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health care

More Obamacare enrollments, still lots more needed

That’s pretty much the story.

It's constitutional - deal with it

It’s constitutional – deal with it

Texas enrollment in the online insurance marketplace created by the Affordable Care Act rose steadily in February but did not meet expectations set forth by the Obama administration, according to figures that the U.S. Department of Health and Human Services released Tuesday.

“As more Americans learn just how affordable marketplace insurance can be, more are signing up to get covered,” Health and Human Services Secretary Kathleen Sebelius said in a call announcing the enrollment data. “We expect that even more will sign up as we approach the March 31 deadline.”

The data is the last to be released by HHS before open enrollment closes on March 31, offering a glimpse at the daunting task facing advocacy groups as they make their final push to sign people up for health coverage.

Texas ranked third behind California and Florida in total enrollments since the launch of healthcare.gov on Oct. 1. As of March 1, 295,000 Texans had selected a coverage plan in the federal marketplace, up from 207,500 the month before.

The number represents a small fraction of the uninsured in Texas, the state with the highest percentage of people without health coverage nationwide. In 2012, more than 6 million Texans, about 24 percent of the population, lacked health insurance, according to U.S. census data.

“That is very low,” said Arlene Wohlgemuth, director of the Center for Health Care Policy at the conservative Texas Public Policy Foundation. “If the goal is to get uninsured people onto the exchange, they are such a long way from doing that.”

Wohlgemuth, of course, was the author of the bill in the 2003 Lege that initiated that disastrous privatization of HHSC, and her fingerprints were all over the bill that cut however many hundreds of thousands of kids off CHIP that same year. In other words, she’s a charter member of the Go Ahead And Die caucus, and as such has Cheney-levels of credibility on anything related to health care.

Be that as it may, the numbers are what they are. We’d like them to be higher, but there’s still time, and millions of people are getting covered regardless of what else happens. The good news is that there will be another open enrollment period in October for next year, and there shouldn’t be any technical problems like there were this time. It may take longer than it should have, but we’ll get there. A statement from the Texas Organizing Project is beneath the fold.

(more…)

Inmates and Medicaid

Other states are doing what Texas has declined to do.

go_to_jail

Being arrested in Chicago for, say, drug possession or assault gets you sent to the Cook County Jail to be fingerprinted, photographed and X-rayed. You’ll also get help applying for health insurance.

At least six states and counties from Maryland to Oregon’s Multnomah are getting inmates coverage under Obamacare and its expansion of Medicaid, the federal and state health-care program for the poor. The fledgling movement would shift to the federal government some of the more than $6.5 billion in annual state costs for treating prisoners. Proponents say it also will make recidivism rarer, because inmates released with coverage are more likely to get treatment for mental illness, substance abuse and other conditions that can lead them to crime.

“When someone gets discharged from the jail and they don’t have insurance and they don’t have a plan, we can pretty much set our watch to when we’re going see them again,” said Ben Breit, a spokesman for the Cook County Sheriff’s Office.

The still-small programs could reach a vast population: At the end of 2012, almost 7 million people in the U.S. were on parole, probation, in prison or locked up in jail, according to the federal Bureau of Justice Statistics. About 13 million people are booked into county jails each year, according to the Washington-based National Association of Counties.

[…]

Medicaid expansion also enables more prisoners to have coverage when they are released. States that don’t expand it can help inmates get subsidized coverage in the insurance exchanges created under the law when they’re released.

Counties in about half the states are responsible for some level of indigent care at hospitals, so getting inmates enrolled can reduce costs, said Paul Beddoe, deputy legislative director for the National Association of Counties.

Cook County has been operating a pilot project to enroll prisoners in Medicaid since April under a federal waiver, while states including Connecticut, Illinois and Maryland and counties such as Multnomah, which includes Portland, have helped hundreds of prisoners apply for coverage under the Affordable Care Act since it took effect Jan. 1. California, Ohio, San Francisco and other jurisdictions are starting programs or considering them.

About 90 percent of inmates are uninsured, and many have never had treatment for their illness, Osher said. They have disproportionate rates of communicable and chronic diseases and behavioral disorders, he said. About 488,000 people in U.S. prisons and jails suffer from a mental illness, according to the National Alliance on Mental Illness in Arlington, Virginia.

