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Don’t believe anything the TPPF has to say about the Affordable Care Act

With the exception of some things they have to say about criminal justice, you shouldn’t believe anything the Texas Public Policy Foundation has to say, full stop. You especially shouldn’t believe anything they have to say about the Affordable Care Act.

It's constitutional - deal with it

It’s constitutional – deal with it

The Affordable Care Act will increase the average cost of insurance premiums, making health care less affordable for those Texans on whom the system financially depends, according to a report from a conservative think tank.

The report, released Monday by the Texas Public Policy Foundation, says premiums for health insurance plans will increase for young, healthy Texans under the Affordable Care Act, also known as Obamacare. The health care law requires private insurers to cover essential health benefits and establishes a federal marketplace for insurers to sell coverage plans, among other requirements.

The report concludes that premiums will be on average “significantly higher than coverage available on the individual market in Texas prior to the ACA.” Nonetheless, it concedes that comparing pre- and post-ACA health care plans “presents some difficulties” because of the costs associated with mandating that health plans cover essential benefits, and because the impact on individuals will vary depending on age, gender, location and other factors.

As an example, the report highlights changes in premiums for catastrophic plans for young people living in metropolitan areas. Catastrophic plans have lower premiums than comprehensive plans but provide protection only from worst-case scenarios. John Davidson, the report’s author, said those plans are the most attractive to young, healthy Texans, and that they operate “the most like insurance” of any health care plan in the insurance marketplace.

“For a 27-year-old, non-smoking male in Austin, low-cost catastrophic plans on the exchange, which are available only to those under 30 or those with low incomes who qualify, will be on average 84 percent more expensive than pre-ACA catastrophic plans,” the report found.

There is, and there has been, a lot of misinformation about the Affordable Care Act, going back well before its passage in 2010. Some of that is due to bad or just credulous reporting, and some of it – a lot of it – is due to misinformation being propagated by opponents of the law. This falls into the latter category, in which cherry-picking of information is spun into a greater whole that is not at all the sum of its parts. Catastrophic plans are cheap because they don’t actually cover anything other than a catastrophe. Even the low-end “bronze” plans in the exchanges will likely cost more up front than catastrophic plans because they do provide coverage of things that even young and healthy people might need. It wouldn’t be hard to make up the cost of the increased premiums if one is a bit unlucky.

Beyond that, it’s important to remember that a cornerstone of the ACA is that people can no longer be denied coverage for “pre-existing conditions”, or for whatever other reason an insurer might not want to deal with you. Millions of people were routinely denied coverage pre-ACA. I know some of these people – they’re friends, family, classmates, neighbors. Maybe no one at the TPPF knows any of these people. More likely, they don’t care about them, since they’ve been working for years to prevent them from getting access to health care. That for sure goes way beyond the Obamacare debate – Texas didn’t become #1 in uninsured population overnight, after all.

“The success of the program is really contingent on young, healthy adults being able to broaden the risk pool and pay premiums to allow them to be more affordable for the older, sicker populations,” said David Gonzales, executive director of the Texas Association of Health Plans.

But Gonzales was hesitant to draw comparisons between pre- and post-ACA coverage. Asked whether rates had gone up, he said, “Unless you’re comparing apples and apples, it’s hard to really know.”

There’s no reason to expect a partisan outfit like the TPPF to take the care to ensure they are doing fair comparisons That’s not their mission. It is true that some people will wind up paying more under the ACA than before, for roughly equivalent coverage. Some of those people had been getting a huge break that the rest of us were paying for. I’m glad they’re paying more now. If the TPPF wants to advocate for them, that’s fine by me. Let’s all just be clear on what exactly it is they would like to see happen. Wonkblog and Better Texas Blog have more.

Another way the Affordable Care Act will benefit Texans

Thousands of people in the high-risk pool will get better coverage at lower prices, thanks to Obamacare.

It's constitutional - deal with it

It’s constitutional – deal with it

At year’s end, Texas will shut down its high-risk insurance pool for some of the state’s sickest residents, pushing participants to find private coverage in the federal health insurance marketplace created under the federal Affordable Care Act. And patient advocates say those participants should focus on making the transition sooner rather than later to ensure that they don’t experience a lapse in coverage or lose access to current health care providers and services.

“Pool policyholders who are in the middle of treatment will especially need to be sure the network offered by their replacement health plan includes their treatment team,” Steven Browning, executive director of the Texas Health Insurance Pool, said in an email.

The high-risk pool is financed mainly by patient premiums and assessments paid by health insurance companies and HMOs, along with some funding from federal grant programs. Since 1998, it has provided high-priced coverage to Texans with pre-existing conditions who can’t find coverage elsewhere. The state has deemed the high-risk pool obsolete, as the Affordable Care Act prohibits insurance companies participating in the federal marketplace, which launched on Oct. 1, from denying coverage to Texans with pre-existing conditions. Gov. Rick Perry signed Senate Bill 1367 in June, scheduling the pool’s abolishment.

The pool will close Jan. 1, and the 23,000 people currently participating in the pool must sign up for coverage on the insurance exchange by Dec. 15 or find coverage elsewhere to avoid a lapse in care.

[…]

With many of the health plan options in the federal marketplace being cheaper than the high-risk pool and covering additional benefits, Stacey Pogue, a senior policy analyst for the left-leaning Center for Public Policy Priorities, said the situation presents an opportunity for Texans in the pool.

“I think that people are going to have many more options and many better options in the marketplace than they do in the health pool today,” Pogue said. “There is not going to be a person who will be better off financially outside the pool than they would be if the pool stayed open.”

As a condition of the pool, Texans generally pay twice the market rate for coverage, said Pogue. They’ll probably see their health care costs halved in the marketplace, she said, because insurers aren’t allowed to charge people with pre-existing conditions more than other consumers. The marketplace also offers tax credits to help purchase a health plan to everyone who makes 100 percent to 400 percent of the federal poverty line — $11,490 to $45,960 annual income for an individual or $22,550 to $94,200 for a family of four.

Pogue said health plans offered in the federal marketplace could also raise the level of care patients receive, as they must cover “essential health benefits,” some of which, such as maternity care, aren’t covered in the pool.

She doesn’t expect there to be major issues with people meeting the Dec. 15 deadline either, she said, because many high-risk pool policyholders have health conditions that require them to deal with their health insurance on a consistent basis and are more likely to interact with their health care provider.

Remember, if Ted Cruz had his way, all of these people would be worse off today. Note that since the high-risk pool has been shut down, they wouldn’t be able to get any coverage at all if the “defund Obamacare” hostage-taking had succeeded. Given that in the end, every Texas Republican voted against the debt ceiling/CR deal, you can plausibly state that every single Texas Republican in Congress voted to take health insurance away from each of these 23,000 people. Note to Wendy Davis, Battleground Texas, et al: You really need to make sure you reach out to each of these people and let them know that. ThinkProgress and Juanita have more.

An awful lot of people tried to sign up for insurance exchanges on Tuesday

That’s a very good thing, even if technical difficulties prevented many of them from completing the job.

It's constitutional - deal with it

It’s constitutional – deal with it

On the first day of sign-ups for President Barack Obama’s health care reform, a wave of consumers across the nation, including many Texans, sought Tuesday to enroll in online health care marketplaces, but glitches with the federal website prevented them from obtaining information about coverage plans and rates.

“I wanted to get in and see what my options are to get signed up,” said Suezen Salinas, 31, who sought help at Legacy Community Health Services in Houston. “Apparently, there are a few glitches in the system, so it’s not letting us get past a certain place to be able to set up my profile and begin.” Salinas described herself as “disappointed, but I’m still excited.”

By midafternoon the Obama administration sought to quell the complaints from across the country.

Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, contended problems were resolved and that consumers were, in fact, able to enroll. But during a telephone conference with reporters she refused to disclose a number, saying “we decided not to release that yet.”

Tavenner said 2.8 million people visited the federal healthcare.gov website since it opened Tuesday morning, but that it was unclear how many of those were repeat users.

“This is day one of a six-month process,” Tavenner noted, adding that people have until March 31 to enroll for insurance. Those who enroll by Dec. 15 will begin coverage on Jan. 1.

As the story notes, five times more than have ever been on the Medicare.gov website at one time were on healthcare.gov trying to use the exchanges. That’s truly incredible, and speaks very loudly to the deep, abiding need for this service. Just imagine for a minute how many more people could be getting coverage right now if the Republican Party hadn’t been engaged in a four year jihad to sabotage and undermine it at every step.

The Trib has a report that was updated a couple of times during the day that reported on some of the experiences folks had in Texas. This bit from their most recent update was really annoying to read.

The Brownsville Community Health Center had 50 people show up on Tuesday ready to sign up for health coverage — many even brought pay stubs and income documentation — but not a single one of them had an email address.

“If you don’t include an email address, they won’t let you through,” said Christela Gomez, the special projects coordinator and lead certification application counselor at the center. Although the center considered helping people sign up for an email account, Gomez said many weren’t comfortable with the idea because they did not have a computer to access the email address later. “Quite a few didn’t even know what an email address was,” she added.

The center’s certified application counselors helped the patients fill out paper applications, but they’ll have to wait for a written response from the federal government to find out whether additional documentation is needed or whether those applicants qualify for tax credits.

Some of the questions on the paper application were difficult for patients to answer, said Gomez. One man who came in to receive assistance finding health coverage currently works as a truck driver, she said. He earns 30 cents per mile, and his income can range from $50 to $100 a week.

“We didn’t really know how to fill in the income part with him,” she said, adding, “We kind of just wrote it in on the side, his situation.”

Paula Gomez, the executive director of the center, said her patients are mostly adults who are too young to qualify for Medicare. Although most of her patients have jobs, pay taxes and want to cooperate with the health care system, there are extenuating circumstances like language barriers that make it difficult.

“I’m sure there are pockets like ours all over the country,” Gomez said. She added that the federal government should be more flexible and consider the different situations people are facing across the country. “They think in terms of everything that’s going on in Washington, D.C., but they don’t look at the reality of the rest of the world in the United States,” she said.

You know what might have addressed that problem? If the state of Texas had created its own exchange, since the whole idea behind state-based exchanges was that local folks would know their interests and their population better than a bunch of distant bureaucrats in DC. If we lived in a state whose leaders cared about its people, that’s what we would have gotten. Instead, we’re stuck with the likes of Rick Perry, David Dewhurst, Greg Abbott, and the like, and this is the result. The fact that we’re using the federal exchanges here in Texas doesn’t mean that people won’t get signed up, and it doesn’t mean that they won’t be able to buy quality plans. But the experience could have been better, and it could have been more Texas-oriented, if Perry et al gave a damn. I understand politics, and I get doing what you can to screw your enemies. I don’t get screwing your own people.

Perry keeps asking for the same Medicaid waiver he hasn’t gotten in the past

Same as it ever was.

Corndogs make bad news go down easier

Free corndogs with every approved treatment!

Gov. Rick Perry is preparing for yet another battle in his war against Obamacare.

In a letter to the state’s health agency on Monday, the governor laid out his plan to request a federal waiver to reform Medicaid as Texas sees fit — without expanding eligibility.

“Seemingly, the president and his administration are content to simply throw money at a problem and hope that any problems will resolve themselves,” Perry wrote in a Monday letter to Kyle Janek, the executive commissioner of Texas’ Health and Human Services Commission. “My response, and the response of the Texas Legislature, has been crystal clear: Texas will not expand Medicaid under Obamacare.”

Instead, Perry has asked that the agency request flexibility in the form of a block grant — a fixed amount of money, rather than matching dollars for Medicaid services — from the federal government to fundamentally reform Medicaid. Specifically, Perry requested that the agency seek a waiver that allows the state to make changes to the program without receiving federal approval, continue asset and resource testing to determine eligibility, and initiate cost-sharing initiatives, such as co-payments, premiums and deductibles, among other reforms.

The waiver “should give Texas the flexibility to transform our program into one that encourages personal responsibility, reduces dependence on the government, reins in program cost growth and efficiently improves coordination of care,” Perry wrote.

[…]

In a second letter sent to HHSC on Monday, Perry requested that the agency develop a mechanism to continue collecting and analyzing income, asset and resource information on Texans who apply for Medicaid benefits. That’s despite a provision in the Affordable Care Act — one that takes effect on Jan. 1 — that requires the state to stop asset testing to determine Medicaid eligibility.

A copy of the letter requesting the block grant is here, and a copy of the letter on asset testing is here. Texas has been asking for a Medicaid block grant since at least 2008, when the Bush administration rejected the request. Perry knows full well what the answer will be, he’s just going through the motions out of spite and the continued delusion that he’ll be appealing to Iowa voters in 2016. If the CMS assigned me the task of writing the response, I’d start out by noting that in any negotiation, there must be good faith and a willingness to give something to get something. As the primary purpose of block granting Medicaid is the limit services, and the primary purpose of the Affordable Care Act is to enroll more people in health insurance plans, Perry’s proposal demonstrates neither of those things. Just this week, we’ve seen two examples of other Republican governors agreeing to expand Medicaid. They both wrung some concessions out of the feds in doing so, but the end result will be more people getting access to health care. And Lord knows, we need a commitment to providing access to health care in Texas.

Texas continued to have the highest rate of people without health insurance in 2012 at 24.6 percent, according to the Current Population Survey estimates released by the U.S. Census Bureau on Tuesday.

“Texas has often had the highest uninsured rate throughout the country,” said David Johnson, chief of the Census Bureau’s Social, Economic and Housing Statistics Division. He added that additional data from the American Community Survey that the Census Bureau plans to release later this week would provide more specific information on health insurance rates in states and metropolitan areas.

The Current Population Survey estimates revealed that the national uninsured rate declined in 2012, to 15.4 percent from 15.7 percent in 2011. The national real median income and official poverty rate were not statistically different in 2011 and 2012, according to the estimates.

Thanks to the insurance exchanges and the ACA subsidies, Texas’ unacceptably high level of uninsured people will decline, though as always Perry is doing everything he can to keep as many Texans as possible sick and unable to do anything about it. Perry and his fellow Republicans just don’t give a damn about the problem. Until they do, I see no reason for the feds to waste any time on these pointless requests.

