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Kathleen Sebelius

Last minute health insurance enrollment help

From the inbox:

It's constitutional - deal with it

It’s constitutional – deal with it

The Houston Department of Health and Human Services (HDHHS) will open four of its multi-service centers on Sunday and extend their business hours next Monday to help people sign up for a health insurance plan by the Affordable Care Act’s March 31 deadline.

HDHHS will open Acres Homes, Denver Harbor, Northeast and Southwest multi-service centers on Sunday, March 30, from 12 p.m. to 6 p.m. It will also extend the four multi-service centers’ business hours on Monday, March 31, until 10 p.m., setting the last ACA enrollment appointment for 8 p.m.

Approximately 99,000 Houston-area residents have enrolled in one of the more than 40 low-cost ACA health plans available in the region. Those without health insurance have only one week left to sign up.

Residents can set up an appointment for one-on-one help from certified application counselors at HDHHS by calling 832-393-5423. The counselors are able to help residents compare health plans and find one that fits their budget and health care needs.

The phone number connects residents to an ACA call center that HDHHS set up as part of the Gulf Coast Health Insurance Marketplace Collaborative, a group of 13 agencies helping people obtain insurance coverage through the ACA.

Certified application counselors and outreach staff with HDHHS and the other agencies in the collaborative have met face to face with more than 151,500 area residents since the enrollment period began in October. They have also reached out or distributed ACA brochures and information to approximately 538,000 people.

Documents needed to enroll during an appointment include:

  • Proof of U.S. citizenship: social security number or copy of U.S. passport for all family members
  • State residency: driver’s license, housing lease or utility bill
  • Income:  W-2 forms or pay stubs; unemployment or disability; social security, pension and retirement income; or copy of 2012 tax return
  • Current health insurance: policy numbers for any current health insurance and information about job-related health insurance
  • Immigration status or legal residency: Immigration document status numbers.

The press release is here, and Stace was also on this. There are going to be a number of rallies and other events aimed at getting people signed up while they still can. Another event, via State Rep. Jessica Farrar, will be Saturday, March 29th from 9:00 a.m. – 1:00 p.m. at the Harris County Department of Education Conference Center, 6300 Irvington Blvd. Anyone who has questions about the exchange or is currently without health insurance is encouraged to attend. Here’s a Trib story about the pre-deadline push.

The Affordable Care Act requires most individuals to purchase health insurance by 2014, specifically by March 31, which will mark the final day of canvassing and enrollment outreach by nonprofits, local governments and community organizations.

At the start of March, 295,000 Texans had selected a coverage plan in the federal marketplace, but the number of total enrollees represents a small fraction of the uninsured in Texas.

National advocates for health reform have homed in on Texas’ enrollment in recent weeks, including U.S. Secretary of Health and Human Services Kathleen Sebelius, who was in Texas last week to promote enrollment efforts, including a final push to mobilize young adults to sign up for insurance through the marketplace.

Enroll America, a nonprofit group promoting the federal health reform law, launched a six-city bus tour through Texas last week to help people enroll in the exchange. Anne Filipic, president of the group, said it has focused on Texas because of the amount of people “who stand to benefit” from the federal health reform.

The organization has also set up a series of enrollment events throughout the state, including the one Donnell attended, as part of the final week of enrollment and is following up with individuals who started their process at one of the events to help them complete their enrollments.

Locally, state Democratic legislators have hosted their own enrollment efforts or have worked with entities like the Texas Organizing Project, a group that advocates for low-income Texans, to host regular enrollment events in Dallas, Bexar and Harris counties.

Federally qualified health centers in Texas also received more than $15 million federal grants to help individuals enroll in the marketplace. Lone Star Circle of Care clinics was among the top recipients in the state, receiving a combined $600,000 in grants to provide enrollment assistance.

Lone Star spokeswoman Rebekah Haynes said its 35 certified application counselors have seen an uptick in demand for enrollment assistance in the last few weeks, and they are working with hundreds of individuals to verify whether they qualify to purchase health insurance through the marketplace.

Texas could have delivered half of the enrollees the Obama administration is banking on. The Kaiser Family Foundation estimates that 3,143,000 Texans are potential marketplace enrollees, but only 9.4 percent of that population has enrolled. (Potential enrollees include uninsured Texans who are U.S. citizens and have incomes above the amount needed to qualify for Medicaid.)

You have to wonder what might have been if anyone in the Republican leadership cared even a little bit about the vast number of uninsured people in Texas. Be that as it may, if you know someone who needs coverage but still hasn’t signed up yet, do whatever you can to encourage them to get it done now. Time is very much running out.