[…]

The Ohio Department of Rehabilitation and Correction, which plans to start enrolling inmates during the next two months, expects that it will save $18 million a year on hospitalization alone, said Stu Hudson, managing director of health care and fiscal operations.

Ex-prisoners who have insurance will be more likely to get treatment that would help them avoid committing crimes that got them locked up in the first place, Hudson said.

“They’re provided good continuum of care from incarceration through their release into the community and onward,” Hudson said by phone.

We’ve discussed this before. Putting aside the considerable cost savings to the state, the potential impact on the many people that regularly intersect with the criminal justice system who have treatable mental illnesses could be huge. We could save a bunch more money just from the reduced rate of recidivism. There’s really no downside to this. Unfortunately, without a change in state leadership, there’s also no chance of it happening. I don’t really care about the day to day vicissitudes of the Governor’s race. This sort of thing is the prize I keep my eyes on.

More on Texas Left Me Out

The Observer reports on the launch of Texas Left Me Out.

Members of the coalition pointed to two different studies that estimate that thousands of uninsured Texans with chronic conditions are likely to die as a result of not expanding Medicaid.

A Harvard University/CUNY study released last week predicts between 1,840 to 3,035 deaths. Another study, by a University of Texas Medical Branch researcher, projected approximately 9,000 preventable deaths per year. Dr. Robert Luedecke of Doctors for America, a national coalition for healthcare reform, said the death toll associated with the uninsured is something many lawmakers won’t talk about.

“What would people do if they didn’t have health insurance?” Luedecke said of critically ill patients who put off seeing a doctor because they can’t afford it. “They would just die—that’s what they’d do.”

Linda Berman, 63, is one of those who says she’s been left out by Texas. She’s languishing in the coverage gap while dealing with diabetes and high-blood pressure. As a small business owner teaching Science, Technology, Engineering and Mathematics (STEM) skills to kids through a traveling workshop, Berman said she’s left with little to no taxable income at the end of the year. The cheapest individual private plan she’s found comes with a $450 monthly premium—out of her price range. She makes too little to qualify for subsidies on the marketplace and she’s never been eligible for Medicaid under Texas’ strict eligibility standards. Two years ago, Berman racked up $70,000 in medical debt after she was hospitalized.

“I knew I had no money to pay for [the visit] but had I not [paid out of pocket], they wouldn’t have saved my life,” Berman said.

Not long after her hospitalization, a debt counselor told her that she would never be able to pay off her medical debts. Berman soon filed for bankruptcy. The hospital was left holding the bill.

“People without insurance don’t get preventative care,” Berman said. “You don’t die of diabetes, you die of complications.”

See here and here for the background. The Trib also tells Ms. Berman’s story, and adds this extra bit of context to the situation.

State Rep. John Zerwas, R-Richmond, who led efforts to craft “a Texas solution,” said he hoped that the period between legislative sessions would give lawmakers a chance to work on a road for reform. However, he said he wasn’t sure that this particular coalition would have a significant impact, and he said a coalition of businesses concerned with health care issues would have a stronger impact. He said a business-focused coalition would “resonate especially with the conservative Legislature.”

Texas has declined billions of dollars from the federal government to assist with Medicaid expansion and will lose $100 billion in federal funds over a 10-year span, according to a report by Billy Hamilton, a tax consultant and former deputy comptroller, for Texas Impact and Methodist Healthcare Ministries of South Texas Inc. The federal government would cover 100 percent of the Medicaid expansion enrollees’ health care costs from 2014 to 2016, then gradually lower its share of the costs to 90 percent over ten years, resulting in 10 percent of financial responsibility for the state by 2020.

The Texas Association of Business, local government officials, and the state’s largest medical associations, including the Texas Hospital Association, and Texas Medical Association, pushed lawmakers to expand Medicaid during the 2013 session, but the issue still failed to gain traction among Texas’ conservative leadership.

Rep. Zerwas has been an honorable actor in this saga, but I don’t know what he’s talking about here. Look at that last paragraph and the supporters of Medicaid expansion in it. If that’s not a sufficiently business-focused coalition to resonate with the Lege, who else is there? We need a change of leadership at the top. That’s the only way this is moving forward.