The obstacles to enrollment

The Affordable Care Act could have a big effect in Houston if the people who would benefit by it can be informed about it and assisted as needed.

It's constitutional - deal with it

It’s constitutional – deal with it

Houston, with an estimated 800,000 uninsured residents, ranks among the nation’s largest cities with the highest number of working poor residents – many of whom could be eligible for health coverage under the Affordable Care Act.

Federal officials, lawmakers and community organizers say Houston is fertile ground to sign up the poor and uninsured as insurance marketplaces open Oct. 1 for enrollments.

Yet it’s unclear how the three nonprofit agencies charged with identifying, educating and enrolling uninsured Houstonians will reach so many people. The agencies, which recently were awarded a total of about $7 million in federal grants, will hire and train navigators and subcontractors to guide the state’s 4.8 million uninsured residents through enrollment.

“It’s important to have the community engaged,” said Marjorie Petty, a regional director of the U.S. Health and Human Services Department whose area includes Texas. She spoke this week at a community meeting held by U.S. Rep. Gene Green, D-Houston,

The groups awarded federal funds are Houston’s Change Happens, the United Way of Tarrant County in Fort Worth and the New York City-based National Urban League. They are to assist uninsured residents in signing up for insurance coverage, which takes effect Jan. 1.

However, health economist Vivian Ho said she doesn’t believe organizations that received grants will have enough money to provide the assistance that uninsured residents need to understand what’s available to them under the health law. Ho is the James A. Baker III Institute health economics chair and an economics department professor at Rice University.

“It’s not even close,” Ho said of the grant awards.

“It’s going to take several hours to guide each person through the process,” she speculated. “It’s very disappointing.”

There are numerous organizations working hard to publicize the exchanges. One public information session at UH over the weekend drew several hundred people. There is some federal money to help with these efforts and for advertising. Against that you have the denialism and obstruction of the state government and Republican Congress. I think in the end a lot of people will get signed up, but not nearly as many as could have been. And every illness, every death, and every bankruptcy that happens to a could-have-been-but-wasn’t-covered person will be on those that worked against them getting coverage.

Pertussis

Not good.

State health officials warn that Texas is on track to see the highest number of whooping cough cases it has registered in 50 years if occurrences of the disease continue at the current rate.

As of this week, Texas has reported 1,670 cases of pertussis, better known as whooping cough, to the Centers for Disease Control and Prevention. The Texas Department of State Health Services stresses that the disease is serious, especially in young children.

Two whooping cough deaths have been reported this year in the state – children too young to be vaccinated, according to the department’s website. Thirteen percent of the whooping cough cases have required hospitalizations, with almost all of them involving infants younger than 1 year old.

Babies are especially vulnerable to the infection because they don’t have full protection against it until they’re 6 months old, when they receive the last of three shots.

Dr. Robert Lapus, pediatric emergency services director at Children’s Memorial Hermann Hospital, said two infants suffering from whooping cough recently were admitted to the hospital. Both were younger than 6 months.

[…]

The disease was common, with hundreds of thousands of cases reported annually, until the 1940s when the vaccine was introduced. For about 25 years, fewer than 5,000 cases were reported annually in the United States. The numbers started to climb again in the 1990s.

The Centers for Disease Control reports there were 159 whooping cough deaths in the United States from 2004 to 2011. Almost all the deaths – 141 of the 159 – were babies younger than 3 months old.

More than 41,000 cases were reported across the country in 2012, with 18 deaths. In Texas, there were 2,218 cases, with 159 in Harris County, 32 in Montgomery County, 12 in Fort Bend County and 10 in Galveston County.

As the story notes, low vaccination rates and higher infection rates are a national problem. As that CDC link suggests, the Affordable Care Act ought to help, since more people will be able to get primary care, which of course includes vaccinations. The bottom line is that we all need to be aware of these things. The vaccinations we got as kids don’t last forever. It’s a good idea to check and see what shots you may need now.

None dare call it Obamacare

You’ve probably seen the Politico story by now.

It's constitutional - deal with it

It’s constitutional – deal with it

Gov. Rick Perry wants to kill Obamacare dead, but Texas health officials are in talks with the Obama administration about accepting an estimated $100 million available through the health law to care for the elderly and disabled, POLITICO has learned.

Perry health aides are negotiating with the Obama administration on the terms of an optional Obamacare program that would allow Texas to claim stepped-up Medicaid funding for the care of people with disabilities.

The so-called Community First Choice program aims to enhance the quality of services available to the disabled and elderly in their homes or communities. Similar approaches have had bipartisan support around the country. About 12,000 Texans are expected to benefit in the first year of the program.

One line of thinking as to why the Texas governor, who has honed his national image in no small measure by denouncing Obamacare, would make such a seemingly inconsistent move goes like this: Treating disabled and elderly people is less politically charged than a sweeping national law forcing people to buy health insurance. Perry recently decided against seeking reelection next year but is mulling a second presidential bid in 2016.

[…]

The Texas Legislature approved the program earlier this year, and Perry signed it into law as part of a larger package of health reforms, as well as in the state budget. Now, his administration is working win approval from the Obama administration to fit the program into the state’s existing Medicaid framework.

“Efforts are under way to develop and submit an application to the Centers for Medicare and Medicaid Services for participation,” said a spokeswoman for the Texas Department of Aging and Disability Services. The goal is to implement the initiative by Sept. 1, 2014.

Supporters of home care contacted by POLITICO worried that even a news story about the connection between the Community First Choice program and Obamacare would spook the Perry administration from participating.

“[I]t would be worse than a shame if Texas’s moving ahead with CFC or BIP policies — both are from the ACA — was hurt as the result of scrutiny from a press inquiry,” said one Texas-based advocate.

Added another local advocate, “I would hate for the CFC to become a political football.”

An official with a prominent national advocacy group noted that Texas isn’t the only resistant state to quietly accept some lower-profile components of the health law. Louisiana, Mississippi, Georgia, Maine and others have already been approved for 2 percentage point increases in their Medicaid fund through a little-known provisions of the health law, the advocate said.

“I think some of those [provisions] are easier because they’re not as high profile and people don’t connect home and community services with Medicaid,” according to the advocate.

There’s been a lot of other reporting on this, plus some snarky commentary. However, I don’t think anyone put it better than Ezra Klein.

Remember Peggy Noonan’s “This is the reason many people don’t like ObamaCare”? The “this” in question was the Community First Choice program, which helps Medicaid cover at-home care for the disabled rather than shunting them into institutions.

The program is so irresistible that even Texas Gov. Rick Perry is asking if his state can be part of it. And you don’t get Obamacare haters more diehard than Perry. But for that exact reason, his office is saying the program, which is literally part of the Affordable Care Act’s statute and which would cease to exist if the entire law was repealed, “has nothing to do with Obamacare.”

To be generous to both sides, Noonan didn’t seem to understand the program she was criticizing, and she relied on other people’s reporting that turned out to be wrong, or at least confused. As for Perry, he can argue that Community First Choice program isn’t related to Obamacare’s core coverage expansion, which is really what people think of when they hear the word “Obamacare”.

But the result is the same: you’ve got Noonan saying that the Community First Choice program is the reason people hate Obamacare even though she seems to want something exactly like the CFC program to exist. You’ve got Perry asking the Obama administration for $100 million from a program created as part of Obamacare even as he swears the program isn’t Obamacare.

It’s almost as if there’s much in the law that Republicans would like if only they felt able to give the legislation a chance.

Yes, well, funny how these things work. As Paul Burka likes to say, we don’t have policy in this state, we have ideology. Rick Perry has to BS about this, he has no choice. It’s hilarious hearing him brag about how he’s been making Medicaid better and didn’t need any stinking Obamacare to do it. Given his pathetic record on health care in Texas, it’s a little like the Astros bragging about having quality middle relief pitching. Honestly, I don’t know why anyone would ever believe a word Rick Perry says. But given the state of things in our great state, what’s a few more lies and denials of reality by Rick Perry if that’s what it takes to make things a little better?

Feds provide money to help sign people up for the exchanges

Every little bit helps.

It's constitutional - deal with it

It’s constitutional – deal with it

With the rollout of many Affordable Care Act provisions fast approaching, the federal government announced Thursday that eight Texas organizations will receive a combined $10.8 million to hire and train “navigators” to help uninsured Texans find health coverage.

“Navigators will be among the many resources available to help consumers understand their coverage options in the marketplace,” U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement. “A network of volunteers on the ground in every state – health care providers, business leaders, faith leaders, community groups, advocates and local elected officials — can help spread the word and encourage their neighbors to get enrolled.”

Along with many other provisions in President Obama’s signature health reform law, the individual mandate to purchase health insurance is set to take effect on Jan. 1. Individuals who land somewhere between 100 and 400 percent of the federal poverty line will be able to apply for sliding-scale subsidies through state health insurance exchanges that the federal government plans to launch on Oct. 1. The health plans offered in the exchange will become active on Jan. 1.

United Way of Tarrant County — in collaboration with 17 other organizations — will receive $5.8 million, the largest of the federal navigator grants awarded in Texas, to help enroll Texans in health plans offered through the federal health insurance exchange (Texas opted not to devise its own state-run exchange). The East Texas Behavioral Healthcare Network will receive $1.3 million, the second largest grant, and six additional organizations will each receive between $376,800 and $785,000. In total, the federal government awarded $67 million to more than 100 organizations across the country. View the full list here.

This is going on across the country, with big non-Medicaid-expanding states like Texas and Florida getting the bulk of the funds. Apparently, in some parts of the country Planned Parenthood was a grant recipient to help people navigate the exchanges. Can you imagine the caterwauling there would have been here if Planned Parenthood had gotten some of that cash? If only.

Not that there wasn’t some pathetic whining, mind you:

Texas Attorney General Greg Abbott and 12 other states’ attorney generals have raised concerns that the federal navigator program could pose risks to patients’ privacy. In a letter sent to Sebelius on Wednesday, the state attorney generals assert that the federal government’s screening process does not require uniform background or fingerprint checks, therefore convicted criminals or identity thieves could become navigators. They also expressed concerns that navigators would not undergo sufficient training.

“We take very seriously the privacy of our states’ consumers and believe that your agency’s current guidance regarding these groups suffers numerous deficiencies,” the attorney generals wrote in the letter.

Some medical professionals and advocates have raised objections to the attorney generals’ concerns, suggesting they are politically motivated. They say navigators must comply with state and federal laws governing the privacy of sensitive medical information. If they do not adhere to strict security and privacy standards, including how to handle and safeguard consumers’ social security numbers and identifiable information, they are subject to criminal and civil penalties at both the federal and state level. The federal government imposes up to a $25,000 civil penalty for violating its privacy and security standards.

“Officials from Texas and the other states that are involved keep trying to sow doubt about the Affordable Care Act, but the law is well on its way to helping millions of our nation’s uninsured receive the health care they need,” Katrina Mendiola, executive director of Engage Texas, said in a statement released by the Texas Well and Healthy Campaign. “What Texans need to know is there will be experts — who are screened and authorized to help — ready to help them find out about their health care options and get enrolled on October 1.”

You know what would have been an excellent solution to that concern about privacy? Texas creating and managing its own insurance exchange, instead of petulantly outsourcing it to the feds because our Republican leaders refuse to lift a finger to help anyone who doesn’t have health insurance. Too bad about that, no? Oh, and Greg Abbott really ought to deal with the mote in his own eye before he goes complaining about someone else’s ability to protect personal data. Trail Blazers has more.

More on Abbott and his lawsuit settlement

I have three things to say about this.

Still not Greg Abbott

When Greg Abbott’s spine was crushed by a falling oak tree in 1984 he had no health insurance, no paycheck and no feeling in his legs.

But he had a good lawyer and, back then, access to a civil justice system that was generally hospitable toward plaintiffs. So Abbott did what many people would do in his situation: he sued.

Nearly 30 years later, as Texas attorney general and the leading candidate for governor, Abbott is facing new questions about the multimillion-dollar settlement he was awarded and about his advocacy of laws that critics say have tilted the judicial scales toward civil defendants.

Those critics, generally Democrats who oppose the Republican-backed lawsuit curbs, say the policies Abbott has fiercely promoted over his career as a judge and elected official make it virtually impossible for a plaintiff to win the kind of award he got.

“You would think that a young man, at the start of his career, crippled by an injury, would want to make sure that others that may have the misfortune to follow in his footsteps would ensure that those people had the opportunity to be compensated for their injuries in the same way he was,” said Tommy Fibich, a Democratic donor and personal injury lawyer. “He instead closed the door because that would help him get re-elected.”

Abbott said the reforms he had backed and helped cement in court rulings had been necessary to curb a rash of frivolous lawsuits. But he said the changes would not affect people like him.

“If there were someone jogging today, got hit by a tree today, suffered the same kind of accident today, they would have access to the very same remedies I had access to,” he said.

“Our legal system was abused in this state,” he continued. “There were many invalid claims that were filed in court, that clogged up the courts, that either denied or delayed access for people who had valid claims.”

Tort laws have changed drastically since Abbott’s accident, adding hurdles for people who sue for personal injuries and making it harder for them to win large sums. But there is disagreement about whether Abbott could receive a similar settlement today.

[…]

Charles M. Silver, a professor at the University of Texas at Austin School of Law and co-author of the study that disputed claims made by proponents of medical malpractice caps, said changes in personal injury law and a “pro-defendant” posture in the judicial branch made such a large financial settlement substantially less likely.

“Today that would be an extraordinarily high recovery,” Silver said. “It would be harder to get that type of award today.”

1. I had previously suggested that Abbott must have had health insurance when he suffered his injury. Apparently I was wrong about that. But I was still right that he never faced any dire financial problems as a result of his injury.

2. Be that as it may, the main point is still that Abbott utterly lacks empathy for anyone unfortunate enough to be in similar circumstances today, or anytime in at least the past two decades. He has done nothing to make the circumstances of anyone in need of access to health care better, and through his repeated lawsuits against the Affordable Care Act has actively sought to prevent anyone else from making their circumstances better.

