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May 2nd, 2013:

If Medicaid is broken, who broke it?

Patricia Kilday Hart asks an excellent question.

It's constitutional - deal with it

It’s constitutional – deal with it

[Rep. Garnet] Coleman’s observation provides part of the answer: Just last session, the Legislature trimmed $486 million in state money paid to Medicaid providers, and ended a student loan-forgiveness program for new doctors exclusively serving Medicaid patients.

The federal government, which has established some rules that restrict the state’s ability to rein in costs, also bears some responsibility.

For example, the federal government will not allow states to charge even small co-pays, which could discourage overuse of services.

In 2009, the Texas Medicaid program paid $467 million for almost 2.5 million emergency room visits – but half of those visits were not emergencies, according to Stephanie Goodman, communications director for the Health and Human Services Commission.

“Private insurance plans typically charge a higher co-pay for an emergency room visit than for going to a doctor’s office because they want to create an incentive to choose the right level of care for the situation,” she said. “Medicaid should do the same.”

[…]

Medicaid has kept its costs down better than other sectors of the health care system. On a per-beneficiary basis, the program’s costs grew only 4.6 percent between 2000 and 2009, compared with a 5.1 percent increase in Medicare and a 7.2 percent increase in costs for patients covered by private insurance, according to the national Center for Budget and Policy Priorities, which focuses on policies affecting low-income families.

“Medicaid is the victim of Swift-boating,” said Anne Dunkelberg, analyst for the Austin-based Center for Public Policy Priorities, referring to the political ad campaign that torpedoed Sen. John Kerry’s 2004 presidential bid. “It is the power of the talking point that is repeated so often that people believe it.”

Medicaid is spending less per recipient today than in 2001, Dunkelberg says. The program’s bigger footprint can be traced to demographics, not overuse, she argued. Texas accounts for half the increase in children in the U.S., says the census, and most of them are poor.

The point about the reimbursement rates being set by the Legislature has been made before, but can’t be made often enough. If you don’t maintain your car, you have no business complaining when it craps out on you. Given the flexibility that the federal government has already shown Florida and Arkansas, there’s no question that co-pays will be allowed – Rep. Coleman has been talking about that, and some other items on Texas’ wish list, all along. The rest is up to us. And please note, if we really cared about controlling costs we’d be all over the Medicaid option. There’s no reason at all to believe that the private insurance way – the Arkansas option – will be less expensive. At the end of the day, if we don’t expand access to health care, via Medicaid or some convoluted not-Medicaid process, it will be because the Republicans chose not to, not because it didn’t make sense not to do so. Burka has more.

Payday lending prospects look grim in the House

From the Observer:

Late into the night on Monday, the payday loan industry strutted its stuff before a very friendly House committee. The hearing came just a week after the Senate passed a surprisingly tough bill that the industry insists would shut down most of Texas’ 3,400 payday and auto-title storefronts. Even though the legislation aired last night is a faint shadow of the Senate bill, it got a rough treatment from six of the seven committee members.

Only the chairman and author of the bill, Rep. Mike Villarreal (D-San Antonio) evidenced any interest in cracking down on the industry.

“I think the tone of the committee was that clearly there was no support for what Villarreal put out there, at least right now,” said Ann Baddour of Texas Appleseed.

What happens next is anyone’s guess but it is possible that payday reform is dead for the session.

[…]

Villarreal’s bill is considered by consumer groups to be a minimalist reform effort. The Senate version would close a loophole that allows payday and title lenders to get around Texas’ anti-usury laws and charge unlimited rates. Instead it would impose a strict 36 percent APR cap on loans, effectively scuttling the business model in Texas. The Villarreal proposal, which focuses on limiting the number of “rollovers” and imposes modest limits on the size of loans based on borrower income, has only received tepid support from consumer groups.

The wording here is a little confusing. Rep. Villarreal has his own bill, HB2706, which was heard in committee on April 22 and which is pending in committee. I believe this bill is similar to the pre-amendment version of Sen. Carona bill, which is SB1247. That now-tougher bill, which passed the Senate last week, is what Rep. Villarreal brought up in committee this Monday. Rep. Villarreal is the chair of the Investments & Financial Services committee, but only one other member of the committee is a Democrat, and two of the Republicans are quoted in the story giving rhetorical foot massages to the payday lenders and the curious notion that their lightly regulated existence is necessary for truth, justice, and the American way. As the man said, you don’t need to be a weatherman to know which way the wind blows.

What happens next is impossible to predict but billions in revenues hang in the balance.

Daniel Freehan, the CEO of Cash America International, acknowledged as much on a conference call with analysts last week.

“Dozens of different scenarios could unfold at this point that run the gamut of this bill never getting out of the House committee, to a bill that passes the House in identical form of Senate Bill 1247. In between these two extremes are multiple permutations that could develop, and it’s impossible to predict how this may unfold with any reasonable degree of confidence.”

A worst-case scenario from the point of view of the reformers is legislation that would strike down city ordinances but not add any new statewide regulations. One such pre-emption only bill, House Bill 2953 by Rep. Ryan Guillen (D-Rio Grande City), is already headed to the House floor.