The coverage gap

As you may know, the intent of the Affordable Care Act was to get people below a certain income level onto Medicaid, with people at or above that income level receiving subsidized health insurance via the exchanges. Unfortunately, when the Supreme Court ruled that the Medicaid expansion mandate was unconstitutional, it meant that in states that refused to expand Medicaid people who fell below that income level but above the income level for Medicaid eligibility as things were would be left out of coverage – too poor to receive insurance subsidies, not poor enough for Medicaid. More than one million Texas adults fall into that coverage gap. Here’s a story about one of them.

It's constitutional - deal with it

It’s constitutional – deal with it

Damaged discs in Irma Aguilar’s neck make it hard to raise her arms, something she must do repeatedly when stacking boxes at the pizza restaurant where she earns $9 an hour as an assistant manager.

Sometimes, her untreated high blood pressure makes her so dizzy she has to grab onto something to prevent a fall.

And she struggles with anxiety, a heart-pounding fear that can strike at any time, but especially at night, when she lies in bed and wonders how she’s going to make ends meet.

Without insurance, she worries about how she will find the money to treat her health problems, which threaten her livelihood and the well-being of her family.

[…]

Aguilar’s four children are covered by Medicaid, which provides free or reduced-cost health care. But Aguilar makes too much money – $19,200 a year – to qualify. Texas’ Medicaid eligibility requirements are among the tightest in the nation, and Aguilar has to be nearly destitute to meet them – making no more than $4,200 a year as head of a family of five.

Emphasis mine. What that means is that if you make more than two dollars an hour working fulltime, you make too much money as the head of a family of five to qualify for Medicaid in Texas. Think about that for a minute.

Still left out of Medicaid, Aguilar hoped to get insurance under the ACA, but to qualify for a tax credit to help her pay for it, she would need to earn more than she does – at least $27,570 a year. Only those earning between 100 percent and 400 percent of the poverty level are eligible for the subsidies. Aguilar is at 70 percent.

This puts her in the gap, with neither Medicaid nor affordable health insurance.

If she could get a subsidy, Aguilar would have shelled out about $46 a month for a midlevel health plan. Without one, the cost would have zoomed to more than $200 a month, a price that puts health insurance out of her reach.

“I have to scrape by as it is,” Aguilar said. “By the time I pay rent, lights and water, there’s not much left over. Sometimes, I don’t eat so my kids can eat.”

[…]

As Texas rejected the extra Medicaid money, state lawmakers committed more resources to health care in the past session, said Stephanie Goodman, a spokeswoman with the Texas Health and Human Services Commission.

The Legislature set aside $100 million in added money for primary care services for women and an additional $332 million for mental health services, she wrote in an email.

“We’ve also developed a strong network of health centers across the state that provides low-income citizens with access to both preventive care and treatment for medical issues,” she said.

Such clinics depend on a mix of revenue – Medicaid, private insurance and patient fees – to enable them to provide care to those who lack insurance.

But those front-line providers don’t have enough money and resources to care for all the uninsured, including those in the coverage gap, said José Camacho, head of the Texas Association of Community Health Centers.

Nor can health centers provide a broad range of services, making them a too-porous safety net, others say.

“They’re no substitute for not having coverage,” said Anne Dunkelberg, a policy analyst at the Center for Public Policy Priorities, which advocates for low-income Texans. “They can’t provide specialty treatment or trauma care. If you’ve been hurt in a car wreck or have a broken bone or cancer, if you need a CT scan, you’re going to be out of luck. Health centers are wonderful for primary care, but they’re not a substitute for comprehensive care.”

Ms. Aguilar has chronic conditions, as noted above, so these health centers likely wouldn’t be of much good to her anyway, assuming she could afford their fees. Even if she could, she wouldn’t be able to afford any medications they might prescribe. So she’s pretty much SOL. I personally think that Rick Perry, David Dewhurst, Greg Abbott, Dan Patrick, Ted Cruz, and everyone else responsible for Texas’ horrible lack of health insurance for so many of its residents should be made to personally explain to Ms. Aguilar and her kids why they don’t want her to be able to get health care. Not that I think it would have any effect on them, but maybe if they had to explain it to all one million plus Texans that they have excluded from coverage it might eventually wear them down.