3. Abbott’s claim that anyone who suffered a similar injury today “would have access to the very same remedies I had access to” strikes me as unlikely in the extreme. It also strikes me as a fact that might be checkable, at least to some extent, though I don’t expect any journalist to try to follow up on that. But seriously, does anyone think in the legal climate we have in Texas today, one that Greg Abbott helped shape as a Supreme Court justice in the 90s, that such an outcome is even remotely likely, especially for someone who isn’t already in a position of influence or with access to ample resources? Attorney Wade Barrow doesn’t think so.

Since Abbott’s settlement, Texans for Lawsuit Reform, one of his most loyal and robust contributors, has been on a perpetual mission to eliminate the rights of catastrophically injured Texans.

The list of limitations that Texans for Lawsuit Reform has passed since 1986, with the help of politicians like Abbott, that would directly limit his claim if he were to make it today include limitations on medical care in the past, lost wages and punitive damages. Abbott’s settlement document specifically references punitive damages.

However, the much graver threat to Abbott’s case today is the Texas Supreme Court’s continued insistence on substituting its judgment for that of juries. In fact, since Abbott’s settlement, the Texas Supreme Court has repeatedly held that “naturally occurring conditions” do not create an unreasonable risk of harm.

Based on this legal precedent, cases similar to Abbott’s are thrown out of court without a jury hearing them. While it is only known generally that a tree fell on Abbott, it is likely that the Texas Supreme Court would dismiss such a case.

If the Court ruled in that manner, Abbott or anyone with the same type of case would collect nothing today.

Catastrophically injured Texans now often find themselves without the legal remedies Abbott had at the time of his settlement, and they are forced to go on government assistance at taxpayer expense because the liable party cannot be held accountable for negligent acts.

It is impossible to reconcile Abbott’s longstanding relationship with Texans for Lawsuit Reform and his own personal experience. Either Abbott made what he would now have to concede are likely “frivolous” claims for his personal injury settlement, or he is complicit in supporting legislation and court opinions that he knows to be unjust based on his own life experience.

Texas Watch recently documented just how much the tort “reform” amendment of 2003 has limited access to the courts, and before that documented how often the Supreme Court throws out jury awards. Even without detailed fact checking, Abbott’s claim is farfetched on its face at best. More from Texas Watch here.

What to do with that extra money?

Some unexpected good financial news for the city, but what to do about it is the tricky part.

Just months after hiking health premiums, shifting costs to employees and plugging a projected multimillion-dollar deficit in its health benefits fund, the city of Houston has found itself with a sizable surplus in that account instead.

The city had used $14 million to fill the projected deficit in its health fund in January, after predictions about claims and premiums proved inaccurate. In a memo issued this week, Human Resources Director Omar Reid said the city’s calculations were indeed off – but in the other direction, with claims coming in lower than expected.

That, combined with the January payment, leaves the health fund with an $18 million surplus, he wrote.

Fresh off benefit cuts and premium hikes in May, the municipal employees’ union is livid. It is demanding that Mayor Annise Parker rescind jumps in co-pays, deductibles, co-insurance and out-of-pocket maximums, and cut the increase in employee premiums from 14.9 percent to 8.7 percent.

The city’s share of premiums, which covers three-quarters of plan costs, with the rest coming from workers, also rose 14.9 percent in May.

City Councilmen Stephen Costello, Dave Martin and James Rodriguez said they are concerned city staff have shown an inability to project health costs and said the public should be wary, too. Health costs make up almost 10 percent of the city’s general fund operating budget.

“To have a change as drastic as this means somebody really didn’t do a very good job of diligence in their financial analysis of the program, and I’m trying to find out why is that happening,” Martin said. “More importantly, what can we do about it in the future, and how reliable is the data today?”

Rodriguez added, “My faith is somewhat shaken in their ability to calculate these numbers.”

I wouldn’t be too hard on the city’s financial analysts. Clearly, they made overly cautious projections, but I find it difficult to crime them for it given the steady drumbeat of pension-related financial doomsaying we’ve been subjected to lately. How could they be anything but overly cautious in an environment like that? I’m quite certain they’d have been taken to the woodshed for being too exuberantly optimistic if their initial projection had been much lower. The story doesn’t detail how this projection was made, but my guess is that the analysts relied heavily on historical data, most likely without sufficiently taking into account the fact that health care costs have grown a lot more slowly in the past five years than at any time in the past fifty years. Of course, they may have accounted for that but also considered that no one really knows why cost growth has slowed, and no one really knows how long that slowdown trend will last. If they erred towards excessive caution, I can understand their thinking.

Still, that caution had a profound impact on the city’s employees, who paid a lot more for their health care than they actually needed to. The union is right to demand that the employees get their money back. I’m sensitive to the concerns that this could be a blip on the graph, but that gets back to my earlier point about how these projections were done. Now that we have some empirical data, how about we revisit what our assumptions were and see where we might make some adjustments? That should inform how we proceed and how we make it right for the city’s employees, who have given up a lot to balance the city’s budget. They deserve a fair shake.

Two ways to deal with a problem you don’t want to solve

First, deny there is a problem.

It's constitutional - deal with it

It’s constitutional – deal with it

Attorney General Greg Abbott said Thursday he would never give up the fight against Obamacare, but the front-running candidate for Texas governor declined to embrace a temporary shut-down of the federal government — one of the key strategies promoted by U.S. Sen. Ted Cruz and other Tea Party-backed Republicans in Washington.

Obamacare, officially known as the Affordable Care Act, was the topic of conversation at a campaign event Abbott staged at a business in north Austin. (As it turns out, the company is one of Abbott’s campaign contractors).

Employing the town hall format, with questions from an audience packed in advance with supporters, Abbott highlighted his efforts to fight the federal law in court and said its financial burdens on employers would kill jobs in Texas.

“The flaws and false promises of Obamacare are now being exposed,” Abbott said. “Obamacare is the wrong prescription for American health care and I will never stop fighting against it.”

[…]

Though Abbott warned of massive financial and regulatory burdens of the federal health care reforms, he said he supported two of its major provisions — one that bans insurance companies from putting lifetime caps on insurance policies and another that bars them from refusing coverage due to pre-existing conditions. The attorney general said those two provisions should be adopted in the law as stand-alone measures.

One reporter noted that Texas has the highest number of uninsured people in the nation and asked Abbott what he planned to do about it. Abbott expressed support for permitting insurance companies to sell policies across state lines but also suggested the problem isn’t as bad as some suggest.

“Just because someone may be uninsured does not mean they don’t have access to health care,” Abbott said. “The percentage of people in the state of Texas with access to healthcare is in the mid- to high-90 percent range. People still have access to quality health care in the state of Texas.”

Tell you what, Greg. How about you and everyone on your staff give up that nice health insurance package that you have that we taxpayers provide for you, and spend the next four or so years paying for your own health care, and going to the local emergency room as an indigent patient when the cost gets to be too much for you? Then you can talk about having “access to health care” in a more authoritative way. What say you, is it a deal?

The other way to deal with a problem you don’t want to solve is to lie about it.

One reason that Abbott gave for fighting the law came in response to a doctor who asked him from the audience about what Texas could do to keep the federal law from interfering with doctors’ judgment about the best way to treat their patients.

“You’re raising one of the more challenging components of Obamacare, and a hidden component in a way, and that is government is stepping in between the doctor-patient relationship and trying to tell you what you can and cannot do, interfering with both your conscience and your medical oath to take care of your patient,” said Abbott, who is campaigning to succeed Gov. Rick Perry.

That is similar to arguments raised against tighter abortion restrictions approved in special session, including a ban on the procedure at 20 weeks, along with stricter regulations on clinics and abortion-inducing drugs.

Asked the difference afterward, Abbott said, “The difference is that in the law that was passed in the state of Texas … what they’re trying to do is to give a woman five months to make a very tough decision, while at the same time get involved in trying to protect the unborn.”

That doesn’t even make sense. I guess I didn’t expect internal consistency, but you’d think by now he’d at least have a better rationalization prepared. This is little more than “Because I said so”.

Anyway. All of this was in part because Health and Human Services Secretary Kathleen Sebelius was in the state trying once again to tempt Texas with a deal to expand Medicaid. Which our Republican leaders won’t do because they don’t care about solving the problem of people not having insurance. They care about the potential for increased paperwork under the Affordable Care Act, and they care that some business owners might have thinner profit margins, but they don’t care that the fatter profit margins those business owners now claim to enjoy come at the expense of their employees. Because why should they care? They have insurance. It’s not their problem, and they’re not interested in solutions.

A reduction in funding for women’s health leads to fewer women getting health care

Shocking, I know.

Right there with them

Right there with them

The number of claims filed for medical and family planning services in the new state-run Texas Women’s Health Program has dropped since the state ousted Planned Parenthood from it and set up its own program without federal financing, according to figures from the Health and Human Services Commission.

Stephanie Goodman, a spokeswoman for the commission, wrote in an email that the program is “running at about 77 percent of the number of claims this year compared to last year.” She added that the agency expects to “see a similar trend with the number of women served,” though those numbers are more difficult to calculate.

“We expected to see a drop-off in the number of claims when we moved to the state program because we knew some women wouldn’t want to change doctors,” Goodman said. “We’ve been able to find new doctors for women who call us, and we’ve got the capacity to increase the number of women we’re serving in the state program.”

[…]

While Planned Parenthood continues to provide services with community donations and other revenue, Danielle Wells, a spokeswoman with Planned Parenthood of Greater Texas, said many patients have expressed frustration “that politicians are telling them where they should and should not go for their health care.”

“We’re still hearing from patients who were in the program and were unable to locate a provider or schedule services in a timely manner,” she said. The exclusion of Planned Parenthood requires many women to travel farther to find an available provider, she said, and to make “tough decisions about paying out of pocket for care or simply putting off vital care that could potentially save lives.”

Amanda Stevenson, a research associate at the University of Texas at Austin’s Texas Policy Evaluation Project, a three-year study evaluating the impact of the 2011 women’s health policy changes, said determining whether women still have adequate access to care is complicated. While the health commission is working hard to enroll new providers to replace Planned Parenthood, she said women may delay care because they do not know which providers are available or end up paying out of pocket costs by continuing to seek services at a Planned Parenthood clinic.

“We’re seeing obviously that access is diminishing in places, particularly [those] that rely heavily on Planned Parenthood providers,” she said. But other areas of the state have not been as affected by the policy changes, she added, referencing a data application created by the researchers that shows how the 2011 policy changes and funding cuts have affected women’s health services regionally.

She also noted that more data is necessary to determine whether the percent reduction in claims represents a persistent trend.

“If things were getting better then we would expect consistent reduction in that proportion, but it’s not happening,” Stevenson said. “There might be a trend, and we might see it, but it’s not enough here to say that it is.”

To be as fair as I can to something that doesn’t deserve fair treatment, Planned Parenthood had previously served forty percent of the Women’s Health Program clients, but the decline in participation is now only about 23% of the pre-cutoff total, which means that at least some of the women who were directly affected by this bit of ideological bloodletting have since found an acceptable alternative. Hooray for small victories. Of course, they were all still forced to change doctors, and we have no way of knowing how much less convenient or more expensive these new arrangements are for them. And Lord knows the people that brought you this little catastrophe aren’t interested in finding out the answer to that. But again, as I said before, even if you could reasonably claim that access to health care is no worse than it was before, hundreds of thousands of women had their access to health care disrupted, for no good reason. And a lot of legislators plus our state leaders count that as a victory.

In related news, that ballyhooed restoration of family planning funds this session is less than meets the eye.

The Texas Women’s Healthcare Coalition has raised concerns that a bipartisan effort to restore access to family planning services by expanding a state-run primary care program isn’t shaping up as planned.

During hearings in the regular legislative session, David Lakey, the commissioner of the Department of State Health Services, told lawmakers that 60 percent of the $100 million allotted to expand the primary care program for women’s health care in the 2014-15 biennium would be used to provide family planning services and contraception. But the forms created by DSHS for health providers to apply to take part in the program do not explicitly state that 60 percent of providers’ services must go toward family planning.

In a letter sent Monday to DSHS and lawmakers, the coalition — which counts the Texas Medical Association, Texas Academy of Family Physicians and Texas Association of Community Health Centers among its 39 members — argued that the proposed rules don’t ensure that the program will achieve lawmakers’ intent of restoring access to family planning services.

“We’re concerned that this was really like a bait and switch,” Dr. Janet Realini, chairwoman of the coalition, said in an interview. Although she does not believe DSHS has intentionally disregarded the legislative intent to increase family planning services, she said, “the system to do that is missing an essential piece of direction for the contractors.”

Carrie Williams, a spokeswoman for DSHS, said the department received the coalition’s letter and is working to clear up misunderstandings about the program.

“We’ve been very open in developing and talking about this program, so it was disappointing to see these inaccuracies being promoted as fact,” Williams said in an email to the Tribune.

She added that family planning services are emphasized throughout the department’s materials on the program, but that the program does not exclusively provide family planning services.

“The 60 percent target for family planning was what we have been proposing all along. While that threshold is not explicitly stated in the materials, it has long been the plan and we have never indicated otherwise,” said Williams.

In its letter, the coalition recommended that the department explicitly prioritize family planning services by setting specific targets and performance measures for contractors. The state could save money and avert unintended pregnancies, the coalition argues, by setting performance targets for family planning services and giving funding priority to contractors that have demonstrated the ability to provide these types of services.

“I think putting it in the materials to let contractors know what you’re looking for is important,” said Realini.

In the private sector, we call that setting metrics. Metrics reflect goals and values. You can draw your own conclusions.

Texas really needs Obamacare

We’ve always known that Texas would be a huge beneficiary of the Affordable Care Act because of our huge volume of uninsured people, but this quantifies it in a way that really brings it home.

It's constitutional - deal with it

It’s constitutional – deal with it

Texas is home to more than two-thirds of the nation’s 30 counties most in need of expanded health insurance coverage, according to a liberal group.

The Center for American Progress Action Fund ranked 22 Texas counties – including Dallas — as among the “30 worst” in the country, citing residents’ lack of insurance and poor health outcomes, such as heart attack deaths.