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 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.


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 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.

Premiums for insurance exchange plans released

Guess what? They’re pretty darned affordable.

It's constitutional - deal with it

It’s constitutional – deal with it

“In just 99 days, millions of Americans will finally have the security and peace of mind that have eluded them for years,” U.S. Health and Human Services Secretary Kathleen Sebelius said on a press call, “as coverage starts to kick in on insurance purchased through the new health insurance marketplace.”

To help people comply with the individual health insurance mandate that takes effect on Jan. 1, the federal government will launch an Orbitz-style online marketplace on Oct. 1 for consumers to apply for tax credits and compare and purchase health plans.

According to the federal report released Tuesday night, Texas will have comparatively low premium rates for health plans offered in the federal marketplace compared with other states. The average monthly rate for a standard plan in the 48 states analyzed in the report was $328, while Texas’ was $305. Fourteen states and the District of Columbia will have lower rates on average than Texas for a standard health plan offered in the marketplace.

“Texas has historically had a reasonably competitive insurance market compared to some states,” said Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the federal Centers for Medicare and Medicaid Services. He explained that in some states one insurance carrier may dominate 75 to 80 percent of the market. “Texas has not had that situation,” he said.

Texans will have on average 54 health plan options available in the federal marketplace. The number of available plans will vary depending on the region. For example, people in Austin will have 76 health plans to choose from on average, while people in the Rio Grande Valley will only have 30 options on average.

Four types of plans will be offered in the marketplace: Bronze, Silver, Gold and Platinum. In general, Bronze plans will have lower monthly premiums but higher out-of-pocket costs, while Platinum plans will have the highest monthly premiums but lower out-of-pocket costs. Premium rates and out-of-pocket costs will vary depending on age, the number of people in the household and the region in which the person lives, among other factors. Ultimately, the prices are based on the estimated cost of health care services over the course of a year.

People who have annual incomes between 100 and 400 percent of the federal poverty line will qualify for sliding-scale tax credits to help them purchase a health plan in the federal marketplace. For an individual, that’s an annual income of $11,490 to $45,960; for a family of four, it’s $23,550 to $94,200.

Click over to see some detailed information about what will be available in Texas, or click here to see the full report. Some highlights from the latter:

Individuals will have an average of 53 qualified health plan choices in states where HHS will fully or partially run the Marketplace

  • Individuals and families will be able to choose from a variety of bronze, silver, gold, and platinum plans in the Health Insurance Marketplace, as well as catastrophic plans for young adults and those without affordable options. Health insurance issuers can offer multiple qualified health plans, including multiple qualified health plan choices within a single metal level. In the 36 states in this analysis, the number of qualified health plan choices available in a rating area ranges from a low of 6 to a high of 169 plans. On average, individuals and families will have 53 qualified health plans to choose from in their rating area. Young adults will have an average of 57 qualified health plans to choose from, including catastrophic plans. The average number of choices will likely increase after including final data from state-based Marketplaces, which tend to have greater issuer participation.
  • On average, there are 8 different health insurance issuers participating in each of the 36 Marketplaces included in this analysis. This ranges from a low of 1 issuer to a high of 13 issuers within a state. About 95 percent of the non-elderly population in these 36 states lives in rating areas with 2 or more issuers. Roughly one in four issuers is offering health plans in the individual market for the first time in 2014.

Premiums before tax credits will be more than 16 percent lower than projected

  • The weighted average second lowest cost silver plan for 48 states (including DC) is 16 percent below projections based on the ASPE-derived Congressional Budget Office premiums.11 In 15 states, the second lowest cost silver plan will be less than $300 per month – a savings of $1,100 a year per enrollee compared to expectations. Overall, 95% of the uninsured potentially eligible for the Marketplaces live in states with average premiums below ASPE-derived CBO projected premiums (see Figure 1).
  • Young adults will pay lower premiums and also have the option of a catastrophic plan that covers prevention, some primary care, and high costs in cases of major accident or illness. The weighted average lowest monthly premiums for a 27-year-old in 36 states14 will be (before tax credits): $129 for a catastrophic plan, $163 for a bronze plan, and $203 for a silver plan. More than half of the uninsured potentially eligible for the Marketplaces live in a state where a 27-year-old can purchase a bronze plan for less than $165 per month before tax credits. There are an estimated 6.4 million uninsured Americans between the ages of 25 and 30 who may be eligible for coverage through Medicaid or the Marketplaces in 2014.