I do know one way that Ms. Aguilar and the million others like her could get helped, and that’s by electing Wendy Davis and Leticia Van de Putte this November. No guarantee that they’d be able to overcome legislative resistance, of course, but there was some sentiment for expansion in 2011, and at least they wouldn’t be adding to that resistance. And if the Lege still can’t stand the idea of expanding Medicaid, there’s another way they could help Ms. Aguilar and many others like her: Raise the minimum wage. If Ms. Aguilar earned a bit more than $13 an hour, then her fulltime salary would make it to that magic $27,500 level – which is to say, exactly at the federally defined poverty line – and she’d qualify for insurance subsidies on the exchange. Either way would be fine by me.

ACA enrollments in Texas

As was the case with the rest of the country, there was a big surge in December.

It's constitutional - deal with it

It’s constitutional – deal with it

Texas enrollments in the online insurance marketplace created under the Affordable Care Act rose nearly eightfold in December, according to 2013 figures that the U.S. Department of Health and Human Services released Monday.

Texas ranks third in the number of 2013 enrollments following the troubled launch of healthcare.gov on Oct. 1. As of Dec. 28, nearly 120,000 Texans had purchased coverage in the federal marketplace, up from 14,000 one month before.

The number represents a tiny fraction of the uninsured in Texas, which has a higher percentage of people without health coverage than any other state. In 2012, more than 6 million Texans, about 24 percent of the population, lacked health insurance, according to U.S. census data.

Florida led the nation in the number of 2013 enrollments, with 158,000. In a media call from Tampa, U.S. Health and Human Services Secretary Kathleen Sebelius praised Florida’s high enrollment numbers. Like Texas, Florida has a largely unfavorable political climate toward the Affordable Care Act, and a high rate of the uninsured, at 21 percent. HHS officials offered no explanation for why more people enrolled in some states compared with others.

“The numbers show that there is a very strong national demand for affordable health care made possible by the Affordable Care Act,” Sebelius said in the call announcing the enrollment data, adding that nationwide enrollment had reached nearly 2.2 million.

The Better Texas Blog breaks the numbers down further.

  • 457,382 individual Texans applied for coverage with completed applications, revealing a high level of interest in Marketplace coverage;
  • 390,658 Texans were determined eligible to enroll in a Marketplace plan, and 180,349 Texans were found eligible for financial assistance in the Marketplace. Many of the 210,000 Texans who are eligible to buy in the Marketplace, but ineligible for subsidies likely fall into the “coverage gap” created when Texas leaders refused federal funds to expand health care coverage through Medicaid to Texas adults below the poverty line;
  • 47,177 Texans were assessed eligible Medicaid/CHIP by the Marketplace (a number that would be much higher with Medicaid expansion);
  • 55 percent of Texans who chose a health plan are women; and
  • 26 percent are between the ages of 18 and 34. Young adults are enrolling in the Marketplace, and previous experience from Massachusetts indicates that enrollment by this age group will increase as we near the March 31 enrollment deadline.

These numbers prove that the law and its website are working–more Texans are able to apply for and select health plans that fit their budgets. (Read about our intern’s experience enrolling in a Marketplace plan). People can enroll in the Marketplace through March 31, 2014.

There’s still a lot more growth to come, in other words. Progress Texas adds on.

Ed Espinoza, Executive Director of Progress Texas, released the following statement:

Twelve weeks of ACA has done more to help Texans without health care than Rick Perry has done in twelve years as Governor.

…Texas Still Has a Significant Coverage Gap

In addition to the top-line numbers, a little digging shows how Rick Perry and Greg Abbott’s refusal to expand Medicaid has created a significant coverage gap in Texas:

  • 210,309 Texans who applied for coverage could have received financial assistance for the Marketplace plans.

Many, if not most, of those 210,000+ Texans who couldn’t get financial assistance would have been covered if Texas had expanded Medicaid. We know that one million low-income Texans are left out of health coverage because elected leaders in Texas chose politics over what was right for our people.

Just imagine how many more people could be getting coverage if Rick Perry wasn’t doing everything in his power to stand in the way. Several Texas Congressional Democrats have now sent a letter to AG Eric Holder asking him to step in and do something about Texas’ ridiculous navigator rules, but I don’t really expect anything to come of that. For more on the national numbers, see Jonathan Cohn, TPM, Sarah Kliff, and Ezra Klein.