In a report released Thursday, the advocacy group said many Republican U.S. House members “are doing everything they can to torpedo” the federal health law despite having many constituents who would benefit from new state health marketplaces that will open on Oct. 1.

Dallas County, with 31 percent of residents uninsured, had the 14th-worst rate of health coverage among U.S. counties with more than 25,000 people, the report said.

Forty-five percent of Dallas County’s young adults — ages 18 to 39 – lacked insurance in 2011. Nine percent of all county residents have diabetes, which is a rate 13 percent higher than the national average, the group found. Nearly 15 of every 100,000 county residents die each year from stroke. That rate is 26 percent higher than the national average.

“There are just enormous human and economic inefficiencies from [having] a large number of uninsured persons in any county,” Tom Perriello, the group’s chief and a former Democratic congressman from Virginia, said in a media conference call.

While several of the Texas counties on the worst list are along the U.S.-Mexico border, the 22 were scattered in all regions of the state.

The report is here and the summary of it is here. What they did was rank the counties on six different factors:

  • Highest overall percentage of uninsured individuals under age 65
  • Highest percentage of uninsured women under age 65
  • Highest percentage of uninsured individuals ages 18 to 39
  • Highest percentage of uninsured young men
  • Highest percentage of uninsured people of color
  • Highest percentage of uninsured working-class individuals

The “bottom 30” list was then taken from the counties that did the worst overall on all six factors. Harris County scored among the worst on “Highest overall percentage of uninsured individuals” (#19, 29.9%); “Highest percentage of uninsured women under age 65” (#18, 28.8%); “Highest percentage of uninsured individuals ages 18 to 39” (#40, 43.1%); and “Highest percentage of uninsured working-class individuals” (#9, 34.2%), where that is defined as “individuals between 18 and 65 earning between 138% and 400% of the Federal Poverty Line”.

The good news is that despite the Republicans’ staunch refusal to do anything about this problem (with some honorable exceptions including county leaders and a few legislators like Rep. John Zerwas, who detailed his frustrations in this interview with the Observer that you should read), Texas will still get a great deal of benefit from the insurance exchanges. According to a report by the Society of Actuaries, Texas’ uninsured rate could drop from 27% to just under 15% if all eligible people take advantage of the exchange and the subsidies available to them; expanding Medicaid would have dropped that number to 10%, with the remainder basically being undocumented immigrants. This requires that people know about the exchanges and the subsidies, and fortunately there are various efforts underway to make that happen, since the state of Texas isn’t doing anything to help. If all goes reasonably well, many Texans could be a lot better off in another year.

Of course, there remain those who hope that nobody is any better off after the ACA kicks in.

Conservative analyst John Davidson of the free market-oriented Texas Public Policy Foundation said the liberal group – and writers of the federal law – ignore Census Bureau data showing that nearly 1 million of Texas’ 6 million uninsured residents make more than $75,000 a year.

“They have the means” to buy coverage, he said. “They don’t see the value in it.”

He said the Affordable Care Act’s success hinges on whether young, healthy adults will be prodded to buy coverage, which will “subsidize older, sicker people. Proponents of the law are going to be surprised how few young people are willing to take that deal,” Davidson said.

Yes, I’m sure that a privileged old guy like John Davidson knows exactly how people with whom he has nothing in common and for whom he has no empathy will behave. He’s just rooting for his preferred political outcome. Let’s see how good he is at making predictions after we get some data on this, shall we? Progress Texas, Health Zone, the Trib, and Kaiser Health News have more.

Fighting for Obamacare

Bring it.

It's constitutional - deal with it

It’s constitutional – deal with it

Obamacare supporters are launching a new war room operation to stick up for the law, mobilizing liberal groups to talk up its benefits and pound Republicans for trying to cut off its funding.

The new effort — to be headed by Americans United for Change, an all-purpose liberal advocacy group, and Protect Your Care, which focused on Obamacare — will include rapid-response messaging and town halls to try to change the conversation over the health care law, its organizers tell POLITICO. They’ll start next week, during the August recess, but they’re promising to stick around during the massive effort to sign people up for Obamacare this fall.

Their goal: Get Democrats and liberals off of defense, and make the Republicans defend trying to take away benefits like health coverage for pre-existing conditions, which will become available to all Americans when the main parts of the law take effect next January.

“This is about being on offense, not being on defense against the repeal crowd. They’re on the wrong side of this now,” said Brad Woodhouse, the former Democratic National Committee spokesman who’s now president of Americans United for Change. “You know what? Obamacare is the law of the land. Hands off my health care.”

Getting off of defense has been the big problem for the Obama administration and its supporters all along. Past efforts by liberals have fallen short, outgunned by the resources of conservative interest groups and the passion of the Tea Party activists who want to wipe the law off the books.

But this time, the pro-Obamacare groups say they’ll have the resources and the firepower to give the White House backup in critical states — and to give groups like Enroll America the “air cover” they need to focus on signing people up for health coverage, according to Eddie Vale, a spokesman for Protect Your Care who’s based at American Bridge, another liberal group that’s ramping up its opposition research on Republican candidates.

They’ll have the backing of Stephanie Cutter, the veteran of President Barack Obama’s re-election campaign and past Obamacare messaging efforts, and Paul Tewes, another Obama veteran who helped run the Democratic attacks that defeated President George W. Bush’s Social Security plan in 2005.

And they’re hiring Democratic consultants to help them organize events and rapid-response campaigns in 10 key states, including Texas and Florida, two of the three states with the highest numbers of uninsured people, as well as swing states like Ohio and Pennsylvania. The others are Wisconsin, Georgia, Illinois, Louisiana, Michigan, and North Carolina.

It’s that last bit about bringing the fight to Texas that made me blog this. Lord knows, we need to have as strong a countervoice to the rebel faction that pervades our state. It also fits in nicely with a campaign against Greg Abbott. I don’t know what this will mean in practical terms, but I look forward to it whatever it is.

Just a reminder that women’s health isn’t the only thing they don’t care about

In case you needed one.

It's constitutional - deal with it

It’s constitutional – deal with it

Texas officials have declined to establish a state-based health insurance marketplace, a major provision of the federal Affordable Care Act. So private organizations are working to educate Texans about coverage options through the federal health insurance exchange, which opens on Oct. 1.

Of the more than 6.3 million uninsured Texans — the state has the country’s highest rate of uninsured residents — almost half will be eligible to buy insurance through the federal exchange, an online tool for coverage shopping.

But Texans suffer from a “general lack of knowledge” about the law, said Allison Brim, a director at the Texas Organizing Project, one of several groups working to reach uninsured families before the federal exchange’s rollout.

“Folks just don’t have a lot of information about the exchanges and what their options will be,” she said.

The Texas Department of Insurance has made no extra effort to publicize the federal exchange, said John Greeley, an agency spokesman. In 2010, it conducted a federally financed campaign about health insurance options but has done nothing comparable since, he said, adding that those with questions could use the department’s website or telephone service.

Brim criticized the state for not promoting the exchange, saying its help would make it possible to reach all eligible Texans by October.

“The state has, as far as we know, done nothing to spread the word to uninsured Texans about the exchanges or the Affordable Care Act,” she said. “It leaves a mountain of work for us.”

In response to questions about publicizing the exchange, Lucy Nashed, a spokeswoman for Gov. Rick Perry, wrote in an email that the state was “not interested in implementing Obamacare, including the exchange.”

That pretty much sums it up. You know the old joke about how God must love the poor because He made so many of them? Rick Perry must love uninsured people, because he’s doing everything he can to make sure there will always be plenty of them.

How I would campaign against Greg Abbott

If you’ve been following Greg Abbott’s gubernatorial campaign kickoff, you’ve probably noticed that in addition to being light on substance, the Attorney General has been hitting his personal story hard, in an attempt to portray him as some kind of empathetic figure.

How Greg Abbott views the process, without the wildebeest stampede

Who needs policies when you have destiny?

Over nearly two decades of public appearances as a political figure, Greg Abbott has not shied from noting the obvious: He uses a wheelchair.

During speeches, the Texas attorney general, who is now a gubernatorial candidate, is known to pre-emptively address any questions on the topic — often humorously — with an explanation of the 1984 accident that left him partially paralyzed. At campaign events dating back to 2002, he has shown brief video clips describing how a falling oak tree crushed his spinal cord while he was jogging with a friend through the Houston neighborhood of River Oaks.

He emerged on the statewide political scene in 1995, when, after Gov. George W. Bush appointed him to the Texas Supreme Court bench, the court building updated its facilities to comply with the Americans with Disabilities Act.

“Court builds ramp to justice, for a justice,” reads one headline from the Austin-American Statesman.

Now, the adversity that Abbott has faced has become the symbolic centerpiece of his recently launched gubernatorial campaign, which he announced on Sunday — the 29th anniversary of his accident.

“My greatest fight began on this date,” he said to a crowd gathered in San Antonio. “It was a challenge that made my even being here, highly improbable.”

In a five-day, 10-city tour across the state since then, Abbott has been introducing himself as a fighter for strong Texas values, a candidate with a literal spine of steel. As someone who uses a wheelchair, he says, he knows what it means to struggle with physical and emotional challenges.

“I demonstrate what every Texan exemplifies every day — the ability to overcome adversity,” he said at a campaign stop in Houston.

See his heartwarming intro campaign video for a distilled version of this. Now we both know that the only thing Abbott fights for is the interests of the powerful. But a lot of people don’t know Greg Abbott well, and they don’t know that he’s never done a thing for regular Texans. To someone who doesn’t know Greg Abbott and is just tuning in now, he might look like an underdog himself, and as long as he manages to avoid talking about his actual record and his beliefs, he might sound downright appealing. The key is making sure that people know about the real Greg Abbott.

Whether Abbott can sway blue-collar voters is uncertain.

Joe Silva, 54, a worker at the boot factory and a lifelong El Pasoan, said he would probably vote for Abbott despite not knowing a lot about him.

“He’s a good man, I heard. He went through that tough accident,” he said.

But when asked if Abbott’s opposition to the federal health care reform legislation or support for the voter ID law mattered to him, Silva paused.

“Oh, I didn’t know that,” he said. “ I guess we’ll see what he has to say. I don’t know much about him.”

Remember, Abbott isn’t used to talking to people who don’t habitually vote in Republican primaries. That’s why he thinks that wooing voters by bragging about the things he’s done that they don’t like is a good idea. He just has no experience talking to non-true believers. That’s all to the good, but we can’t count on that. More to the point, we can’t let Abbott get away with using his personal story as a way to smooth out his extremely rough and, well, extreme edges. To borrow a page from the Karl Rove playbook, we need to turn his strength into a liability.

How to do that? There’s no question that Abbott has overcome a great deal of adversity in his life, the kind of adversity that most of us are fortunate to never face. That speaks well of his character and inner strength, but there’s an aspect to his success at overcoming that adversity that I have not yet seen mentioned anywhere. I don’t know Abbott’s medical history, but I think it’s safe to say that it includes surgeries, medication, physical therapy, medical equipment, and other things that undoubtedly cost a lot of money to provide. I have to wonder where Greg Abbott might be today if he had been one of the millions of Texans that don’t have health insurance at the time of his awful accident. Medical bills force millions of people into bankruptcy every year. Many other people deal with the problem by simply not getting the help and treatment that they need. Last week, Dear Prudence ran a letter from a woman who lost several teeth during a prolonged stretch of unemployment for her and her husband because she just couldn’t afford to go to the dentist. I guarantee you, there are a lot more stories like that in Texas than there are stories like Greg Abbott’s, and it’s not because the people behind those stories lacked character.

Thankfully for Greg Abbott, he never had to deal with any of that. Yet he has spent the past three years doing everything he can to keep the millions of Texans who lack health insurance from getting it by his relentless litigation against the Affordable Care Act. If he has any alternate ideas how to alleviate this longstanding problem, he’s not talking about it now, and never once in his ten plus years as Attorney General has he used his platform – never mind his personal experience as someone who relies heavily on quality medical care – to advocate for those in that position. In short, he would deny the same type of care that he himself has benefited from to millions of people who could not now receive it. His personal story may be admirable, but it sure hasn’t helped him to learn empathy. If Democrats don’t start pointing that out now, he might just be able to get through this campaign without people realizing that. We cannot let that happen.

Note that I made it this far without mentioning the multi-million dollar award that the strongly pro-tort “reform” Abbott received after his injury. Lisa Falkenberg talked to him about that, and somewhat to my surprised threw him off his talking points a bit. I say “somewhat to my surprise” because Sen. Kirk Watson tried to make an issue of this in the 2002 AG race and it largely backfired on him. That was before the strict med-mal cap was adopted, though, so perhaps another go at it might be worthwhile. It’s clear from reading Falkenberg’s piece that Abbott has the same lack of insight about just how far removed his own experience has been from so many other people’s as he does with health insurance. The point remains that there are some very tough questions that Abbott can and should face, and the sooner the better.

Remembering the bad old days

We’re headed back to them if the courts don’t intervene.

Dr. Howard Novick winces as he recalls treating two and three women a week for infections and complications from botched abortions. It was the early 1970s, before the procedure was legalized, and the experience persuaded him to devote his life to this area of medicine.

Now, more than 40 years later, new abortion restrictions passed by the Texas Legislature could force Novick to close the Houston abortion clinic he opened in 1980 because, he says, he does not have $1 million to $1.5 million to convert his run-of-the-mill medical office into a fully loaded surgical center with wide corridors and sophisticated air-flow systems.

“I have saved some women’s lives. They are so grateful we’re here for them and nonjudgmental,” Novick said. “I really feel a kinship for this.”

The legislation, passed late Friday following weeks of mass protests and a high-profile filibuster, allows abortions only in surgical centers, requires doctors who perform them to have admitting privileges at nearby hospitals, dictates when abortion pills are taken and bans abortions after 20 weeks unless the woman’s life is in imminent danger.

Abortion-rights advocates argue the costs associated with converting clinics into surgical centers are so high they will force more than 35 clinics to close, possibly leaving only a handful of facilities across the vast state. In rural areas such as the farthest reaches of West Texas or the Rio Grande Valley, that could put the closest facility 300 or more miles away.

