was said in story #2:

Transportation is another key issue, [Rep. Bill] Callegari said.

“Texas is doing really well bringing business to the state, but if we can’t bring adequate transportation, they’re going to stop coming,” he said.

Funding for transportation could be a topic for debate, he added.

“We have a gas tax that we use to fund transportation,” he said. “Cars use less gas, and less gas means less income. We’re going to have to look for ways to finance transportation in the future.”

Improving infrastructure is how Callegari believes the state can protect the economy.

“Our economy is doing well, but it is contingent on making sure we have more funding for transportation, water and rail,” he said. “The most important thing is that we can keep rolling to work and keep moving goods across the state to keep our economy moving.”

So is this genuine concern about finding adequate funds for transportation – and they’ll need a lot of funds – or just boilerplate talking points going in to a new session? With the happy budget news, it seems to be more the former, but we’ll see how that actually plays out. For now at least I will note that the discussion has mostly centered on what the state needs and the need to pay for it – water issues are another common thread – and there’s little to no talk about the need to cut back. Again, maybe this means nothing, but it is a different sound than what we were hearing two years ago. Make of it what you will.

Aereo

From Dwight:

Aereo, which already has disrupted the television landscape in New York City, is coming soon to Houston and 21 other U.S. markets – but only if it survives legal attempts to kill it.

On Tuesday, Aereo CEO Chet Kanojia announced at CES in Las Vegas that the company would embark on a major expansion of its service, which currently is only available in the Big Apple. Aereo will fuel its efforts with a $38 million financing round.

Aereo lets you receive traditional broadcast television on non-traditional devices, streaming the signals to PCs, tablets, smartphones and even Roku boxes. It works by providing each subscriber with his or her own dime-sized antenna – clustered by the thousands in arrays – which then pulls in local signals for each market. The service includes an in-the-cloud DVR so you can pause, rewind and fast-forward shows.

Aereo starts at $8 or $12 a month for a subscription, or you pay $80 a year. There’s also a $1 day pass. You can also try out Aereo, but only if you’re in New York City.

Even though it collects cash from its customers, it doesn’t pay broadcast stations a penny, and that’s caused some consternation – and, as you’d expect, legal challenges.

Here’s more on those legal challenges.

A federal judge in New York ruled in July that the service doesn’t appear to violate copyright law because individual subscribers are assigned their own, tiny antenna at Aereo’s Brooklyn data center, making it analogous to the free signal a consumer would get with a regular antenna at home. Aereo spent the subsequent months selecting markets for expansion and renting space for new equipment in those cities.

“The court decision was the green light in our perspective,” CEO and founder Chet Kanojia said in a recent interview at Aereo’s sparse offices in a former engine factory in Queens. “This is an opportunity of a lifetime to build up something meaningful to change how people access TV.”

Aereo is one of several startups created to deliver traditional media over the Internet without licensing agreements. Past efforts have typically been rejected by courts as copyright violations. In Aereo’s case, the judge accepted the company’s legal reasoning, but with reluctance.

If the ruling stands, Aereo could cause a great deal of upheaval in the broadcast industry. It could give people a reason to drop cable or satellite subscriptions as monthly bills rise. It also might hinder broadcasters’ ability to sell ads because it’s not yet clear how traditional audience measures will incorporate Aereo’s viewership. In addition, it could reduce the licensing fees broadcasters collect from cable and satellite companies.

Broadcasters have appealed the July ruling. At a November hearing, appellate judges expressed skepticism about the legality of Aereo’s operations. In addition, the original judge’s ruling was preliminary, made as part of a decision to let Aereo continue operating while the lawsuits wind their way through court. Even if courts continue to side with Aereo on the legality of its setup, broadcasters still could nitpick on the details and try to argue that the antennas don’t actually operate individually as claimed.

I’d certainly call Aereo’s business model disruptive, so there’s quite a lot at stake here. For now, all you can get on Aereo is broadcast channels plus the Bloomberg Network, which reached a deal with Aereo. I’d think that if Aereo survives the challenges, or gets Congress to clarify the law in a way that accommodates what they do, it’s likely they’d make deals with other cable channels to carry them as well. It’s possible that this could lead to the kind of a la carte TV service that people have been predicting/demanding for years. Or it could get squashed and nothing will change for a decade or more. Who knows? Aereo’s press release is here, and you can pre-register for their service here. Hair Balls has more.