HHSC publishes rules relating to HB2

HHSC is all in on the omnibus anti-abortion bill passed during the special session this summer.

Texas health officials have a message for the more than 19,000 folks who wrote in to oppose new abortion regulations: Each individual commenter failed to show that clinics will close or that women will face an undue burden under the rules.

In what amounts to a robust defense of Texas’ sweeping new abortion law, the state Health and Human Services Commission is set to publish responses to the crush of public comments it received while wrapping up the last set of regulations for House Bill 2.

Final rules go live Friday in the Texas Register to spell out how the state will implement a portion of the law that requires clinics to meet the standards of ambulatory surgical centers. That document will contain a 16-page preamble to directly address the 19,000-plus commenters who asked regulators to amend the rules to prevent potential widespread clinic closures by carving out waivers for existing facilities

As expected, however, the commission earlier this month gave its blessing to a set of final rules that ignored those requests and instead adhered strictly to legislative intent.

In the document, state health officials argue the new standards will improve patient safety and said the rules are not intended to punish abortion clinics and do not “pose a substantial obstacle to a woman who seeks an abortion in Texas.”

The agency also pointed a finger back at the people who wrote in, saying individual commenters failed to produce even a shred of evidence proving the new rules would cause an undue burden for women seeking an abortion.

“The department is aware of no comments that explain how particular abortion-seeking patients will face unconstitutionally long travel distances, unconstitutionally long wait times, or unconstitutionally high costs for abortion services in any particular part of the state,” according to a copy of the final rules obtained by the Express-News.

The rules are here. It takes a special kind of willfulness to refuse to see any harmful effects of this dangerous and unnecessary legislation, but then these people are Rick Perry appointees, so they’re just doing their jobs. This story only reports on what HHSC was doing, so we go to this Trib story to hear from the folks on the sharp end of HHSC’s antics.

Amy Hagstrom Miller, executive director of Whole Woman’s Health, which operates five abortion clinics in Texas, called the department’s claim that it doesn’t know of any abortion clinics that have closed or will close “preposterous.” She emphasized that the new restrictions have already caused abortion facilities in the Rio Grande Valley, Killeen and Waco to stop performing abortions, leaving thousands of women without access to care.

“Women can still decide to terminate a pregnancy, but thousands of them can no longer actually access safe, professional medical care to receive that termination,” Miller said in an email to the Tribune. “A right is meaningless if you cannot act on it. Without providers, the right to an abortion is an abstraction that does not exist for thousands of Texan women.”

Abortion providers in Texas have challenged the constitutionality of two laws that took effect in November: the admitting-privileges rule and another requiring doctors to follow federal guidelines — rather than a common, evidence-based protocol — when administering drug-induced abortions. The rules finalized on Friday also require abortion facilities to meet the same standards as ambulatory surgical centers starting in September.

Although six abortion facilities already qualify as ambulatory surgical centers, only three of them currently have a physician on staff with hospital admitting privileges. The department wrote in the rules that it’s aware of three ambulatory surgical facilities that abortion providers plan to open in Dallas, San Antonio and Houston by September.

[…]

As the case moves through the courts, roughly a third of abortion providers operating in Texas have discontinued abortion services because they do not have a physician with hospital admitting privileges. Some facilities that discontinued services when the law first took effect now have physicians who have obtained hospital admitting privileges, such as the Whole Woman’s Health facility in Fort Worth.

Planned Parenthood was forced to stop performing abortions at four facilities in Texas when the new law took effect in November because those facilities do not have physicians with such privileges. Planned Parenthood facilities that offered abortions in Bryan, Midland and San Angelo have also recently closed.

Although the finalization of the new rules are a “deeply troubling development,” said Sarah Wheat, vice president of community affairs for Planned Parenthood of Greater Texas, the organization would continue to evaluate its options and take steps to secure women’s access to health services.

“These restrictions will do nothing to protect women’s health and safety, which is why doctors and leading medical groups — as well as thousands of Texans — opposed them,” Wheat said in a statement. “By cutting off access to safe, high-quality medical care, these restrictions will endanger women’s health and safety.”