The law could also create a backlog so great in the remaining clinics that women seeking abortions will miss the 20-week deadline, said Amy Hagstrom Miller, president and CEO of Whole Woman’s Health, a company that runs five clinics in Texas.

Abortion opponents insist, however, that the new rules are designed to guarantee the best health care.

“All we’re asking for is better surgical care for women seeking these procedures,” said Christine Melchor, executive director of the Houston Coalition for Life.

[…]

Novick says the law is medically unnecessary. The Texas Medical Association, the Texas Hospital Association and the American College of Obstetrics and Gynecology agree.

“It’s been years and years since we had to send someone to a hospital,” Novick said of his clinic.

This has never been about safety, or women’s health. The unanimous opposition from doctors’ groups speaks to that, not that it had any influence over the Republicans. Remember, a big part of the strategy all along has been about delaying access to abortion as much as denying access to it. Waiting periods, sonograms, requiring multiple office visits, now requiring a doctor to dispense abortifacient drugs, it’s all about making it increasingly difficult to get an abortion early on, when it is the least invasive and thus the least medically risky. And of course, carrying a child to term and giving birth is far more medically risky than an abortion at one of Texas’ existing clinics.

Texans should be made aware of the state’s grimmest medical statistic: women are more likely to die from childbirth than from an abortion. That’s according to a study published in the February 2012 issue of Obstetrics & Gynecology Medical Journal. The study, conducted by Dr. David Grimes, a clinical professor in obstetrics and gynecology at the University of North Carolina School of Medicine, found that nationally the risk of death associated with a full-term pregnancy and delivery is 8.8 deaths per 100,000, while the risk of death linked to legal abortion is 0.6 deaths per 100,000 women. That means a woman carrying a baby to term is 14 times more likely to die than a woman who chooses to have a legal abortion.

In Texas, the statistics are worse. In 2011 Texas women died in childbirth at a rate of 24.63 per 100,000. “It’s alarming,” said Dr. Donald Dudley, Obstetrician & Gynecologist at the UTHSC San Antonio.

Texas should be seeing only about 5 deaths per 100,000 said Dudley, and the present rate is comparable to a developing nation.

Childbirth morbidity is seen as the most sensitive indicator of the general health of a population, especially in urban conditions.

In the last legislative session, two bills were passed and signed into law by Gov. Rick Perry, forming a Texas Childhood Morbidity Task Force and creating levels of care designations for hospitals that provide neonatal and maternal services.

The task force will look for answers as to why giving birth in Texas is so deadly. Researchers say they already know: lack of prenatal care; women giving birth later in life; obesity; diabetes, and lack of access to quality lifelong health care. The task force will gather the data to back those observations up.

The goal of HB2 is to force more women to give birth. State Sen. Dan Patrick, who I remind you is running for Lt. Governor, is quite explicit in his desire to end all abortions in Texas. It’s about the health and safety of the mothers, you see. What have he and his colleagues done to improve the health and safety of women who do give birth in Texas? Not a damn thing, and though their refusal to expand Medicaid they have actively worked to make it worse. Patrick and his cronies can say they care about women’s health all they want. Their actions speak very clearly otherwise.

People who don’t know about Obamacare can’t benefit from Obamacare

One suspects that’s the point.

It's constitutional - deal with it

It’s constitutional – deal with it

Texans, and in particular the state’s Hispanic population, might remain in the dark on the benefits of the new federal health care law because outreach efforts are largely focusing on the 24 states participating in the Medicaid expansion and state-based insurance exchanges, officials with the Centers for Medicare and Medicaid Services said [last] Monday.

Texas is not among those states; Gov. Rick Perry and Republican leaders have argued federal health reform would eventually bankrupt the state. But Dr. Olveen Carrasquillo, a member of the U.S. Health and Human Services Department’s Advisory Committee on Minority Health, said at a Monday meeting that just because a state like Texas isn’t expanding Medicaid or implementing a state-based health insurance exchange doesn’t mean it should be excluded from federal marketing aimed at Hispanics.

“We can’t pretend all is rosy,” he said. “I don’t think this communication plan is working.”

Two-thirds of Hispanics in the U.S. say they do not have enough information about the health reform law to understand how it will affect them, according to the Kaiser Family Foundation’s Health Tracking Poll. Texas has more Hispanic residents than any state but California, and without the Medicaid expansion, 22 percent of them will remain uninsured, according to the Urban Institute’s American Community Survey.

[…]

Special federal funding known as navigator grants, which require at least one community-based nonprofit to operate as a health reform outreach provider, will become operational in Texas around September or October, according to Kelly Dinicolo, technical adviser at CMS. These nonprofits will provide in-person enrollment assistance to help people buy insurance — in Texas, it will be via a federal health insurance exchange — or direct them to Medicaid, if they qualify.

Dinicolo and other government officials said they have launched some limited advertising in Texas, but mainly through online marketing because it is easier to target a younger demographic. For those who do not have access to online information, CMS has announced a partnership with libraries to help people navigate the health reform changes.

The newly launched informational website about health care reform, Healthcare.gov, has also launched a Spanish version, CuidadoDeSalud.gov.

There’s also Be Covered Texas, in English and Spanish, which is a statewide campaign launched in March by Blue Cross Blue Shield Texas to help enroll Texans in the exchange, and Get Covered America, launched in June, aimed at informing people about the October 1 enrollment period opening. Hopefully, they can help to fill the gaps. But let’s be clear here: The reason we’re in this position is because 1) Rick Perry and most of the Republicans in the Legislature refused to expand Medicaid; 2) Perry and the Lege refused to do a Texas insurance exchange and have not lifted a finger to abet the federal effort; and 3) the Republican-controlled Congress has refused to appropriate any more money for the federal information program about exchanges. If people remain uncovered or uninformed despite the hard work of the people and groups heroically trying to overcome these obstacles, it’s not their fault.

With Rick Perry, you always have to ask “Who benefits?”

Texas Politics had an item on Friday that perhaps should have received a higher profile.

One of the controversial tenets of the abortion restriction bill would require all abortions to be performed in ambulatory surgical centers, which are a distinct type of healthcare facility set up for outpatient surgeries. Abortion rights advocates say the new requirement would force many clinics to close because they wouldn’t be able to afford to upgrade their facilities. They also say the upgrades are unnecessary and that no data shows current clinics aren’t properly equipped to provide good care.

If the bill passes, only five Texas abortion clinics would remain open — those that are already equipped as ambulatory surgical centers, advocates say. But a question remains: would the 420 other ambulatory surgical centers that exist in Texas begin performing the operation? Abortion rights advocates predict that the demand for the procedure won’t disappear with passage of the law.

One company that will be faced with that decision is United Surgical Partners International, based in Addison, TX. Their vice-president of government affairs is Milla Perry Jones, Gov. Rick Perry’s sister. She is also on the board of the Texas Ambulatory Surgical Center Society. It should be noted that the legislation now under consideration by the Texas Legislature is patterned after proposals that have been adopted in other states, so it did not originate with Gov. Perry’s office. Rich Parsons, a Perry spokesman said he could not say whether Perry has discussed the legislation with his sister, but said, “he strongly supports protecting women’s health by raising the standard of care they receive at abortion clinics.”

Uh-huh. As both Texpatriate and Nonsequiteuse noted, there’s more to the story than that. Here’s a Texas Observer story from last year that delved into the Perry connection to ambulatory surgical centers.

Corndogs make bad news go down easier

Beware the power of the corndog lobby

Both Governor Perry and his sister have championed doctor-owned facilities in Texas and Washington.

The trade publication “Who’s Who in the Ambulatory Surgery Industry” describes Milla Perry Jones as “a true advocate for the physician-owned healthcare model.” Industry publications say she manages United Surgical’s “state and federal advocacy efforts” and coaches entrepreneurial doctors on how to lobby public officials. The governor’s sister has held leadership positions with the Texas Physician Hospitals Advocacy Center and the Texas Ambulatory Surgery Center Society, both headed by Austin lobbyist Bobby Hillert. Hillert’s ambulatory group “supports physician ownership in all forms” and opposes “any attempts to ban or restrict physician ownership in Texas, in any manner.” Hillert says Milla Perry Jones sat on the PAC committee of his ambulatory group, which endorsed Rick Perry’s 2010 reelection. Milla Perry Jones declined to discuss her work with the Observer, referring all questions to Hillert. “I’m trying to be as helpful as I can,” she said before terminating the call. “I should’ve hung up two minutes ago.”

President Obama and other critics argue that doctors who own stakes in medical facilities drive up health costs because they have a financial interest in ordering excessive procedures. In one of many such studies, a 2006 federal report found that Medicare costs are 20 percent higher at doctor-owned orthopedic surgical hospitals than at competing community hospitals. These studies typically do not determine if the extra procedures are beneficial. The doctor-owned industry says it delivers superior care and points to contradictory research that does not associate doctor ownership with higher costs.

No state has more doctor-owned hospitals than Texas, which claims more than 90 of about 300 such hospitals nationwide. Only California has more doctor-owned ambulatory outpatient facilities, most of which are part owned by physicians. Milla Perry Jones’ company owns interests in 13 U.S. surgical hospitals and 171 surgical centers. United Surgical co-owns its typical facility with both doctors and local non-profit hospitals. The company’s 2010 annual report says that the hospitals provide access to health insurers and doctors. “Our sales and marketing efforts are directed primarily at physicians, who are principally responsible for referring our patients to our facilities,” the report says. Before joining United Surgical in 2004, Milla Perry Jones worked for a foundation supporting Dallas-based Baylor Health Care System, which invests in more United Surgical facilities than any other hospital.

[…]

In 2010, a doctor-owned hospital in Tyler, Texas and a national trade group that Perry’s sister works with filed a lawsuit alleging that Obamacare restrictions on doctor-owned hospitals are an unconstitutional taking of private property. Rejecting this claim, a federal judge appointed by George W. Bush ruled in 2011 that “it is not the function of the Court to determine the wisdom of congressional action.” Three judges on the New Orleans-based U.S. Firth Circuit then threw out the lawsuit on appeal. They ruled in August that the plaintiffs must exhaust their administrative appeals to U.S. Health Secretary Kathleen Sebelius before they go to court.

Unlike Obama, Governor Perry avidly promotes the doctor-owned industry. In 2009 Congress considered restricting doctor-owned hospitals to pay for children’s health insurance. This prompted the governor of the state that leads the nation in doctor-owned hospitals and uninsured people to write Texas’ congressional delegation. Doctor-owned facilities “play a vital role in health care delivery in the state,” Perry wrote, “a role that is rightfully determined by the needs of Texas communities.” Perry spokesman Josh Havens wrote in response to Observer inquiries that the governor “believes that a patient should have options when addressing their health care needs and, respecting free-enterprise, he supports physician-owned hospitals as one of those options.”

Of course he does. Nonsequiteuse correctly compared this to the HPV vaccine executive order of 2007, which also stood to greatly benefit a Friend of Perry, in that case his former chief of staff Mike Toomey. Principles, such as he has them, will always take a back seat to helping a crony. The only surprise here is that it’s taken this long for someone to make the connection.

Enrolling the uninsured

This is going to be such a huge job.

Get Covered America

Fresh produce wasn’t the only thing you could find at the Farmers Market [last] Saturday.

Volunteers with the Get Covered America campaign were passing out flyers and letting people know that starting Oct. 1, American citizens can enroll for low-cost health insurance as part of the Affordable Care Act.

“Get Covered America is a national grassroots campaign to educate people about the enrollment opportunities made possible by the affordable health care act,” volunteer Ian Davis said. “The enrollment period will start in October and today marks the 100 day countdown, so we’re doing a national day of action.”

Davis, an organizer with Get Covered Texas, says it’s important Texas is included.

“Texas has the most uninsured of any state in the country, so this is ground zero of really solving the health care problem,” Davis said.

Musician Daniel Smith is someone who doesn’t have health insurance.

“It’s just kind of like, don’t get hurt or sick you know,” Smith said.

Davis says there are plenty of people like Smith who don’t know they’re eligible.

“Over half the folks that are eligible for those benefits are unaware,” he said.

There were kickoff events like this around the country last weekend. BOR was at the Austin event. There was an event in Houston on Saturday the 22nd, right here in the Heights, but the only information I saw about it was an email that same morning. I hope we can do a better job of getting the word out than that. This is the only thing I saw in the Chronicle, so when I say “we”, I mean them, too. They did have a story on the federal push to get people enrolled on Tuesday, so perhaps they’ll be on the case going forward. We’ll see.

The actual enrollment period for the health insurance exchanges begins on October 1, and the race is on to get the word out. Something like 2.6 million Texans may qualify for insurance subsidies under the Affordable Care Act, but they have to know about it and they have to know what to do to get the subsidies and enroll in an insurance plan. This is a massive national undertaking that will be done without the assistance of the state government here, for obvious reasons. One organization that may be helping to promote the exchanges will be the NBA, and I for one look forward to seeing what the Houston Rockets will do as part of that effort. (The NFL, and thus the Houston Texans are also in play.) Let’s hope we hear a little bit more about it between now and then.

RAND reminds us what we’re not getting

Not expanding Medicaid is a really bad deal for Texas, and all those other states like Texas.

It's constitutional - deal with it

It’s constitutional – deal with it

States that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending, at least in the short term, on the cost of treating uninsured residents, according to a new RAND Corporation study.

If 14 states decide not to expand Medicaid under the Affordable Care Act as intended by their governors, those state governments collectively will spend $1 billion more on uncompensated care in 2016 than they would if Medicaid is expanded.

In addition, those 14 state governments would forego $8.4 billion annually in federal payments and an additional 3.6 million people will be left uninsured, according to findings published in the June edition of the journal Health Affairs.

“Our analysis shows it’s in the best economic interests of states to expand Medicaid under the terms of the federal Affordable Care Act,” said Carter Price, the study’s lead author and a mathematician at RAND, a nonprofit research organization.

