As I’m sure you’re aware, I’ve been banging the drum pretty much nonstop for Medicaid expansion. I see it not only as a state issue but a county issue as well, which is why I’ve made a big deal about what Harris County is or isn’t doing about it. I haven’t seen the subject come up in Chronicle reporting on health care issues relating to Harris County, nor have I seen a news story devoted to the matter. I finally got an answer to one of my biggest questions on Sunday in the form of this Chron editorial.
Near the top of the to-do list is lessening burden of indigent health care, which costs county taxpayers close to $600 million in unreimbursed expenses annually.
Emmett, a mainstream conservative Republican, makes no bones about the solution. He says he is “full bore” for expansion of Medicaid, the federal program that addresses the health care needs of the poor and indigent. That means pressing the GOP majority in Austin to do what does not come naturally: Recognize the utter necessity of accepting federal dollars to pay for Medicaid expansion in Texas.
Emmett’s dollars-and-cents argument, borrowed from the Legislative Budget Board, is compelling: If Texas contributes $50.4 million in the next two years, he says, the state will receive $4 billion in funding from Washington in the coming biennium – and much of that is money Texans sent to the nation’s capital in the first place.
Getting relief for Harris County Jail as a dumping ground for our mentally ill is another priority. Making fuller use of the Harris County Psychiatric Center is one likely solution.
Well, that’s very good to see. I had not seen any clue about how Judge Emmett felt before that, and I think it’s fair to say that I’ve been paying close attention to the matter. Still, it’s certainly possible that there had been some reporting on it by the Chron that I’ve missed, or some reporting elsewhere. I did a search on “Emmett Medicaid expansion” in the Chron archives, both at the legacy chron.com site and the subscriber-only houstonchronicle.com site. I got three results – the editorial noted above, an unrelated story about Virginia, and this editorial from a couple of days earlier:
The problem of the uninsured in Texas is numerically daunting. More than 6 million of our fellow Texans go without insurance, including nearly 2.7 million whose incomes are between zero and 133 percent of the federal poverty level. About 800,000 are undocumented workers, but 5 million are citizens.
Community Health Choice is calling for what it describes as a “unique Texas solution” that would acknowledge the political reality in this state where federally administered registries are unacceptable.
Instead, it backs a system that would cut down on the complexity of Obamacare while matching up well with the needs of huge numbers of Texans all across the income strata.
Houston and Harris County property taxpayers have an enormous stake in the successful creation of such a program. Each year more than $500 million in county property taxes goes to fund health care expenses. This burden is dumped on local taxpayers by the refusal of the state to create a fair and equitable system.
Harris County Judge Ed Emmett, who is on the very front lines in this battle, supports the expansion of Medicaid, noting that “it doesn’t make any sense for the state not to take federal dollars.” Emmett is a mainstream Republican whose views should be heeded in Austin.
I also did a Google search on the same terms. I got the same Chron pieces, some of my own writing, a number of irrelevant matches, and on page two, this Guidry News story from last week, reporting from an H-GAC meeting:
Harris County Judge Ed Emmett discussed two issues, indigent health care and transportation funding.
“While it’s nice to say that the state’s going to stand up against Obamacare, the truth of the matter is indigents are going to get health care and it’s going to be paid for by somebody,” Emmett said. “So one of the issues – and we have no position on it yet, but something everybody needs to be aware of, particularly those at the county level – if we don’t go with Medicaid expansion then that means the local property tax(payers) are going to foot the bill for indigent health care. It’s that simple.”
I presume Judge Emmett was not using the royal “we” in that sentence but was speaking about Commissioners Court. Given all this, I think I can reasonably exonerate myself for my ignorance. And in case anyone else had been wondering about this, Judge Emmett addressed the matter directly in his State of the County 2013 speech, which he delivered yesterday. Here’s the crucial bit from the speech:
The second looming issue is health care. Harris County is home to the Texas Medical Center, arguably the greatest concentration of health care expertise in the entire world. Yet, almost with in the shadows of this institution exists a huge uninsured and underinsured population. The Harris County Hospital District has a legal and moral obligation to provide indigent health care. The best value for taxpayers and the best outcome for patients comes from establishing medical homes through neighborhood clinics. I believe we must do a better job of coordinating public and private resources to meet the health care needs of the entire county. This is not just about the health of individuals. It is critical to the health of our entire community.
With the advent of the Section 1115 waiver process, the State of Texas is taking a big step toward creating an indigent health care delivery system that crosses county lines and encourages innovative approaches.
In the debate about health care, it must be remembered that in any delivery system, someone has to pay. The Texas Hospital Association, the Texas Medical Association and even the Legislative Budget Board believe Texas should expand Medicaid coverage in order to take advantage of the federal matching funds. I agree with the health care professionals. While the political debate over the Affordable Care Act continues, poor people will continue to get sick and need care. Harris County taxpayers should not have to foot the bill while our federal tax dollars are sent to other states.
Of course, with the Legislature in session, there is one subject about which I am obsessed. Funding for mental health care must be increased at the state level, and a plan must be implemented to divert those with mental health issues from the criminal justice system. The Harris County Jail should not be the largest mental health facility in the state. The Harris County Psychiatric Center should be fully utilized, and Harris County should take the lead in developing a pilot project that will make the entire nation take notice. State Sen. Joan Huffman and members of the county legislative delegation are working on legislation to create just such a pilot project. It is shameful that Texas ranks 51st in spending for mental health. It is also wasteful of taxpayer dollars. By spending wisely on mental health, we can save much more in the criminal justice arena. Even more importantly, we can improve lives and do what is right.
I’m glad to hear it. It’s what I expected from Judge Emmett, who’s always been more about doing things than making political points. Obviously, Rick Perry doesn’t care about any of this, but I have some hope that what he’s saying here can sway a few people. It must be noted that doing the right thing carries some risk for Judge Emmett, as there’s already talk about a primary challenge to him. I rather doubt this stance will be an asset to him in such a campaign, if one materializes, but maybe it won’t be that much of a burden if the trend of Republicans coming to accept Obamacare and Medicaid expansion as the law of the land makes its way here. Maybe. In any event, I’m glad this has been cleared up. Now I hope that Commissioners Court follows the Judge’s lead and passes a resolution calling on the Lege to do its part.
UPDATE: Here’s the Chron story:
Emmett, using the bully pulpit of his sixth annual State of the County speech to the Greater Houston Partnership, drew widespread applause when he said he agrees with recommendations from the Texas Hospital Association, Texas Medical Association and Legislative Budget Board on expanding the federal health care program for the poor.
Ron Cookston, executive director of Gateway to Care, a health care education and outreach group, called Emmett’s announcement “oustanding.”
“Leaders in Fort Worth and Bexar County and other counties across Texas are beginning to step up and recognize the importance of moving forward with the expansion,” Cookston said. “That’s just huge in terms of the working poor that would have access to adequate health care resources.”
Emmett, like Perry, a Republican, said after his speech that his address was not meant as an appeal to political moderation, but to logic. No one has accused Republican governors Rick Scott of Florida, John Kasich of Ohio or Jan Brewer of Arizona of being liberals, he said, but each has decided to support Medicaid expansion.
“To me, it is conservative to spend $50 million to get $4 billion,” he said. “When things are going well, that’s when we need to spend money to make sure things keep going well in the future. If I got that across, then I accomplished my purpose.”
I’d use other words than “conservative” in that last paragraph – “sensible”, “smart”, “a no-brainer” – but whatever works for you is fine by me. It’s just unfortunate that none of these words have any meaning to Rick Perry.