I suppose one could claim there’s a difference between closing down a clinic that provided abortion services and simply forcing that clinic to stop providing those services, but I daresay it’s a distinction that would be lost on the women who no longer have access to those services. It also rather egregiously ignores the stated intent of Rick Perry, Dan Patrick, and a huge swath of other Republican elected officials, which is to outlaw abortion in Texas, if not in the actual statutes then in the effect of them. If HB2 doesn’t fulfill that goal, then I guarantee you they’ll be back with another bill next session. There’s no end game here – if they succeed at making abortion illegal or impossible, they’ll move on to closing down Planned Parenthood or restricting access to birth control or something else. There will always be something next on their list.

The one thing that won’t be on their list is working to improve health care for women. They claim that that was that goal of HB2, but an amicus brief filed by the American Medical Association and the American College of Gynecologists on behalf of the plaintiffs in the federal lawsuit against HB2 puts the lie to that. From the brief these medical groups filed:

H.B. 2 does not serve the health of women in Texas, but instead jeopardizes women’s health by restricting access to abortion providers and denying women well-researched, safe, evidence-based, and proven protocols for the provision of medical abortion.

[…]

The privileges requirement imposed by H.B. 2 does nothing to enhance the safety of, or healthcare provided to, women in Texas. There is no medically sound reason for Texas to impose a more stringent requirement on facilities in which abortions are performed than it does on facilities that perform other procedures that carry similar, or even greater, risks. Therefore, there is no medically sound basis for H.B. 2’s privileges requirement.

You can see the full brief here (PDF), or click the BOR link above for the highlights. The full appeal of HB2 before the Fifth Circuit is one of many high-profile lawsuits that will be heard beginning next week. There’s still a lot of this story to be told.

Texas Left Me Out

This.

It's constitutional - deal with it

It’s constitutional – deal with it

Obamacare advocates are actively recruiting those left out of the Medicaid expansion in Republican-controlled states to lobby state officials to change their minds and participate in that key provision of the health care reform law.

So far, the effort is most organized in Texas, which is also the state with the most people in that Medicaid expansion gap: 1 million. But it’s likely to pick up elsewhere as the Obama administration and outside advocates apply pressure to the 25 states that have resisted expansion for the first year.

Texas Left Me Out, the combined effort of several community groups, is a website designed to collect those people’s stories and organize them into a cohesive political action constituency. It asks those in the Medicaid gap to sign a petition to stay informed about advocacy events and share their story on the site.

Are they going to turn Texas blue on the backs of people who have traditionally been ignored by Republicans? Are they going to convince an anti-Obamacare stalwart like Rick Perry to buy into the law? That’s a tough sell. But they’re going to try.

“When you personalize a policy, when you make it real, it’s always much more powerful. It’s always going to resonate,” Tiffany Hogue, state health care campaign coordinator at the Texas Organizing Project, one of the groups involved with the campaign, told TPM. “People have really have awakened to the fact that people really are getting left behind.”

Texas Left Me Out had a soft launch in October in preparation for a January rollout. The Texas Organizing Project says it has already contacted 100,000 people who are in the gap and convinced 20,000 to commit to be part of the campaign. They hope that those numbers will grow substantially before the Texas legislature reconvenes in 2015, its next opportunity to expand Medicaid under Obamacare. They’ve set recruitment targets for specific legislative districts to focus their efforts.

The broader coalition is also eyeing the 2014 elections. The presumed Democratic frontrunner for governor, state Sen. Wendy Davis, has enthusiastically endorsed expansion, and a more Democratic legislature would also be more likely to sign onto a major piece of the health care reform law.

The strategy is simple: sheer political force. They’ll ask people to turn up at legislative committee hearings and stage protests at the state capitol. Conference calls and press conferences will be the norm. They aren’t waiting for 2015 either. A group is going to a state insurance department meeting Dec. 20 to rally for expansion.

The website is here. I’m not at all surprised to see that Progress Texas is one of the forces behind it. The goals are ambitious, but we’re not going to get anywhere by thinking small.

And despite the ferocious efforts by Texas Republicans to deny health care coverage to its residents, demand for health insurance is strong.