“States that do not expand Medicaid will not receive the full benefit of the savings that will result from providing less uncompensated care,” Price said. “Furthermore, these states will still be subject to the taxes, fees and other revenue provisions of the Affordable Care Act, without reaping the benefit of the additional federal spending which will costs those states economically.”

Price and study co-author Christine Eibner used the RAND COMPARE microsimulation model to estimate the likely effects if 14 states choose not to expand Medicaid under federal health care reform. Among the measures studied are the impacts of Medicaid expansion on insurance coverage, federal payments into the states and state spending on care for the uninsured.

The states studied are Alabama, Georgia, Idaho, Iowa, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas and Wisconsin. Although governors in additional states oppose expanding Medicaid, the 14 states in the study were the first whose governors said they would not expand Medicaid. At the time of the analysis, these were seen as the least likely to expand Medicaid.

[…]

The RAND study found that the cost to states for expanding Medicaid generally would be lower than the expense state and local governments will face for providing uncompensated care to uninsured residents after implementation of the Affordable Care Act.

Researchers estimate that increased insurance coverage triggered by health reform will reduce state and local spending on uncompensated medical care by as much as $18.1 billion annually across all states. Those savings may continue beyond 2020, when the states’ share of Medicaid costs plateaus.

“State policymakers should be aware that if they do not expand Medicaid, fewer people will have health insurance, and that will trigger higher state and local spending for uncompensated medical care,” Price said. “Choosing to not expand Medicaid may turn out to be the more-costly path for state and local governments.”

The study suggests that changes could be made to the Affordable Care Act to help some people targeted by the Medicaid expansion to get health insurance coverage through other means. Those options include a smaller expansion of Medicaid or changes in the new state insurance exchanges to allow more poor people to purchase private health insurance.

The RAND study shows the alternatives could help provide health insurance to some people targeted by the Medicaid expansion. But none of the options examined would provide health coverage to as many people as full Medicaid expansion.

Researchers also outline how failing to expand Medicaid could have more than financial consequences. Based on earlier research showing that past expansions of Medicaid has led to decreases in deaths, the study estimates that an additional 19,000 deaths could occur annually if the 14 states studied do not expand Medicaid.

I was hoping to see state-level data, but the press release doesn’t go into detail, and the full study is behind a paywall. Still, in the abstract, the authors estimate that as a result of these 14 states’ intransigence, “3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016, compared to what would be expected if all states participated in the expansion”. It’s a hell of a parlay, and we all know who to thank for it. The Huffington Post has more.

Medicaid “expansion” likely dead

The calendar is a harsh mistress.

It's constitutional - deal with it

It’s constitutional – deal with it

The House’s lead health care budget writer says his bill to force Gov. Rick Perry’s administration to explore the potential for a “Texas solution” on Medicaid expansion is dead.

Rep. John Zerwas, R-Richmond, said Tuesday that his bill outlining an expansion of coverage for poor adults using private insurance, health savings accounts and cost sharing by the beneficiaries “got hung up in Calendars.”

He was referring to the House Calendars Committee, which is the traffic cop deciding which bills go to the House floor — and in what order.

“Wasn’t anybody there to rescue it,” Zerwas said of Calendars and his measure.

Although the Calendars Committee is expected to meet Tuesday, Zerwas said the only way his bill could avoid Thursday’s midnight deadline for passing House bills would be if it were placed on Thursday’s major state calendar. That would bump it ahead of scores of bills.

“I don’t think that’s in the cards at all,” said Zerwas, chairman of the Appropriations subcommittee on health and human services.

I can’t claim to be surprised. It just wasn’t a priority for the powers that be. The Trib notes that even though Zerwas bent over backwards to try to accommodate Rick Perry and the slash-and-burn crowd at the TPPF, they were still agin’ it, and that was enough to bottle it up. Yes, Calendars could still schedule it ahead of a bunch of other bills, which would endanger them all since HB3791 would surely take all day to debate, and yes it could get attached as an amendment to a so-called “Christmas tree” bill, but I wouldn’t count on either of those things happening, and even if they could they probably shouldn’t. Whatever you think about this – and to me, this bill barely rates a D minus – it deserved a real hearing, with everyone having the opportunity to amend it. It shouldn’t be tacked on to something else, and it shouldn’t get its time on the floor at the expense of everything else. Let’s start talking now about how our tax dollars will now go to help expand Medicaid in New York and California, and how we won’t even get that much money to enroll people in subsidized coverage through the exchanges in large part because Rick Perry didn’t give a crap about that, either. This was always about politics, so let’s make the failure to take action be about politics, too. Texas Politics has more.

Hotze sues Obamacare

You would think that once the Supreme Court ruled that the Affordable Care Act was constitutional that that would settle things, but then you would not be Steve Hotze.

It's constitutional - deal with it

It’s constitutional – deal with it

Steve Hotze, a Houston-area physician and major Republican campaign donor who has built his career around alternative medicine, says he is filing suit against the federal government to try to prevent the enforcement of the Affordable Care Act in Texas.

He’ll announce the suit, to be filed against U.S. Health and Human Services Secretary Kathleen Sebelius, on Tuesday morning in a press conference hosted by Lt. Gov. David Dewhurst.

Hotze, the president of Conservative Republicans of Texas, said his suit will address “new and unconstitutional problems that stem from Obamacare.”

“It is imperative that Texas challenge this unwarranted federal overreach and ensure that Texans maintain the most innovative and economically viable health care system in the country,” he wrote in a statement.

Hotze has built a lucrative practice in suburban Houston around nontraditional therapies and treatments for allergies, thyroid problems and yeast infections. He’s best known for promoting natural progesterone replacement therapy for women, a treatment the FDA has questioned the effectiveness of. As recently as 2011, he had a daily health and wellness show on Republican Sen. Dan Patrick’s Houston radio station, KSEV.

At first I thought this was just another example of wingnut rage against the machine, another desperate act by another impotent Obama hater who doesn’t care about the millions of people that lack access to health care. But then I remembered that Hotze is not a traditional doctor as we tend to think of them, and as a commenter on that Trib story suggests this may simply be about reforms in Obamacare affecting his own bottom line. It’s not clear to me how or why that might be the case, however, since alternate medicine is largely included in the Affordable Care Act, and as that Press story notes, insurance companies had already refused to pay for Hotze’s drugs, supplements, and what have you that you could only get at his in-house pharmacy. The Trib story is now updated, and it fills in some details:

The lawsuit presents two constitutional challenges: First, it argues that the ACA violates the rule that requires revenue-raising bills to begin the U.S. House, because the original bill began as a tax credit bill for veterans —not a revenue-raising bill. Second, the lawsuit argues that the ACA violates the Fifth Amendment of the Constitution by essentially requiring citizens to pay money to other citizens by compelling employers to pay private insurance companies for health coverage.

Because Hotze’s business, Braidwood Management, has more than 50 employees, the law requires him to purchase employee health insurance or pay a $2,000 penalty for every full-time employee above a 30-employee threshold.

“This is going to be a huge expense. I’m grateful that Dr. Hotze is stepping forward,” state Sen. Dan Patrick, R-Houston, said at the press conference. “I think he’ll have the support of many business owners and people around the state.”

Hotze said Gov. Rick Perry, Lt. Gov. David Dewhurst and Attorney General Greg Abbott were made aware of his intention to file a lawsuit, and none objected. Dewhurst was originally scheduled to speak at the press conference but did not attend.

The state of Texas will not be involved in pursuing or paying for the lawsuit. Hotze plans to cover the costs of the suit and has established a legal defense fund for other individuals and businesses to donate to his cause.

I’m not a lawyer, and having read numerous analyses when the first lawsuit was filed about how it was going to get slamdunked by SCOTUS I’m not going to say that it’s bogus and doomed to fail. But I will note that none of Perry, Dewhurst, or Abbott bothered to show up to Hotze’s press conference, and none will be helping out with it. I mean, if Greg “I sue the Obama administration for fun” Abbott isn’t right there holding Hotze’s hand, that suggests to me that maybe he’s not all that high on the merits of the suit. Indeed, Texas Politics adds on about that:

Phillip Martin of the progressive activist group Progress Texas said: “Hotze’s lawsuit appears to be a copy-cat lawsuit of one already filed by the Pacific Legal Foundation. As the Department of Justice has already stated, the Patient Protection Affordable Care Act actually began as House Resolution 3590. It went through a ‘gut and amend’ process in the Senate, and became the law as it is today. In the history of the Supreme Court, only 8 “Origination Clause” cases – like the one presented by the Pacific Legal Foundation and copied, months after the fact, by Hotze – have been heard, and not once has the court invalidated an act of Congress because of it.”

The Progress Texas blog cites that same Houston Press story I linked to above, which includes a summary of some of Hotze’s wacko beliefs. I haven’t seen a copy of the lawsuit itself so I can’t tell you any more about it, but hopefully it will appear online eventually. The Observer has more.

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.

Zaffirini and Uresti stand against needless abortion restrictions

Good to hear, but given their histories it’s wise to be vigilant.

Texas Republicans are one vote short of passing a controversial abortion bill in the Senate — and the fate of the legislation now rests squarely on the shoulders of two South Texas Democrats.

Sens. Carlos Uresti, D-San Antonio, and Judith Zaffirini, D-Laredo, oppose the bill, and without their votes it won’t have the supermajority needed under Senate rules to get to a floor vote.

Both senators occasionally have sided with Republicans to pass anti-abortion measures, voting as recently as 2011 for a contentious bill that requires women to have a sonogram before an abortion. But if they maintain their opposition to Senate Bill 537, which would increase regulations for abortion clinics, the bill is stuck.

The measure has been on the Senate’s calendar for nearly two weeks but has yet to be considered. The Senate requires a two-thirds majority, or 21 votes, to consider legislation. SB 537 has 20 supporters — 19 Republicans and a lone Democrat, Sen. Eddie Lucio of Brownsville.

[…]

Zaffirini said she is “strongly pro-life” but opposes this bill because it “does nothing to make abortions less necessary” and “has the potential to limit access to critical health care services for thousands of Texas women.”

“Instead of attempting to address problems that do not exist, the Texas Legislature should focus on making women’s health care and prenatal care more accessible and affordable,” she said.

Uresti, who voted against the measure in committee, said it would reduce health care services, including abortion, for women in his district, specifically in rural areas.

“I don’t want to create barriers for women to access health services,” said Uresti, noting that the American College of Obstetricians and Gynecologists opposes the bill.

They’re saying the right things, but believe me, I have not forgotten their role in letting the awful sonogram bill pass in 2011. All we needed was one of them plus Lucio to say no, since Jeff Wentworth was also a No vote, but in the end Uresti sold out for a small modification to the bill that somewhat exempted his own district from its reach. Ultimately, Uresti and Zaffirini need to hear from Democrats, around the state but especially in their district, thanking them for holding fast on this, with at least the vague hint of a threat to be primaried if they cave in. They have it exactly right on what it is that SB537 will do. All they need to do is stick to that.

And before anyone says “Kermit Gosnell”, read this and this and this and this. Kermit Gosnell is what happens when women don’t have access to reliable abortion providers. It’s called the back alley, and it was supposed to have been banished forty years ago. Take away enough other choices, however, and it’s what’s left, just like it was before 1973.

What Obamacare will do for Texas

Even without Medicaid expansion, the Affordable Care Act will help millions of Texans get access to health care.

It’s constitutional – deal with it

Nearly 2.6 million Texans could qualify for tax credits to purchase health insurance in 2014, according to a report released Thursday by Families USA, a nonprofit that advocates for health care consumers.

The tax credits will be offered through the health insurance exchange — an Orbitz-style online marketplace for health insurance — that the federal government plans to launch as part of the Affordable Care Act in October. Beginning in January, families with an income of up to 400 percent of the federal poverty line, between $47,100 and $94,200 for a family of four, will be eligible for a tax credit subsidy to purchase insurance through the exchange. The tax credits will be offered on a sliding scale, so that lower-income families will receive larger credits.

“These are typically the families where folks are working, sometimes more than one job,” U.S. Rep. Pete Gallego, D-Alpine, said of the report. “Regardless of where you are on the political spectrum, I think that’s something we can all support.”

Nearly 5.8 million Texans — nearly a quarter of the state’s population — are uninsured. The Health and Human Services commission estimates the tax credits offered through the health insurance exchange and other provisions in the Affordable Care Act will lower that rate to 16 percent. If Texas also expanded Medicaid — an unlikely scenario given Gov. Rick Perry’s opposition — the uninsured rate could be lowered to 12 percent.

“Given the large number of people in Texas that are uninsured, many of whom are poor, this is an extraordinary opportunity,” said Ron Pollock, executive director of Families USA. He said it was “short-sighted” for the state’s leadership to oppose Medicaid expansion, as it would bring billions of federal dollars to the state, and increase job opportunities.

You can see the report for Texas here, and for other states here. That still leaves about a million people who would be able to get Medicaid if the state agrees to expand it, but we know how little Rick Perry cares about these people. Trail Blazers has more on the Families USA report.

Elsewhere on the Medicaid front, HHSC Commissioner Kyle Janek has been given the go-ahead to negotiate with the U.S. Centers for Medicare & Medicaid Services. At the time, he wasn’t given any direction about what to negotiate for or toward, but perhaps now that the Zerwas bill has been discussed in committee there’s something tangible for him to talk about. We’re unlikely to hear much about his effort and any progress he may make since apparently talking about it in public spooks people, the way saying the name “Voldemort” does in the Harry Potter books. Lord only knows what might happen, but hey, at least they’re talking. EoW has more.

Williams’ “Medicaid” plan

I’m really not sure what to make of this.

It’s constitutional – deal with it

State Sen. Tommy Williams, R-The Woodlands, is crafting a Medicaid reform plan that would use premium tax revenue to subsidize private health plans for uninsured Texans, his office confirmed on Tuesday night.

Gary Scharrer, a spokesman for Williams, said the proposal is “still a concept,” one that is designed to “buy some time” as Texas debates how to overhaul Medicaid in the midst of pressure from the federal government to embrace elements of the Affordable Care Act, or “Obamacare.”

