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January 18th, 2013:

Friday random ten: Inauguration 2

It’s Inauguration 2 Weekend for President Obama. Here are a few suggested songs for the party playlist.

1. Back Where You Started – Tina Turner
2. Starting All Over Again – Mel & Tim
3. Serious Business – John Mellencamp
4. Work To Do – The Isley Brothers
5. Still Crazy After All These Years – Paul Simon
6. Winner Takes It All – ABBA
7. The Strangest Party (These Are The Times) – INXS
8. Everything’s Gonna Be Better Next Year – The Rescues
9. Things Can Only Get Better – Howard Jones
10. Hello Hopeville – Michelle Shocked

Song #5 of course is a special dedication to any members of the Republican Congressional caucus that happen to wander in. What tunes would you offer up for the occasion?

Hall is in

It’s on.

Ben Hall

Former Houston City Attorney Benjamin L. Hall III announced his candidacy for mayor Wednesday, choosing a slogan of “Hall for All!” and emphasizing his ability to unite people.

Hall said he filed a form designating a campaign treasurer late Tuesday, the first formal step in his bid to unseat Annise Parker this fall. The Rev. Bill Lawson, pastor emeritus at Wheeler Avenue Baptist Church, is listed as treasurer on the form, but a Hall campaign press release said former State District Judge Alvin Zimmerman also will serve as co-treasurer.

“By selecting these two pillars of our community,” Hall said in the release, “I intend to signal an aggressive intention to applaud our diversity and differences as strengths in our city and not weaknesses. United we are stronger! Our diversity is a great asset.”


In our conversation this morning, Hall stressed job creation, economic growth, international trade, and a more creative, compromise-seeking approach to the city’s pensions issues, and also emphasized that the city’s strength lies in its diversity. He said Parker’s 16-year tenure at City Hall as a council member, controller and now mayor, has produced “leadership fatigue.”

Hall said he plans announcements on international trade (“I figure a person shouldn’t just be promising things, they should try to get ahead of it, and say, ‘Well, this is what we’ve done.’”), pensions, Metro/rail and drainage in the coming months.

“This is really a world-class city, and we’re treating it as kind of nothing more than the fourth-largest city,” he said. “This city is in communication and dynamic relationships with the entire world, but we need a vision coming out of the mayor’s office that actually promotes that as a priority, as opposed to a tertiary or corollary idea.”

On pensions, Hall said Parker didn’t push aggressively for reform as controller and only recently turned her focus to the issue as mayor. He said creativity and good working relationships — which he said he had — with key legislators and local officials can solve the current disputes.

He said the city must think bigger and work on issues of greater import than how and where the hungry can be fed.

“If you ask the question, ‘In 16 years what policy has been advanced by this administration that has aggressively grown this economy?’ I think you’ll have to scratch your head a long time,” Hall said. “I’m not intent on driving a negative campaign. I just simply want to say we’re at a place of leadership fatigue, and I think that we need a fresh new look at a way forward for this city.”

We’ll see what those later announcements have to say, but for now it’s a bit unclear what Hall has in mind to do as Mayor. The thing about promising vision and fresh ideas and whatnot is that you have to actually come up with something fresh and visionary, and that’s harder than it looks. The main thing I’ll be watching for is what he has to say about pensions. Hall shouldn’t have any trouble picking up support from the firefighters, who endorsed Fernando Herrera in 2011 and who have no love at all for Mayor Parker, but given what Todd Clark and Chris Gonzales said in my interview with them, if what he’s getting at here is that he thinks he can do a better job negotiating concessions from the HFRRF than the Mayor can, well let’s just say I have my doubts. But I don’t know if he’s saying that because I don’t know yet what he is saying, so we’ll have to wait.

One more thing:

Hall initially entered the 2009 mayor’s race, but soon withdrew and threw his support behind Gene Locke (also a former City Attorney), who eventually lost to Parker in a runoff. Hall also toyed with the idea of facing Parker in 2011, but did not enter the race.

Hall may have thought about entering those two Mayoral races, but what he didn’t do in either of them was vote. In fact, he hasn’t voted in a city of Houston election since 2001. This is because he resided in Piney Point, and was registered to vote there during that time. If you’re going to complain about a lack of leadership in the city, it seems to me you should have been doing something about it, and voting is the very least you could have done.

Dewhurst and Nelson push Medicaid reform

I’m reserving judgment on this for now.

Sen. Jane Nelson

Lt. Gov David Dewhurst and Sen. Jane Nelson, R-Flower Mound, on Wednesday touted Senate proposals they say would bring down spending on Medicaid, the state’s health program for the poor, by instituting quality-based payment reforms for long-term care services and measures to catch Medicaid fraud and abuse.