Texas has the second-highest number of people who have purchased health plans through the embattled online insurance marketplace created by the Affordable Care Act, according to enrollment figures for October and November released Wednesday by the U.S. Department of Health and Human Services.

But as a percentage of the uninsured in the second-largest state — which has the nation’s worst rate of health coverage — the number is tiny: 14,000 Texans had purchased coverage through healthcare.gov by the end of November.

The number of people who purchased coverage in the federal marketplace, which has been riddled with technical problems, was four times higher in November than in October: 137,204 people, including 14,000 Texans, had purchased coverage there as of the end of November, whereas only 27,000 people, including 3,000 Texans, had purchased coverage there at the end of October.

“Evidence of the technical improvements to HealthCare.gov can be seen in the enrollment numbers,” U.S. Health and Human Services Secretary Kathleen Sebelius, said in a press statement.

Florida had the highest enrollment numbers, with 17,900 people purchasing coverage in the federal marketplace, followed by Texas, and Pennsylvania, with 11,800 people purchasing coverage. 2.2 million people, including 245,000 Texans, have now completed applications through the federal marketplace.

Texas has the nation’s highest rate of people without health insurance at 24.6 percent, according to U.S. Census data. About 48 million Americans — including more than 6 million Texans — were uninsured in 2011 and 2012.

Those numbers are two weeks old now, but there’s no indication that the pace has slowed since then. Remember when you hear a Texas Republican whine about Obamacare that they have been in complete control of Texas’ government for over a decade now. If they cared at all about those six million uninsured people, they’ve had ample opportunity to do something about it. But they don’t, so they haven’t. Nothing will change until our state government changes. That’s why efforts like Texas Left Me Out matter.

County jail diversion program moving forward

News like this is always welcome.

Harris County is moving forward with a much-anticipated jail diversion program aimed at reducing the soaring number – and the associated cost – of mentally ill residents who repeatedly cycle through the county lockup.

Harris County Judge Ed Emmett this week announced his pick to head the four-year pilot program, authorized by the Legislature this year. Regenia Hicks, former director of children’s mental health services at Mental Health & Mental Retardation Authority of Harris County, started as program director last week.

The Minneapolis native, 61, is “somebody that’s got a lot of background, experience and training in this,” Emmett said. “She’s familiar with the community here, so I was glad she was available.”

Hicks is tasked with creating a diversion model that state and local officials hope eventually will serve as a template for a statewide program aimed at reducing the jail recidivism rate among mentally ill populations.

[…]

“Our hope is that we’re going to be able to help pull together the existing services that we right now have here in Harris County, layer over some additional services and support that will really be able to stop that kind of revolving door,” said Hicks, who has lived in Houston for 19 years and previously worked as a research scientist for the American Institutes for Research, a Washington, D.C.-based nonprofit behavioral and social science research organization.

Harris County has done a commendable job on expanding mental health services and diverting folks who need treatment to the proper services and away from the jails. Commissioners Court, Judge Emmett, Sheriff Garcia, and a whole mess of non-elected people deserve kudos for it. Imagine how much more they could get done if Texas expanded Medicaid and took advantage of all the mental health and other services that come with it. Harris County would certainly benefit, but that’s out of their hands. We need new leadership at the top for that. Be that as it may, the county is doing what it can with what it’s got, and good on them for it.

Once again, the cost of not expanding Medicaid

We are paying for Medicaid expansion, regardless of what our “leaders” want. The only question is whether we get a benefit from it, or if it all goes to other states.

It's constitutional - deal with it

It’s constitutional – deal with it

If Texas keeps refusing to enlarge Medicaid under the Affordable Care Act, the state will pass up a heap of money, a new study has found.

In 2022, the state would pass up federal money for Medicaid expansion equal to more than twice its haul that year in federal highway aid, according to researchers Sherry Glied and Stephanie Ma of New York University.

Texas would forfeit $9.6 billion of federal Medicaid matching funds in 2022. That’s one-fourth of what the federal government expects to spend on defense contracts in the state that year, the study said.

“No state that declines to expand the program is going to be fiscally better off because of it,” said Glied, a former Obama administration health planning official who is dean of NYU’s Robert F. Wagner Graduate School of Public Service.