Premiums after tax credits

  • Tax credits will make premiums even more affordable for individuals and families. For example, in Texas, an average 27-year-old with income of $25,000 could pay $145 per month for the second lowest cost silver plan, $133 for the lowest cost silver plan, and $83 for the lowest cost bronze plan after tax credits. For a family of four in Texas with income of $50,000, they could pay $282 per month for the second lowest cost silver plan, $239 for the lowest silver plan, and $57 per month for the lowest bronze plan after tax credits.
  • After taking tax credits into account, fifty-six percent of uninsured Americans (nearly 6 in 10) may qualify for health coverage in the Marketplace for less than $100 per person per month, including Medicaid and CHIP in states expanding Medicaid.

It should be noted that it’s not all butterflies and lollipops, as Wonkblog explains.

Health experts say it is a good sign for consumers that premiums have come in lower than expected. Under the law, the plans must offer a basic set of benefits, including mental health and maternity care, which previously were not included in many private plans. Insurers are also forbidden from rejecting or charging people more because of preexisting conditions.

Many experts worried that those factors would drive up the cost of insurance. They partially credit competition on the marketplaces, where people will be able to directly compare plans from different insurance companies, for restraining premiums.

But they warn that premiums don’t tell the whole story.

The low rates are possible in part because insurance companies created special plans that include fewer in-network doctors and hospitals than many current plans.

This may not be a problem for healthy people who currently lack insurance. But those with illnesses may discover that their specialists are not covered by an exchange insurance plan. Low-income people accustomed to a certain community clinic may find that going there is no longer an option. And everyone may encounter long waits to see a doctor.

In addition, many of the lowest-cost plans may carry high deductibles, despite a cap imposed by the law that limits out-of-pocket costs to $6,350 per person per year.

“Despite the fact that the premiums are lower than expected, enrollees on exchanges are likely to face very high out-of-pocket costs before they hit their cap, and they are at risk of being in very narrow network plans that may or may not include all the providers they need access to,” said Caroline Pearson, vice president of health reform at the consulting firm Avalere Health, which did its own report on rates this month.

It’s still going to be a lot better than having no insurance, and for people who are currently paying exorbitant prices for individual plans, or who can’t get insurance at all because of pre-existing conditions, it will be awesome. That will include millions of Texans, some of whom are friends of mine, and all of whom Ted Cruz cares nothing about. Kevin Drum and the Kaiser Family Foundation have more.

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.

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.

State fails to get injunction against terminating Womens Health Program funds

As you know, last year the Lege passed a law that forbade Planned Parenthood from participating in the Women’s Health Program on the grounds that PP does abortions even though none of the PP clinics that participate in the Women’s Health Program perform abortions – they’re in a separate organization all together. The federal government then told Texas it would cut off funds for the WHP, since denying PP’s participation meant denying women their choice of provider, which is against Medicaid regulations. The state then announced it would create its own Women’s Health Program with its own money, but they still wanted those federal funds anyway, and sought an injunction barring the feds from cutting off the funds. They lost.

Right there with them

Texas’ request to force the U.S. Health and Human Services to continue funding its Women’s Health Program was denied Friday, as a judge sided with federal authorities who say the state’s exclusion of Planned Parenthood violates HHS guidelines.

U.S. District Judge Walter Smith’s ruling won’t affect the state’s decision to move forward next year with an entirely state-funded program, even though the state was also seeking to keep its federal funding, said Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission. But Planned Parenthood, which serves more than 40 percent of the low-income women in Texas’ program, questioned whether the state’s efforts would be effective without federal funding or its clinics.


Texas officials say they have created an entirely state-funded program, which, starting Jan. 1, will provide the same services but exclude Planned Parenthood, Goodman said. The program is estimated to cost $40 million a year.

Goodman said the commission had found “pockets of money” in its budget to fund the Women’s Health Program through the end of the current fiscal year, which ends in August. The Legislature will have to pass funding to continue the program from September on, she said.


Joseph Mead, an attorney from the U.S. Department of Justice, said federal law gave Sebelius discretion to approve or deny state funding requests. Medicaid rules also guaranteed patients the chance to choose their provider, Mead said.

“The state wants to have its cake and eat it too,” Mead said.

Smith did not detail why he declined to grant an injunction.

Goodman said the state has signed up more than 1,000 new providers to replace Planned Parenthood, and that its surveys indicated there were enough providers for major metropolitan areas. Officials are still evaluating some smaller and rural areas, she said.

