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March 25th, 2019:

How would you implement Prop B?

Here, from last week, is Mayor Turner’s official announcement about layoffs, following a failure to come to an agreement with the firefighters’ union about a time frame to fully implement Prop B. Here’s the Chron story about the firefighters protesting the layoffs, which we knew were coming – indeed, we’d known since last year, as that was one of the main points Mayor Turner made during the Prop B campaign. The Chron editorial board agrees with Turner that given the limited options available, layoffs are the only reasonable choice.

Now, to be sure, there is the garbage fee proposal, which Council will vote on this week. It would, at least in theory, pay for the increased costs that Prop B imposes, though there are objections. I’ve laid some of them out – a trash fee should be used for solid waste collection, the potential for litigation is non-trivial – and I’ll add another one here: If a garbage fee is the mechanism for funding Prop B, that necessarily means that only some Houstonians are contributing to that. Anyone who doesn’t live in a house that has city of Houston solid waste service would not be subject to this fee. (At least, I assume so – it’s not clear to me how this fee will be assessed.) Maybe you think that’s a big deal and maybe you don’t, but I guarantee someone will complain about it.

So the question remains, how would you implement Prop B? We all agree Prop B will cost some money to implement. The firefighters have never put a dollar figure on it themselves – they have made claims that the fire department brings in revenues that could be spent on the fire department instead of other things, which doesn’t actually solve anything but just recapitulates the argument that the city should spend more on firefighters. Raising the property tax rate is out, as it would violate the stupid revenue cap. Indeed, as we know, the city has had to cut the tax rate multiple times in recent years, costing itself a lot of revenue in the process. The basic options are a flawed fee that will charge some households up to $300 a year and others nothing, and layoffs. And if you’re going to do layoffs, the ones that make the most sense are the firefighters themselves, as the vast majority of calls to HFD are for emergency medical services and not fires – EMTs are cheaper to hire, don’t require expensive fire trucks to get to where they’re going, and aren’t in scope of Prop B. And that, barring any late-breaking agreement to implement Prop B more slowly, is what we are going to get.

So then, what if anything would you do differently? I’m open to suggestion.

UPDATE: Here’s City Controller Chris Brown saying the cost of Prop B is unsustainable outside an agreement to phase it in over five years, which is what the city has been pushing for.

Still lots of houses at risk of flooding

This is going to take a long time to really mitigate.

A new study is raising concerns that restrictions on new construction put in place after Hurricane Harvey could leave low-income residents with fewer choices for affordable housing.

More than 475,000 people in Harris County live in multifamily units at risk of flooding, according to the study released Thursday by the Greater Houston Flood Mitigation Consortium. The group includes the University of Houston, the Kinder Institute and the Local Initiatives Support Corporation, among others. Even without the flooding risk, units are becoming less and less affordable.

“The issue of flooding and the issue of affordable housing are very connected,” said Christof Spieler, the consortium’s project manager. “We have a lot of Houstonians who are in the difficult position where the housing they can afford is the housing that puts them at risk of flooding.”

In Harris County, 26 percent of all multifamily units — buildings with two or more units — are currently located within a flood-risk area. After Harvey, Houston leaders passed an ordinance known as Chapter 19 that requires elevation for rebuilding in the flood plain. The down side, according to the consortium, is that this requirement may lead to the loss of affordable multifamily units in the floodplain.

“Chapter 19 has the best interests of people in mind, but I just don’t think that we really thought through the potential impact on multifamily units,” said study co-author Susan Rogers, the director of the University of Houston’s Community Design Resource Center. “I don’t think any of us want to encourage apartment owners to continue to renovate and put people in (apartments) clueless of what could happen to them.”

While most of the multifamily units in Houston that are being rebuilt were permitted before the ordinance took effect, researchers heard through focus groups that property owners are worried about what will happen after the next storm.

“If you’re trying to keep affordable units, but safe and not-falling-apart units, you don’t want reputable property owners to either go bankrupt and abandon their properties to the kind of ‘owner of last resort’ who will potentially not bring things back up to where they should be,” said Kyle Shelton, director of strategic partnerships at Rice University’s Kinder Institute and another of the study’s lead authors.

The press release is here, the full report is here, and Mayor Turner’s response to this report is here. All of the Consortium’s research is here if you need to read more. I don’t have much to add to this, just that if we want to make good policy decisions to fix the mistakes of the past and prevent making more of them in the future, we really need to understand the full scope of the issues. I’m glad we have this group doing that work for it.

Rideshare for Medicaid?

This could make sense.

Rep. Dade Phelan

Texas would soon start relying on Uber, Lyft and other ridesharing services to shuttle Medicaid patients to and from the doctor, if a new House bill becomes law.

The state is one of several eyeing rideshare as a way to save money and ensure Medicaid patients make it to their health care appointments. Each year an estimated 3.6 million people delay or forgo care due to lack of transportation, studies have found, leaving providers with cancellations and patients with potentially more costly medical issues in the future.

“It’s about better outcomes for patients, health care providers and, at the end of the day, much better outcomes for the taxpayers,” said state Rep. Dade Phelan, R-Beaumont, who authored the bill, HB1576.

The proposal, which has wide support in the Texas House, comes roughly a year after Uber and Lyft broke into the health care market with services that let hospitals order rides for patients. With some 4.3 million low-income residents on Medicaid, most of them children, the bill could dramatically expand the business in Texas.

The state already pays several transportation firms roughly $160 million a year to arrange free rides for Medicaid patients to visit the doctor, dentist and pharmacy. But the trips must be scheduled at least two days in advance, Phelan said.

His bill would let Medicaid managed care companies order a ride for patients who can’t give advanced notice, including those who come down with a sudden illness or are discharged from the hospital early. The legislation would also let the existing transportation firms use rideshare, in addition to their own vehicles.

[…]

Under the bill, Medicaid managed care companies would take on the responsibility of ordering rideshares for patients. The Texas Association of Health Plans, which represents many of the managed care companies, didn’t return a request for comment.

Hannah Mehta, with the group Protect TX Fragile Kids, said there’s no question the Medicaid transportation system needs improvement. A 2017 report by the Legislative Budget Board found the shifting of rides to private firms increased costs and client complaints, while decreasing access.

But Mehta is worried about handing the coordination of rideshares over to Medicaid managed care companies, which a recent Dallas Morning News series found have denied patients critical care. Mehta, whose son is covered by Medicaid, also questioned which patients would qualify and how that would be determined.

“Accessibility is a great goal,” she said. “But the devil’s in the details.”

Here’s HB1576, which as you can see has a slew of co-authors. The story notes that ensuring accessible rides for people with disabilities would be necessary; having the managed care companies in charge of arranging the rides, which would include the existing transportation companies as options, should handle that. The basic idea here is to make transportation to medical services for people who need it easier to arrange, which is something Uber and Lyft are good at, and presumably also to reduce costs. This at least sounds good in theory, but we’ll see how it develops.