According to early details, Williams’ plan would scrape premium tax revenue from newly insured Texans who sign up for coverage under the state’s health insurance exchange — an online insurance marketplace that is mandatory under federal health reform — and use it to subsidize private coverage for poor, uninsured Texans starting in late 2015.

Scharrer cautioned that Williams’ proposal does not call for expanding Medicaid, which the state’s top Republican leaders adamantly oppose. Nor does it call for raising taxes; the premium tax revenue will be a side effect of more Texans being forced to buy insurance under the Affordable Care Act.

Williams is “really emphatic that Texas will not extend or expand the current Medicaid system,” Scharrer said.

I can’t tell what the goal of this is. Is it to help provide health care coverage to people who otherwise wouldn’t have it? In particular, is it intended as a way to provide some kind of health care coverage to people who would be eligible for Medicaid if Texas would agree to expand it? The Express News suggests that this is indeed the case.

Williams said the money from the extra premium taxes could be used to pay for Texas’ cost of expanding health care coverage to those who would otherwise qualify for Medicaid expansion.

His preference would be to add them to the insurance exchange and help them to buy coverage, although he said it also could be done by putting them in a revised Medicaid program.

He would like to wait until September 2015. That would give lawmakers another regular legislative session in 2015 to examine the program.

“And so I don’t want us to get committed to any program that we can’t pay for and that the federal government is not going to pay for,” Williams said.

Of course, the federal government is paying for it, assuming that Williams’ Republican colleagues in Washington don’t succeed in figuring out some way to cripple it. One must admit there is some risk to that, however perverse the whole thing is. Be that as it may, I’d like to know how much revenue Williams thinks he can “scrape” this way, and how many people it would help. I’m going to step out on a limb and guess that the number is smaller than the number of people who would be eligible for expanded Medicaid. More importantly, why this for a revenue source and not the billions of dollars of federal money available? Back to the Trib for that:

State Rep. John Zerwas, R-Simonton, confirmed Wednesday that he will incorporate into his own Medicaid reform bill a proposal by Sen. Tommy Williams, R-The Woodlands, to use premium tax revenue to subsidize private health policies for the uninsured.

“It fits very well with Texas’ attempt to find a unique solution that would be sustainable,” Zerwas said. He said the measure would allow Texas to embrace some parts of federal health reform “earlier versus later,” and would “hopefully bring insurance policies to these people that otherwise wouldn’t have them.”

But the two lawmakers diverge on a key point — whether or not to draw down billions of federal dollars to expand the state’s Medicaid-eligible population under the Affordable Care Act.

[…]

Medicaid expansion is “completely off the table — what I’m interested in is a reform program,” Williams said Wednesday morning.

Zerwas said he authored House Bill 3791 to craft a “Texas solution” to Medicaid reform that would allow the state to draw down federal Medicaid expansion financing while implementing cost containment reforms. So far, Zerwas has suggested those reforms include co-payments and wellness incentives, but the details of his plan remain thin.

Still not clear what, other than straight up antipathy to Medicaid and the ACA, is driving Williams’ refusal to draw down federal funds. The sad thing is that even this baby step, two years out, would be a big improvement over anything the Republicans have done to health care in Texas. It’s ridiculously limited and needlessly complicated, which gives you some idea of just how bad the status quo is, but it’s still a tiny nudge forward. I just hope Rep. Zerwas’ perspective wins out in the end.

Yes, Rick Perry still hates Medicaid

We’re not surprised by this, right?

It’s constitutional – deal with it

The Texas rhetoric around a key facet of federal health reform — whether the state will expand subsidized insurance to its poorest adults — reached the high water mark on Monday, with back-to-back press conferences at the Capitol featuring political leaders on both sides of the aisle.

Republicans including U.S. Sens. Ted Cruz and John Cornyn, Gov. Rick Perry, Lt. Gov. David Dewhurst and members of a conservative think tank gathered first, reaffirming their opposition to expanding Medicaid, a key tenet of “Obamacare” that is widely supported by Democrats. The expansion — and in particular, the flexibility the federal government has shown some Republican-led states in implementing it — has in recent months drawn the support of some fiscal conservatives reluctant to pass up billions of federal dollars and the opportunity to curb Texas’ ranks of the uninsured.

“For those states buying into this, they will come to rue the day,” Cruz said.

“When the federal government retreats,” Cornyn added, “the state’s going to be on the hook.”

[…]

Republican lawmakers want the Obama administration to give Texas a block grant for Medicaid, which the state would use to subsidize private health savings accounts for low-income recipients. Medicaid recipients would either enroll in a Medicaid managed care plan or be given subsidies on a sliding scale based on their income. The state would also likely include “personal responsibility” measures, such as higher co-pays for patients who went to the emergency room for minor ailments.

Perry said federal leaders need to “decide if they trust” Texas to run Medicaid as the state sees fit, and called the Obama administration “harder to deal with than previous administrations.” But when asked whether he, Cruz or Cornyn had reached out to begin negotiations with the Obama administration on ways to reform Medicaid with federal dollars, Perry said that was the job of the Legislature and the state’s health and human services commissioner.

Did I mention that Perry would make bogus claims about the feds not negotiating in good faith? Why yes, I did. It’s really very simple – Perry, Dewhurst, Abbott, Cornyn, Cruz, the poo-flinging nihilists at the TPPF, they don’t want to help anyone who doesn’t have access to health care. They could not care less about these people. It’s not about the money, it’s not about compassion (since none of them have any), it’s about ideology. They could not be any clearer about this.

Note, by the way, the cloistered nature of Perry’s gathering of the elites, which includes lobbyists but no one who is or would be affected by the decision to expand Medicaid. Now contrast that to some of the people who are affected by that decision.

The county judges of Texas’ most populous counties, as well as the Chambers of Commerce of most of Texas’ largest cities, have endorsed Medicaid expansion as a means of paying for health care in a state with the highest number of uninsured individuals in the country. Without it, they say local taxpayers foot the bill as poor people seek care in expensive emergency room settings.

Some of those people came to the Capitol as well, though they weren’t invited to Perry’s little conclave.

Democrats in Congress and the Legislature, uninsured parents, the head of the state’s main hospital trade group and top local officials in Dallas and San Antonio urged state GOP leaders Monday to negotiate with the Obama administration to expand Texas’ Medicaid program for the poor.

“The public hires us not to do the ideological thing but the smart thing,” said San Antonio Mayor Julian Castro.

Dallas County Judge Clay Jenkins said it’s unacceptable to leave a large bloc of the population relying on safety net hospitals’ emergency rooms for care when their maladies could receive earlier attention and treatment.

“Do we want to insure the 1.5 million uninsured Texans that need this primary care and are eligible under the expansion population?” he said. “It’s time to put politics aside and stand up to the extremist factions of political parties and work together on the local, state and federal level to find a plan that fits the unique needs of struggling Texans and expands our Texas economy.”

[…]

Ofelia Zapata, an Austin housewife and mother, said her husband is an uninsured laborer who works long hours but can’t afford private coverage. And yet he makes too much to qualify for Medicaid, said Zapata, who is a leader of the Industrial Areas Foundation group Austin Interfaith.

She cast the policy question in moral and religious terms.

“As a Roman Catholic, we believe in dignity of a human person and demands that we stand in solidarity with the poor,” she said. “We must therefore expand Medicaid for Texas families.”

I’m terribly sorry, Mrs. Zapata, but Rick Perry and his cronies don’t care about you. They don’t care what people like Ed Emmett and the Lubbock Chamber of Commerce think. They don’t care about the lives that would be saved by expanding Medicaid, because being “pro-life” has nothing to do with living people. They don’t care what a bunch of protesters think. (There are pictures here and here if you care what they think.)

Oh, and just so we’re clear, this full-on opposition to the Affordable Care Act in general and Medicaid expansion in particular is strong evidence that the GOP’s ballyhooed efforts to “re-brand” themselves and reach out to Latino voters is just so much hot air. Latinos strongly support the Affordable Care Act. In general, Latinos and other voters of color support a much more robust role for government, which kind of complicates the whole “small government/starve the beast” message the GOP has to offer. In addition, the bulk of uninsured Texans are Latino. These are the people that would greatly benefit from Medicaid expansion. But of course, Rick Perry and his cronies don’t care about them. I’m still not terribly hopeful that Perry’s obstinacy will have an electoral effect next year. But that day, and that effect, is coming.

UPDATE: More from PDiddie, and the Texas Organizing Project, which was responsible for some of those protesters from yesterday, has more in store for today:

A recent study shows sixty-eight percent of working class Texans don’t know they’d be covered under the health care expansion if it comes to the Lone Star State, but community activists from Texas Organizing Project want to change that. They’re meeting in Austin to lay out their “Find the 1.5” campaign which sets an ambitious goal to identify the 1.5 million Texans that would benefit from Health care Expansion. They’ll be joined by State Senators Rodney Ellis, Wendy Davis and Sylvia Garcia for a press conference laying out the details of the campaign where they’ll canvass clinics, grocery store parking lots and neighborhoods in Dallas, Houston, San Antonio and the Rio Grande Valley to inform and organize those poised for coverage under the expansion.

“I didn’t know I would qualify for coverage until someone showed me the details,” said Gloria Payne who chairs the health care campaign in Houston. “We’re not going to sit back and let them make decisions for us, we want in on the conversation,” concluded Payne. The campaign will begin it’s neighborhood rollout Wednesday in Houston and the Rio Grande Valley, Thursday in San Antonio and Friday in Dallas.

Who: State Senators Rodney Ellis, Wendy Davis and Sylvia Garcia; Texas Organizing Project and allied organizations.

What: Press conference for statewide neighborhood rollout campaign to “Find the 1.5” million working, uninsured Texans that would benefit from health care expansion.

When: Tuesday, April 2, 2013 at 10:00 AM

Where: Texas State Capitol, Lieutenant Governor’s Press Room, Room 2E.9

The limits of the Arkansas option

I’ve mentioned the Arkansas option for expanding Medicaid several times, under which the state uses Medicaid money to buy private health insurance for those who would be eligible for Medicaid under the Affordable Care Act. It’s not my preferred solution, but it has some merits and would certainly be better than doing nothing. However, while the federal government has shown a great deal of flexibility in allowing an arrangement like this and like what is on the table in Florida if their legislature doesn’t deep-six it, that flexibility has its limits, as the state of Tennessee found out.

It’s constitutional – deal with it

Tennessee wanted to pursue a plan like that of Arkansas, one where it would use the Medicaid expansion dollars to buy private insurance coverage. And while Arkansas received a preliminary go-ahead from HHS, Gov. Bill Haslam had a quite different experience: He says that Health and Human Services would not support his plan to expand Medicaid and, as a result, he will not move forward.

“As a result of the lack of clarity from HHS,” his office said in a late Wednesday statement, “the governor will not ask the General Assembly for approval to accept the Medicaid expansion federal funds as he continues to work for the flexibility needed to implement his plan.”

Haslam told local reporters that the Obama administration didn’t reject the entire proposal. “Of our request to Medicaid,” he said, “we got one or two yes’s, one or two no’s, and a whole lot of I don’t knows.”

[…]

But some of the other points in the Tennessee proposal might have raised eyebrows in the Hubert Humphrey Building. The governor proposed “co-pays for those who can afford to pay something.” As for what that would mean in practice, Andy Sher at the Chattanoga Times Free Press reports that the governor wanted Medicaid beneficiaries to pay the same cost-sharing as other exchange enrollees.

Medicaid experts I’ve spoken with have made it clear that such an approach wouldn’t fly: Even if they receive private coverage, the Medicaid agency would need to ensure they aren’t spending more out of pocket than they would in the public plan.

Officials in Arkansas agree with this interpretation, too. “Medicaid definitely has strict rules for people below the poverty line and then they issued some new rules this year, for people above the poverty line,” Arkansas Medicaid spokeswoman Amy Webb told me last month. “We still believe those apply, and we intend to follow those.”

I bring this up because while there has been some talk about the “Arkansas solution” among Texas Republicans, what they’re really talking about is more akin to the Tennessee proposal. Specifically, “copays, deductibles and premium payments on a sliding scale for poor patients, using asset testing to ensure services are going to people who truly need them” are among the items Rick Perry and his ideological cohorts are demanding. The shell bill filed by Rep. John Zerwas that would direct HHSC to negotiate with the Obama administration over a “Texas solution” includes this language, though it’s not clear to me if it’s an option or a requirement. If it’s the latter, I think we now know how these negotiations are going to go.

The point I’m trying to make here is that we need to pay attention to the contents of HB 3791 and listen carefully to what people like Rep. Garnet Coleman have to say about it. If the final bill includes demands for things that the feds have already categorically rejected, then we need to be aware of that up front. Because if it does contain such a requirement, then we need to be prepared for when Rick Perry claims that he “tried” to negotiate with the Obama administration but they were too inflexible and unwilling to compromise so we can call it out for the BS that it is. If Texas negotiates in good faith, the feds have shown that they can be very accommodating. If not, we shouldn’t be surprised when the negotiations fail, and we shouldn’t let the state claim that they made a legitimate effort. Perry and his cronies have made it abundantly clear that they really, really don’t want to expand Medicaid. We should take them at their word and not be distracted by side issues.

Businesses say they want Medicaid expansion, too

This really comes down to two things.

It’s constitutional – deal with it

Chambers of commerce representing companies such as Exxon Mobil Corp. (XOM) and Kimberly-Clark Corp. (KMB) are challenging Texas Governor Rick Perry and lawmakers to expand health care for the poor in the state with the highest percentage of uninsured people.

The chambers of five cities are sending lobbyists to press Republican leaders to increase Medicaid coverage under President Barack Obama’s health-care law.

Businesses are often allied with Perry, a failed contender for last year’s Republican presidential nomination. The chambers, however, argue Texas shouldn’t pass up $100 billion over the next decade to cover 1.5 million adults. Obama’s plan would pay all costs until 2016, then the state’s share would gradually increase to 10 percent in 2020. Perry says that’s too expensive.

“This may be the only time that we have taken an actual formal position that is opposite that of the governor,” said Richard Dayoub, chief executive officer of the El Paso Chamber of Commerce. “I don’t know of any issue that has created so much concern across the state and has amassed so much support across party lines and throughout the business sector.”