“Our Medicaid costs have doubled, doubled since 2002-2003,” said Dewhurst, adding that Medicaid costs are crowding out room in the budget for “services people in Texas want to see,” such as public education, higher education and transportation.

Dewhurst said Senate Bills 7 and 8, filed by Nelson, the chairwman of the Senate Health and Human Services Committee, would bring down ballooning state Medicaid costs. “What we’re trying to do, Senator Nelson and myself, is improve the quality of health care for our Medicaid population” by providing incentives that lead to better patient outcomes.

The idea of payments based on medical outcomes rather than simply payment for services rendered is of course one of the cornerstone reforms of the Affordable Care Act. Given the Republican origins of many parts of the ACA, it’s hard to say if Dewhurst and Nelson are cribbing from it or if they’ve just gone old school. Either way, I’m quite certain that they would recoil from any attempt to compare their bills to the ACA, because of socialism or something like that.

SB 7 would redesign long-term and acute care services for the disabled and elderly — the most costly services in Medicaid — by instituting quality-based payment systems and expanding Medicaid managed care to cover services provided in nursing facilities.

SB 8 would ensure that providers found guilty of Medicaid fraud in Texas or other states would be barred from participating in the state’s program, strengthen prohibitions against marketing to Medicaid patients, add medical transportation services to managed care and enable the Health and Human Services Commission’s Office of Inspector General to establish a new data system to catch Medicaid fraud earlier.

Nelson highlighted that the OIG has identified more than $6 billion in fraud and waste between 2004-2011 in Medicaid, and she said a computerized claims monitoring program could be used “to identify outliers, anomalies and red flags in the Medicaid program so we can deal with those abuse trends on the front end.”

I want to hear from the professional wonks about this, but the Trib story doesn’t have any such quotes. Looking elsewhere, I do find some reactions. Here’s one in the Statesman:

Anne Dunkelberg, associate director of the Center for Public Policy Priorities, said Nelson’s goals of eliminating fraud and trying to create a Medicaid payment system that doesn’t provide incentives for too much or too little care “are goals everyone shares.”

Dunkelberg said her organization, which advocates on behalf of low-income Texans, will watch certain issues, particularly attempts to target fraud in the Medicaid transportation system, which many children, elderly Texans and disabled people rely on to make medical appointments.

Fairly nondescript, but not negative, which is good. Here’s the Chron:

It’s important for the state to take steps including making every effort to prevent providers from defrauding the state, said Bee Moorhead, executive director of the interfaith advocacy group Texas Impact. But Moorhead said the legislation touted Wednesday “is not the heart of the matter.”

“The biggest Medicaid problem Texas has is (that) so many people should be getting it, but aren’t,” she said.

Moorhead said more than 1 million children are eligible for health care but aren’t getting services. She also noted the opportunity for Texas to add 1.6 million people to Texas Medicaid over a decade through the expansion.

More of the same, so it would seem there isn’t anything particularly controversial. Going after fraud is relatively low-hanging fruit, and is unlikely to generate much opposition. Who doesn’t want to prevent fraud, and to punish those who do offend? I’d just note that any line item based on “money saved from fraud detection and prevention” is likely to be questionable, and anti-fraud measures have their own costs, since it takes people and other resources to investigate, prosecute, and collect repayments.

Expanding Medicaid is indeed the heart of the matter, but we know how that’s going to go.

Dewhurst also announced at Wednesday’s news conference that Texas would not expand Medicaid to cover impoverished adults, as outlined by the federal Affordable Care Act. “One size does not fit all in the health care arena,” he said, explaining he would rather apply for a block grant from the federal government to run the state’s Medicaid program independently.

Republican lawmakers have been under pressure to expand Medicaid to bring down the rate of uninsured and cut uncompensated care costs for hospitals and local government entities. Some Republicans in other states — such as Arizona Gov. Jan Brewer — have agreed to support the Medicaid expansion.

The Legislative Budget Board — headed by Dewhurst and House Speaker Joe Straus — issued a performance review on Wednesday morning recommending that the state empower counties to choose whether to expand Medicaid. Supporters of the Medicaid expansion say turning the decision power over to counties would relieve political pressure on Republican leadership.

The LBB report recommends that lawmakers pass a statute allowing counties to use local revenue to fund the expansion. In that way, local money that is currently spent on uncompensated care for the uninsured could be used to pull down $2.5 billion in federal funds for the 2014-15 biennium and cover 1.3 million impoverished adults in the six most populous counties.