But Planned Parenthood and its supporters question whether participants in the state-funded program will have access to care if the reproductive care provider is excluded. It has sued in state court to be included in the new program.

I agree with Attorney Mead, and I consider this move on Texas’ part to be another admission that they’re not ready to replace Planned Parenthood in the WHP despite their bluster and braggadocio. It would be funny in a pathetic sort of way if the Lege is unable to get that money it needs to keep their WHP program afloat appropriated. Don’t think for a minute there isn’t someone in the Lege who’s misogynistic and zealous enough to want to torpedo the whole thing for some bizarrely sexist reason. Whether such a person is able to make such an attempt is a different question, but I have no doubt there will be someone whose first thought is “why do we even need this at all”.

The Trib interviews Garnet Coleman

The Trib has a too-brief conversation with State Rep. Garnet Coleman on health care and Medicaid. This is the crucial bit:

TT: What do you want out of this meeting with [the Center for Medicare & Medicaid Services]?

Coleman: Two things. One, it’s important that we extend the enhanced FMAP (the Federal Medical Assistance Percentage, or the percent of Medicaid expenses the feds cover — which was enhanced with stimulus dollars to meet the national recession). That would help every state accomplish its goals in terms of dealing with what a recession causes, and the ability to balance their budgets, and it’s a simple fix. [The FMAP ratio is] still 70-30, federal to state, with the enhanced match. The goal is to continue the enhanced match past when it expires in June.

TT: How much would that help Texas alleviate its budget shortfall, estimated at between $15 billion and $27 billion?

Coleman: I worked really hard, and so did other members from across the country, to get that enhanced match, which gave Texas $850 million in real general revenue savings the first time around. If we had that for another year, we would get approximately $2.5 billion in savings. If we had it for another two years, we’d have approximately $5 billion in GR savings. And so this is extremely important. The other piece is, in terms of Medicaid in general, and the use of Upper Payment Limit, or UPL funds (federal funds paid to hospitals to bring Medicaid reimbursements up to Medicare levels), under the current rules, you can’t have a statewide managed care program and get UPL. And then if you did have that managed care system, you’d have to carve out hospitals. The question is whether the federal government will approve [allowing managed care programs to participate in UPL]. I went up in December to have a conversation about that, and I’m going to revisit it with [Deputy Medicaid/Medicare Administrator] Cindy Mann in her office about that.

That sure would make a dent in the budget shortfall, no? It would certainly be nice if our legislative Republicans and our Congressional Republicans got together to help make it happen. Assuming that finding constructive solutions to these problems interests them, of course. In related news, some of those legislative Republicans and our Lite Guv got together with one of the local slash-and-burn interest groups to push some unworkable alternatives for Medicaid. Rep. Coleman points out all of the problems with their approach here.

Rick Perry loves the stimulus

He just hates to admit it.

When 47 state and territorial governors sent a letter on Feb. 22 asking for more federal matching dollars for Medicaid, Perry refused to sign. He likes to talk about how he thinks the American Recovery and Reinvestment Act is a waste of money.

Yet on Aug. 25 Perry wrote an unpublicized letter to Kathleen Sebelius, the health and human services secretary formally requesting that Texas receive the increased federal match for Medicaid. The extension is part of the Education Jobs and Medicaid Assistance Act, and gives states a 3.2 percent increase in the matching funds from January to March 2011, and a 1.2 percentage point increase from April to June 2011. Additional increases are available for each quarter during this period for states with high unemployment rates. This higher matching rate was originally slated to expire at the end of 2010.

Perry’s office released the letter only after the Observer inquired about Perry’s position on the matching funds. It appears the Obama administration has also grown weary of governors like Perry rejecting the stimulus program publicly, and then accepting the funds privately.

Sebelius wrote a you-better-check-yo-self letter on Aug. 16 letting governors know that although President Obama had signed off on the additional funds that 47 of them had requested, those funds would only be made available to states whose governors formally requested them. Apparently Perry blinked in this game of chicken and wrote his letter like a good governor should.

I believe the proper expression here is “Thank you, sir, may I please have another”. While Perry prefers money he can spend unaccountably, he’ll still take whatever he can get. Those $21 billion shortfalls aren’t going to fix themselves, you know. As long as he can still bite the hand that’s feeding him, it’s all good with Perry.

Texas rejects high-risk insurance pools

No big surprise.

Gov. Rick Perry told federal officials Friday that Texas would not participate in health insurance pools for high risk individuals that are being set up under the new national health care law.