Chambers supporting expansion in Dallas, San Antonio, Fort Worth and Arlington include members ranging from publicly traded companies to small shoe stores and family restaurants, many of them strained by health costs.

[…]

About 29 percent of Texas citizens lack insurance, according to a March 8 poll by Gallup Inc. The state ranked 40th in health last year because 30 percent of residents are obese and one of every four children lives in poverty, according to United Health Foundation, affiliated with UnitedHealth Group Inc. (UNH)

Hospitals have urged expansion because it will reduce expensive and ineffective emergency-room visits, said Stephen Mansfield, chief executive of Methodist Health System in Dallas and next year’s chairman of the 2,100-member Dallas Regional Chamber.

“The eight other Republican governors were just as opposed to this initially as Rick Perry,” said Mansfield, who met with him in February. “They came to understand the economics.”

Chamber lobbyists from Dallas, Fort Worth and San Antonio have discussed Medicaid with legislators during the current session in Austin, officials said. Dayoub of the El Paso chamber spoke with Lieutenant Governor David Dewhurst and House Speaker Joe Straus, both Republicans, and about 35 legislators of both parties.

As a reminder, Progress Texas‘ list of all the groups that have endorsed Medicaid expansion is here. I keep harping on this theme, but it all comes down to whether any elected official feels like they might lose support for their position, and I just don’t see the evidence for that. Chambers of commerce don’t necessarily speak for their member businesses, as anyone who has followed the exploits of the increasingly hard-right US Chamber of Commerce can attest, so it’s not clear how much pressure they could apply to the likes of Rick Perry or Greg Abbott if the wanted to. Maybe they can put some heat on certain individual legislators, but I’m not holding my breath for that, either. People are going to have to lose elections over this, and that’s much easier said than done right now.

Business groups “are looking short term,” said Republican Senator David Duell (sic), a Greenville physician who met with chamber representatives. He said he doubted the Obama administration’s commitment “with the long-term viability of the federal government in question.”

Such opposition is “idiocy,” said Margaret Jordan, a former Federal Reserve Bank of Dallas director who is president of Dallas Medical Resources, a consortium of hospital executives and businesspeople headed by billionaire oilman Ray Hunt. “Medicaid expansion is a win-win for everybody.”

[…]

The tension is evident 330 miles (531 kilometers) west of Dallas in Lubbock, a wind-swept city of 230,000 that is the hometown of 1950s rock ’n’ roll pioneer Buddy Holly and Texas Tech University. Medicaid divides the chamber of commerce, which favors expansion, and Republican Senator Robert Duncan, a lawyer who has served in the legislature since 1989.

After officials at the city’s UMC Health System explained how Medicaid expansion could cushion cost increases, chamber directors unanimously approved a resolution, said Chairman Carlos Morales.

“It’s a lot of money we’d be missing out on,” said Morales, who is executive vice president of Caprock Home Health Services Inc., a company that employs 2,200 in 12 Texas offices.

Duncan, however, says Texas can’t afford the deal because Medicaid crowds out spending for education, parks and other priorities.

“It’s not a free lunch,” Duncan said. He said he was unconvinced by studies by former deputy State Comptroller Billy Hamilton and Waco economist Ray Perryman suggesting expansion would boost the state’s economy by increasing business activity and productivity.

So on the one hand, you have people like Sen. Bob Deuell, who thinks we’re going bankrupt despite trillions having already been cut from the deficit, Medicare costs trending downward, and the entire basis of our medium-term debt-to-GDP ratio being a function of a temporary glut of old people. On the other hand, you have Sen. Robert Duncan, who doesn’t care what a bunch of high-falutin’ economists think when he just knows in his gut that spending money can only be a zero-sum game. Yeah, good luck changing that dynamic. In the meantime, the fanatics at TPPF present their never-gonna-happen case for Medicaid block grants so they can more efficiently deny access to health care to all those shiftless poor people, and the Democratic Congressional delegation chides Rick Perry for his continued mulishness on this topic. EoW and BOR have more.

On managing health care costs

Fascinating story in the Statesman on one approach they are taking to manage health care costs in Travis County.

A new world of health care is unfolding for some chronically ill Austin-area residents like [Marshall] Kettelhut, who was a cook at Long John Silver’s before he became too sick to work in 2010.

Health care providers are being nudged to change by a convergence of events: the 2010 federal health care law; efforts to overhaul government health coverage by innovating; new government payment schemes that reward — and punish — hospitals for performance; and a realization by health care providers that a system of ever-rising costs that pays based on procedures is unsustainable.

Kettelhut is among the first to experience changes that might one day touch almost everyone who receives health care. The treatment he is receiving from two Seton Healthcare Family clinics provides a glimpse into the future of a system being tugged toward paying for quality, not quantity.

“If we are able to spend more time with the patient, their costs are going to go down,” said Dr. Norman Chenven, CEO of Austin Regional Clinic. “They won’t go to the ER and won’t have to be hospitalized. It doesn’t take very much to avoid that admission.”

Toward that end, major hospital systems in Central Texas have paired up with providers such as Austin Regional Clinic to help patients avoid costly and preventable ER visits and hospitalizations. They are targeting the biggest hospital users: chronically ill people, elderly patients and low-income people with complicated health problems.

“What medicine is looking for is value,” said Dr. Ernest Haeusslein, Kettelhut’s cardiologist and medical director of the Seton Heart Specialty Care and Transplant Center.

Right now, the value is in targeting patients like Kettelhut, Haeusslein said.

[…]

Temple-based Scott & White Healthcare has long had a system of integrated electronic patient records, and “doctors and hospitals (are) working with patients to decide what care is appropriate and what care is redundant and has no value,” said Dr. James Rohack, director of the hospital system’s Center for Healthcare Policy.

Like Seton’s work with Kettelhut, Scott & White and St. David’s are experimenting with programs that shower resources and attention on the sickest patients. At Scott & White, frail and vulnerable patients meet with an aide before they leave the hospital and are seen afterward at home for a week or two, said CEO Dr. Robert Pryor.

Scott & White also is keeping its clinics open later to prevent overuse of the ER, he said. And it has opened a free clinic.

“We are focusing on the 20 percent of the population that causes 80 percent of the health care costs,” Rohack said.

Basically, this is the same approach that Harris County is taking with its Chronic Consumer Stabilization Initiative, and it’s based on the idea espoused by Malcolm Gladwell several years back. It’s an eminently sensible way of going about the business of managing costs, and as Harris County has shown it can be a real cost-saver, but it’s also politically risky since it depends of devoting a fair amount of resources to people who are otherwise powerless and generally not terribly sympathetic. The fact that an even greater amount of resources are expended on these people, in a much less effective and efficient fashion, in the absence of such programs, is almost never acknowledged in the arguments against them, but that’s how it goes. I wish Travis County a ton of success, and I hope of a lot of other entities follow their lead, because we’re going to need this example duplicated all over the country if we’re going to get our hands around the health care cost problem.

You can present that “Texas solution” any time now

State Rep. John Zerwas takes to the op-ed pages to assure us that yes, the Republicans really truly do want to do something about the vast number of uninsured people in this state if only they are given the freedom to do it their way.

It’s constitutional – deal with it

The Texas Medicaid program as it presently exists has reached an unsustainable capacity. The current network of hospitals and physicians who care for our state’s Medicaid population has reached a true breaking point. They can no longer welcome new patients under the existing model of coverage.

At the federal, state and local levels, debate has focused on expanding coverage through Medicaid for the nation’s un- or underinsured. This has been a question heavy on the hearts of our state government, healthcare providers and those 1.1 million Texas residents still seeking medical coverage across the state.

It is true that Texas stands to gain coverage for a significant number of now-uninsured residents through any healthcare expansion, but an expansion of Medicaid also results in an expansion of patient need.

As it stands, only about 30 percent of Texas physicians are willing to accept new Medicaid patients. Without reforms, those new patients will still find the Texas healthcare system inaccessible for preventive and primary care, leaving them seeking care in emergency rooms at a continued high cost to Texas taxpayers. The state’s existing system is broken, and placing more pressure on an already broken system sets us up for a crisis.

[…]

No other solution exists for those up to 138 percent of the FPL except for a healthcare expansion that picks up this underserved population. The funding option on the table allows for a significant federal return on our state’s investment. Medicaid expansion, however, is not the answer. Texas needs a Texas-sized, Texas-based and Texas-owned solution.

House Bill 3791 is the birth of such a solution. The bill directs the Texas Health and Human Services Commission to negotiate with the federal Centers for Medicaid and Medicare Services to forge a plan that considers our particular needs, our economy and our unique and growing population. Through House Bill 3791, it is clear that our state must be able to design a Texas-shaped plan while also achieving the flexibility to make these expansion-related decisions without approaching the federal government for approval at every turn.

There’s not really anything new in what Rep. Zerwas has to say, so there’s not really anything new in the three things I have to say about what he said.

1. The reason that so few doctors are taking new Medicaid patients is because the reimbursement rate is so low. Of course, the reimbursement rate is entirely at the discretion of the legislature, which Zerwas doesn’t mention, so this problem is entirely within their power to solve if they wanted to. Yes, that would cost more money, but it’s not like having millions of uninsured people isn’t costing us a ton already.

2. There’s still no clear idea what the Republicans want in a non-Medicaid solution. I presume they’re aiming for something like the Arkansas plan, once their pipe dreams of no-strings-attached block grants are officially beheaded, but nowhere does Zerwas say what he thinks the answer should be.

3. I’ve said it before and I’ll say it again: The Republicans have had ten years to do something about the appalling lack of health care access for so many people in Texas. They have done exactly nothing, unless you count all the things they have done to make the problem worse. The only reason they are doing anything now, however grudgingly, is because they’ve been forced to do it. If it had been up to them, the Affordable Care Act would have been thrown out by the Supreme Court, and they could have gone right back to their preferred system of completely ignoring health care when they’re not cutting its budget. If some kind of system is eventually crafted for the state that the feds will accept, Zerwas and his colleagues will deserve very limited credit for it.

Nine hundred million reasons why expanding Medicaid is a good idea

It’s all about the money.

It’s constitutional – deal with it

Expanding Medicaid could make available at least $900 million in state money that otherwise would be slated for health care as lawmakers work to pay for Texas’ priorities, according to an analysis released Tuesday.

“More efficient health spending means there’s more money available for other needs like water and education,” said Bee Moorhead of Texas Impact, a faith-based advocacy group that commissioned the analysis with Methodist Healthcare Ministries of South Texas Inc. Both groups support Medicaid expansion.

[…]

Moorhead said in a statement that moving people out of programs that are funded piecemeal with general revenue and into “prevention-focused managed care” would “give lawmakers more resources to tackle the other big issues on their plate this session.

The analysis was prepared by Billy Hamilton Consulting. Hamilton is a former longtime state deputy comptroller.

His analysis says that under starting-point legislative budget proposals, at least $1.2 billion in general revenue funds would be spent over the next two years on state programs serving people who would potentially be eligible for Medicaid. Additional federal funds under Medicaid expansion would take the place of that state money, according to the analysis.

Hamilton estimated that Medicaid expansion would require about $300 million in general revenue for state-paid administrative costs in Texas for the next two-year budget period. The Legislative Budget Board previously has cited a $50 million estimate for administrative costs over two years.

Using the higher figure for administrative costs, the groups said that would mean $900 million could be spent on as lawmakers would like – whether on health care or other programs – and it would not count against the state spending cap because it is considered current spending.

The Trib has a breakdown of the numbers. I’m not sure if this is a new report, a previously unpublicized section of the original report from January, or a summation of Hamilton’s testimony – there’s no obvious link on the Texas Impact webpage, and there’s no link or download in the Trib story. It’s also not clear how these numbers might change under an “Arkansas solution” scenario. Private insurance costs more than Medicaid, but the feds are picking up the full tab through 2015, which is the time period covered by this report, so it may not vary for the first two years. The point is that every way you look at it, this is the right thing to do, and the only rationale for opposition is ideology and a deep indifference to the suffering of others. Burka has more.

More concern of convenience

David Dewhurst channels Dan Patrick.

Being immoral makes Dewhurst sad

Dewhurst, noting his differing view from Straus, said he’s a product of public schools and wants to support them, but said he doesn’t want to leave an estimated 315,000 Texas students in academically unacceptable schools.

“I’m mad. I’m mad as hell about that,” Dewhurst said, adding that it takes on average six years to turn a failing school around. He drew applause from the crowd when he said, “We need to focus on the children, not the educators, not the unions.”

Beyond the ability to transfer to better performing public school, the Senate is looking at a “parental trigger” that would allow a high-performing charter school to take over a failing school after two years, Dewhurst said. He also favors a tax credit bill championed by Sen. Dan Patrick, R-Houston, that proposes tuition tax credit for businesses funding scholarships to private and religious schools.

“It is immoral to leave children trapped in failing schools,” Dewhurst said.

How touching. What is apparently not immoral to David Dewhurst is letting thousands of people die every year, including many children and their parents and other loved ones, because they don’t have access to health care. Putting the health and well-being of thousands upon thousands of children at risk because their parents can’t afford to take them to the doctor, or to the dentist, that’s just aces by David Dewhurst. Putting children who do have insurance at risk of losing it by making their parents do extra paperwork in the hope that some will forget and thus save a few bucks in the budget, totally moral as far as David Dewhurst is concerned. (Yes, I know, he eventually came around on that. Eventually.) He’s so freaking moral I can barely stand it. What a shining example of morality for us all to follow. If he and Dan Patrick cared about children one tenth as much as they care about this school choice crap they’re pushing, the state of Texas would be a vastly better place than it is right now.

Obviously, I think vouchers are lousy policy, and I’m deeply skeptical that more charters will necessarily improve educational outcomes. I’m happy to debate those things on the merits if you want to. But with the appallingly abysmal record that Dewhurst and Patrick and all of the other Republicans have on healthcare access, especially healthcare access for children, they can take that pious bullshit and stick it where the sun don’t shine. Their actions speak far louder than their phony words of concern.