The Chron quotes Dewhurst as saying expansion is off the table “at the present time”, for whatever that’s worth. I can’t say I expected Dewhurst to say anything different about Medicaid expansion – it would have been a bombshell if he had – but there are other aspects of the ACA that will affect Texas whether Dewhurst et al like it or not. This may not have been the venue to address that, but it would be nice to hear what he and others think about that. Be that as it may, here’s what that performance review says about Medicaid expansion:

Of the 535 hospitals in Texas, 108 hospitals owned by city, county, or hospital districts accounted for 48 percent ($1.5 billion) of charity care spending reported in fiscal year 2011. Most of the charity care (94 percent) local public hospitals provided was attributable to six hospital districts—Bexar, Dallas, El Paso, Harris, Tarrant, and Travis. Local public hospitals that account for a significant amount of uncompensated care spending report that 90.8 percent of patients receiving some form of charity care were non-elderly adults. With certain exceptions, federal law allows states to use intergovernmental transfers to obtain funds for use as the non-federal share for Medicaid services. By using local funds as the non-federal share for expanding Medicaid to newly eligible population, Texas could generate an estimated additional $2.5 billion in Federal Funds for fiscal years 2014 and 2015.

I had previously noted an announcement by the Center for Medicare and Medicaid Services saying that there would be no option for a “partial or phased in Medicaid expansion”. My interpretation of that was that it meant the county option for Medicaid expansion had been mooted. Obviously, the LBB and I can’t both be right, and I’d assume they’re the ones that are correct. I haven’t heard much on this option, if it still is one, since September, so I have no idea if anyone in the Lege is currently pursuing this. Dewhurst said that neither he nor Sen. Nelson endorsed the idea, which isn’t the same as saying they opposed it but which does present an obstacle. The Chron story has reactions from the type of people who might want the Lege to provide this option:

Local officials said their first choice would be for Texas to expand the program statewide. That would provide a uniform program across Texas and ensure a funding source while relieving them of some of their costs of uncompensated care.

The Legislative Budget Board assumed the higher match would apply for newly eligible adults with a county-based expansion.

If counties were to do an expansion, local officials said it would be important for private hospitals to contribute, not just leave the cost to local taxpayers. They suggested a fee as one option.

David Lopez, president and chief executive officer of the Harris Health System, said, “If this becomes a local option, then … everybody needs to have skin in the game.”

Ron Cookston, executive director of Gateway to Care, a Harris County-based nonprofit collaborative focused on health care, said letting communities manage expansion could have a real benefit, but a state-level expansion would be preferable.

“If it is not done at the state level, there is going to be, community by community, variations in the services … ,” Cookson said. “That creates an infrastructure nightmare.”

That second paragraph makes it sound like the LBB isn’t fully certain that county-based expansion is an actual option. It would be nice to have some clarity on that. As I said before, one does have to be concerned that if some counties opt to expand Medicaid on their own, some others will try to leech off of that, which is unfair all around. The county folks clearly understand this. Full statewide expansion is the only way to deal with that, but that ain’t happening, at least for now.

One more thing, from Trail Blazers:

Dewhurst and Nelson repeated their opposition to expanding Texas’ Medicaid program to add non-disabled adults between 18 and 65 whose incomes are below 138 percent of the federal poverty level. The federal health care law provides full funding of adding the adults for three years and will pick up at least 90 percent of the cost after that. But Texas Republicans have said they fear federal deficit-reduction efforts will undo the federal government’s promise to pay most of the cost. Nelson said she’s “concerned about the cost three years from now.”

If that’s your concern, then tell your colleagues in Congress to tone down their deficit obsession, which as we all know only really manifests when there’s a Democrat in the White House. The White House has already come to the realization that including Medicaid in any deficit-reduction “grand bargains” would undermine their own efforts to expand Medicaid, so I’d largely consider Nelson and Dewhurst’s concern to be no big deal. Unless Republicans get their way at the national level and disembowel Medicaid via the Ryan budget or something similar, of course. As above, I don’t really expect them to embrace my line of thinking here. The Observer has more.

Where are the doctors?

The Morning News tries to verify that the Dallas-area providers listed for the new Texas Women’s Health Program are in fact providing health care services to the women in this program as advertised. It goes about as well as you’d expect.

Right there with them

A Dallas Morning News survey of 336 contacts listed online for the program showed that 18 percent of the 55 unrepeated physicians and offices surveyed knew they were a part of the program and are accepting new patients. Two listings point people to businesses with no connection to the program — a sports medicine clinic and a title company.

A spokeswoman for the Health and Human Services Commission, which operates the new program, acknowledged that the list has problems.

“It’s not that it’s a list that they shouldn’t be using, it’s that there are addresses on that list that shouldn’t be there, so we’re going to have to do some work to clean that list up,” said Linda Edwards Gockel.