Texas Republican leaders have resisted Medicaid expansion, saying federal rules are too rigid and state costs in future years would soar. GOP leaders predict that federal budget cuts and the Affordable Care Act’s rollout problems will force a rollback of the generous pledge of federal funding.

Last year, Texas took $17 billion in federal money for its $28 billion Medicaid program. It currently covers 3.6 million children, pregnant women, seniors and disabled Texans.

More than 1 million poor adults of working age would be added to the program by 2016 if Texas changed course and embraced expansion, according to the state Health and Human Services Commission.

You can see the study here. The usual suspect at the corporate-owned “think tank” TPPF make their usual blatherings about Medicaid being something they don’t like, but they never address two key facts. One is as noted above, that we’re paying for this one way or another, and it’s up to us whether we reap any benefit from it or if we just give it away to New York and California and so on. Two, we’re still paying for the health care of these folks one way or another, too. We pay for it in local taxes when they visit the ER for things that could have been treated more easily and efficiently if they could have done a routine doctor’s visit, and we pay for it in lost productivity and economic potential, especially for the children. Not that the sociopaths at the TPPF care, of course. But we are paying for it. We’re wasting a ton of money doing it the way we are now. We do it differently and get a huge benefit for not much more, and possibly even save a few bucks if we really do it right. Not as long as people listen to the TPPF, though.

Of course Wendy Davis needs to talk about health care

It’s not even a question.

Sen. Wendy Davis

Sen. Wendy Davis

In order for Davis to defeat Attorney General Greg Abbott, her likely Republican opponent next November, political strategists say she needs to win big among two key demographics: Hispanics and white women. Among Hispanics in particular, Davis can’t let her Republican opponent claim more than about 30 percent of the vote.

Texas has a wealth of Hispanics not registered to vote, but with only a year before the election, Davis will need to focus on winning over and turning out registered Hispanic voters. That’s a taller order than in many states; against the national trend, in Texas Hispanics have been more open to supporting Republicans. Because 2014 is not a presidential election year, getting the base to turn out and vote could be a battle.

“The Latino vote will be more important in the Texas 2014 election than it has ever been before in the history of the state,” said Matt Barreto, co-founder of the polling group Latino Decisions. “If Davis can somehow find a way to engage and mobilize Latinos, she will have a very real chance to win.”

That’s where Obamacare comes in – though Davis is unlikely to call it that. Instead, she would be smart to talk about expanding Medicaid.

When Gov. Perry decided not to expand the state’s Medicaid program, turning down $100 billion from the federal government over the next decade under the Affordable Care Act, he consigned up to 2 million Texans to live without health insurance. According to the Kaiser Family Foundation, Hispanics make up 60 percent of the non-elderly uninsured and 34 percent of the poor in Texas. In other words, there are a lot of Hispanics who will not get coverage, or have to pay significantly more for health insurance, without the expansion. Davis needs to persuade them that it is Perry’s fault.

Unlike the rest of the country, or even the rest of Texas, Texan Hispanics do not distrust the Affordable Care Act. Polls last year showed 58 percent of Texan Hispanics want to keep the law, while 60 percent said the government should ensure access to health insurance. “Our polling data has clearly documented access to affordable health care is a very important issue to Latinos in Texas and this could be one of the issues, along with immigration, that could very much help Wendy Davis reach out to [them],” Barreto said. So Davis can issue Hispanics a stark choice: Vote for me and you’ll get health care; stay home or vote for Abbott, and you won’t.

I don’t dispute any of this, but it’s even more basic than that. Before we get to that long awaited/prophesied/hoped-for increase in Latino turnout, before we get to any Anglo suburban women who might be willing to cross over, Wendy Davis needs to make sure that base Democrats turn out. Not just off-year Democrats, but Presidential year Democrats. Some full-throated attacks on Rick Perry, Greg Abbott, and the rest of the Republicans for their fiscally irresponsible and morally reprehensible resistance to every effort to expand access to healthcare in Texas on top of their decade-plus record of doing absolutely nothing to address the problem themselves would be an effective way to get the faithful fired up. It’s a bread-and-butter Democratic issue, and I feel confident saying that Democratic voters want their candidates to be on the offensive. There aren’t enough voters at the margin to put us over the top if we’re not maximizing the voters we know we already have. It ain’t rocket science.

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.