Last night, Rob Norcross of the Consumer Services Alliance of Texas, a group that represents 80 percent of all the payday and title storefronts in Texas, tried to play down the pre-emption issue, saying that he believed the industry would prevail in its court. But there’s no doubt that ordinances passed in Austin, Dallas, San Antonio, El Paso and Denton are cutting into profits. In January, Mark Kuchenrithe, the CFO of Austin-based EZCorp, told analysts that the company’s “profitability… was negatively impacted by over $1 million” during the last quarter of 2012 “as a result of ordinances enacted in Dallas and Austin.”

Here’s HB2953. Far better that nothing passes than this does. I’m okay with rolling the dice in the courts if it comes down to it. BOR has more.

UPDATE: The Trib adds on.

The Houston Hackathon

From the Mayor’s office:

Mayor Annise Parker

Mayor Annise Parker

Houston Mayor Annise Parker today announced the City of Houston will host a 24-hour “Open Innovation Hackathon” on May 17-18 at the Houston Technology Center and at Start Houston. A hackathon is a day-long event in which software developers, designers, and data analysts collaborate intensively on data and software projects. Over 24 hours, Houston’s “civic hackers” will pitch ideas, form teams and develop innovative new websites, mobile apps, and insightful data visualizations to address community and city problems.

“Houston leads the nation in science, technology, engineering and math (STEM) job growth, and we want to leverage local talent to produce outcomes,” Mayor Parker said.  “Everyone involved has worked very hard to define high-impact projects that solve our problems and that can be completed in 24 hours.  We want to use the applications and insights that are created at the Hackathon as soon as possible.”

Mayor Parker also announced the launch of the City’s Open Data Initiative, a program that puts public city data in the hands of citizens. The open data originating from dozens of city systems will be critical for the civic hackers in using technology to build tech solutions that solve city problems.

“We’re really excited that Houston is taking this historic step toward liberating data,” said City Council Member and Hackathon Co-Chair Ed Gonzalez.  “Hackathons are a great way to engage citizens and start a dialogue between City officials and our talented analytical and software developer communities.”

Preparation for this initiative and the Hackathon involves publishing data on a publicly accessible website.  Over the last three months, the City has identified more than 25 “weekend projects” that a team of software developers, designers, analysts and others could reasonably complete, ranging from a Houston bike app that displays all bike lanes, trails, B-Cycle kiosks, and bike shops to dashboards that show citizens how the city is performing and where it can do better.

While Houston’s Open Data Initiative is modeled after programs in New York, San Francisco, Austin, and Palo Alto, Houston will also include a STEM outreach component designed to teach children across the city about career options.  “Sometimes, just talking to a successful software developer can inspire a child to pursue a career in technology,” Council Member Gonzalez said.

The city is expecting strong turnout from citizens, corporate participants, and members of Houston’s startup communities.

More information, including some sample projects and the form to enter, is here. The open data portal on which these and other apps will be built is here, though it appears to be not quite finished yet. Making this kind of data publicly available, and in a standard format, is the key. It should spur innovation even in the absence of a hackathon, though that’s a pretty good way to kick things off. I’m especially delighted to see the shoutout about bike maps, since I have whined before about how crappy the current maps are. I look forward to seeing what comes out of this.

Texas blog roundup for the week of April 29

The Texas Progressive Alliance would have gotten rid of the entire sequester, not just the part that inconvenienced the few, as it brings you this week’s roundup.

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Have your say on the Uptown/Memorial Park TIRZ

From the inbox, and the office of CM Oliver Pennington:

CM Oliver Pennington

CM Oliver Pennington

To the Residents of District G:

As many of you are aware, the May 1, 2013, Council Agenda contained several items related to the Reinvestment Zone Number Sixteen (Uptown Zone), also known as TIRZ 16. Included on the agenda today were Items 15 (enlarging the TIRZ boundaries), 15a (extending the duration of the TIRZ), 15b (authorizing the issuance of bonds by the TIRZ) and 15-1 (adding land to the Harris County Improvement District No. 1, also known as the Uptown Management District). Those Agenda Items, and the back-up provided by the administration, can be viewed at this link: http://www.houstontx.gov/citysec/backup/2013/043013.pdf

At the City Council Meeting this morning, Council Member Pennington made a successful motion to delay further consideration of these 4 agenda items for two weeks so that these matters can be presented to and discussed at a Committee Meeting. That will allow the public to fully learn the plans relating to the Post Oak METRO project and the re-forestation of Memorial Park.

There will be a presentation regarding TIRZ 16 at the Budget & Fiscal Affairs Committee Meeting on Tuesday, May 7, 2013, at 10:00 A.M. The Public is invited to attend and there will be an opportunity for all concerned citizens to speak at the meeting. The meeting will be held in Council Chambers, located at City Hall, 901 Bagby, 2nd Floor, Houston, TX 77002.

So if you share Lisa Falkenberg’s concerns about this TIRZ, here’s your chance to put them on the record. You might even suggest some ways that your concerns could be addressed. If you can’t make it to this meeting, my advice is to send an email to Mayor Parker and the members of the Budget and Fiscal Affairs Committee with your feedback. You can find Council member contact information here. As they say, speak now or forever hold your peace.