Gockel said the list, which has been available on the program website for more than three months, is not the same list of 3,500 approved providers the state has touted. It represents all the locations a potential provider billed from in the past.

She said the commission hopes to have the list corrected by next week. Gockel could not say why it was not removed sooner, but that women can always call the 1-800 number listed on the website. After The News pointed out the list’s failings, subsequent press releases from the commission avoided mention of the website.

In fact, if you go to the Texas Women’s Health Program website now and click the Find A Doctor link, you will not see any providers listed at all:

According to Trail Blazers, the site “will be fixed sometime this week”, though it looks now like that has been pushed out a few more days. Reps. Donna Howard and Lon Burnam had previously found the same problems that the DMN reports on here in Austin and Fort Worth. Now other Democrats are getting in on the action.

“It is unacceptable that thousands of Texas women may be cut off from access to the program due to the program’s inability to meet demand,” said Rep. Jessica Farrar, D-Houston, the House Democratic Caucus chairwoman, in a prepared statement. “My main concern is to ensure that women may be given the opportunity to affordable and accessible health care.”

Using the Texas Public Information Act, Farrar requested that the agency release a list of the available providers enrolled in the Texas Women’s Health Program along with the number of patients they anticipate serving, the number of patients served by the former Medicaid Women’s Health Program and the geographical areas in the state where provider enrollment does not meet demand.

Good on you, Rep. Farrar. What all this says to me is that the list that had been given on the website was complete and unadulterated junk and that they have taken it down in a desperate attempt to fix it. Remember that the state has been bragging for months about how they’re all fired up and ready to go without Planned Parenthood and with a list of 3,000 providers all set to step in. Is there any reason now to believe that was anything but a lie? Further, given the obvious problems and the complete disconnect between what the state has been saying and what everyone who has bothered to check has discovered, is there any reason to think the state will get this fixed any time soon? I say no and no.

I also say it’s time to get the people primarily responsible for this mess on the record about it. That includes State Sen. Bob Deuell, who requested the AG opinion that declared the state could sever ties with Planned Parenthood while still receiving federal money for the WHP (and how has that turned out so far?); Kyle Janek, the chair of the Health and Human Services Commission; and of course Rick Perry himself. Good on the DMN and Reps. Howard, Burnam, and Farrar for uncovering this lie, but it’s time for everyone else to get in the game as well. Rick Perry isn’t going to care about this until he’s forced to care about it.

City pension funds make their case

This deserves more visibility than it’s gotten.

Representatives of Houston’s three employee pension boards told a Houston City Council committee Monday that the sky is not falling and pleaded with council members to be patient in examining the city’s pension obligations.

The presentations from the firefighters’ pension, the municipal employees’ pension and the police pension were organized in response to an informational presentation from the city’s chief pension executive, Craig Mason, before the same Budget and Fiscal Affairs committee last month.

Mason’s presentation had examined how the city’s liabilities would increase or decrease if the pension plans were to change their assumed investment returns, their annual cost-of-living adjustments or made other adjustments. He made no recommendations.


City Councilman Stephen Costello, chair of the budget committee, began Monday’s meeting by saying the city won’t be able to fund the pensions in the future without reform. The city’s unfunded liability stands at $2.5 billion, he said.

“This year alone we will pay $242 million in pension costs and in five years our costs will increase by another $110 million. By the year 2020 it’s projected that the contributions will be between 30 percent to 45 percent of payroll, which in my opinion as a business owner is unsustainable,” he said. “It’s obvious the city cannot sustain this rate of growth without having to cut services, lay off employees, or raise taxes. This is not a problem that is 30 years away. It’s a problem that’s within 3 to 8 years.”

Pension representatives responded that pensions are long term and stressed that the majority of retiree benefits are paid from investment returns and employee contributions, not city contributions. Cutting or threatening to cut benefits could spur waves of retirements from the city, they added, as changes to the police pension did in 2004. They noted Houston’s economy is strong and improving, and will allow the unfunded liability to be reduced over time.

Go give a listen to that interview I did with Todd Clark and Chris Gonzales of the firefighters’ pension fund if you haven’t done so, it helped me clear up some of my own confusion. I think the broad outlines of this debate are fairly well known by now, but the one factor I haven’t see discussed much is how the improved economy has affected the city’s short to medium term budget outlook. I would venture to say that if we hadn’t had the collapse of 2008 and the lean years that followed we would not have spent nearly as much time talking about pensions at any level as we’ve done. I’m very much looking forward to seeing the city’s budget numbers for this year to see how things stand now. I do think there will need to be some action taken to ensure that the city’s pension liabilities don’t become unmanageable, but I suspect there’s less we have to do now than there was a year or two ago.