Perry, citing some of the same reasons he used to pull out of the Race to the Top education funding grant program in January, said there are not enough health care rules to guide the states. He also said he believes the $5 billion Congress set aside to set up pools in all 50 states for four years is inadequate.

“Most experts believe this amount to be insufficient. In the coming years, state officials could be forced to reduce health coverage, raise premiums or ask state taxpayers to pay for these high-risk pools once federal funds run dry,” Perry said in his letter to U.S. Health and Human Services Secretary Kathleen Sebelius.


Under the new federal law, if states opt out of running a pool, the U.S. Department of Health and Human Services would be allowed to create its own risk pools in those states or contract with an outside party. The pools would be in place until 2014, when health insurance companies no longer would be allowed to deny coverage to people in poor health.

The department announced Friday that 27 states had opted to set up pools to cover uninsured people with medical problems, according to the Associated Press. The department said 15 states had decided not to participate. Texas was not included in that list. Friday was the deadline for states to agree to participate or opt out.

Most of the states rejecting the insurance pools are run by Republican governors.

So they’d rather leave it up to the feds than do it themselves. Kind of an odd message for that crowd to be sending, but one shouldn’t expect consistency. The Trib and Postcards have more.

If you can’t beat ’em, shout ’em down

Ladies and gentlemen, your modern day Republican Party:

Angry teabaggers and other opponents of health care reform are heckling members of Congress at their town hall meetings back home in an effort to sway the debate and drown out reform supporters.

This weekend, a group of teabaggers showed up at a town hall in Philadelphia with Sen. Arlen Specter (D-PA) and Health and Human Services Secretary Kathleen Sebelius. They shouted and booed to drown out remarks from both officials and questions from the audience.

They’ve made their appearance in Texas, too – Mean Rachel was there with a firsthand report. As TPM reports, all this is part of a coordinated national effort, much like the teabagger events themselves were. It’s funny in that way that makes you wince to think about the reactions that a similar Democratic effort at Republican town halls might have engendered, especially in the leadup to the invasion of Iraq. Can’t you just hear the tongue-clucking and see the finger-wagging about the “angry Left” and how out of control it is and how conservatives would never behave like that? Boy, those were the days.

The good news is that at least one target of this thuggish anti-democratic behavior is undeterred by it.

This mob, sent by the local Republican and Libertarian parties, did not come just to be heard, but to deny others the right to be heard. And this appears to be part of a coordinated, nationwide effort. What could be more appropriate for the “party of no” than having its stalwarts drowning out the voices of their neighbors by screaming “just say no!” Their fanatical insistence on repealing Social Security and Medicare is not just about halting health care reform but rolling back 75 years of progress. I am more committed than ever to win approval of legislation to offer more individual choice to access affordable health care. An effective public plan is essential to achieve that goal.

Good for you, Rep. Doggett, especially in pointing out the distinction between activism and astroturfing, which unfortunately some reporters are unable or unwilling to do. May all your colleagues follow your lead. Mark Kleiman has some good advice for them if they need it. McBlogger, John Coby, and Harold Cook have more.

UPDATE: Here’s an example of a town hall meeting that wasn’t disrupted by the teabaggers. Let’s learn the lessons of that.


Who says Republicans don’t have any ideas about health care reform, or anything else for that matter? Here’s Rick Perry’s plan to overhaul the system.

This afternoon, Rick Perry’s office released a letter the governor has sent to Health and Human Services Secretary Kathleen Sebelius. In the letter, Perry once again threatens to invoke the “state’s rights” protections in the 10th Amendment to resist any health care reform passed by Democrats in Washington. (Perry first hit on that rather seditious idea last week.)

Instead of Obama-care, Perry wants the feds to approve a free-market-based plan that Texas officials pitched about 18 months ago.

Under the Perry plan, Texas would divert Medicaid money to allow uninsured Texans to shop for, and buy, health coverage from private insurers.


Perry writes in his letter to Sebelius that his plan “presents a strategic alternative to continued reliance on government-run health care programs and our already overburdened safety net systems of care.”

I have just one question: Does Perry not realize that Medicaid is a “government-run health care program”? Or that using Medicaid money to fund his plan isn’t reducing our reliance on government-funded health care at all?

(Here’s a pdf of Perry’s letter to Sebelius. And, for all the policy geeks out there, here’s a pdf of the original Texas proposal from December 2007.)

Okay, so maybe it’s just that they don’t have any good ideas, or any original ideas. Diverting tax revenues to private industries is certainly something Rick Perry has tried before (*cough* *cough* Accenture *cough* *cough*), with not so good results. What could possibly go wrong this time?