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Ken Janda

Of course Obamacare repeal would have a big negative effect on Texas

I mean, duh.

Right there with them

As many as a half-million Texans could become uninsured under the Republican plan to replace the Affordable Care Act, wiping out at least half the gains the state has made in reducing the number of uninsured residents in recent years, according to health care analysts.

Texas still has the nation’s highest percentage of people without health insurance, but that uninsured rate has dropped significantly, falling to about 19 percent from 26 percent over the past four years. About 1 million more Texans gained coverage under the health care overhaul known as Obamacare, which became law in 2010.

Under the Republican plan to repeal and replace the health care law, 500,000 could lose coverage by 2020, either through changes in federal assistance to purchase coverage and Medicaid, the government health care program for the poor, or the end of individual mandates that require people to have insurance, said Ken Janda, president and CEO of Community Health Choice whose company offers insurance plans on the federal exchanges.

Analysts such as Vivian Ho, health economist at Rice University’s Baker Institute for Public Policy, advocates like Elena Marks, CEO of Houston’s Episcopal Health Foundation, and insurers, such as Molina Healthcare, confirmed Janda’s estimates.

“Certainly, Texas is going to have more uninsured people again,” Janda said. “I don’t see much positive coming out of Congress.”

[…]

Dr. Mario Molina, CEO of the California-based Molina Healthcare, a Fortune 500 company, said in an interview he cannot yet commit that his company will be in the Texas market next year on the exchange because of the uncertainty that currently exists surrounding the promise to repeal and replace the ACA. Currently his company is one of only three insurers who offer ACA coverage in Houston.

“I am very nervous,” he said. “There is little that Congress has done so far that indicates the insurance market will be stable.”

Blue Cross and Blue Shield of Texas, which offers plans on the exchange in every Texas county, including Harris, also expressed concerns about the uncertainty of federal health care policy.

“It’s imperative that we have market stability and regulatory certainty,” the company said in an emailed statement. “We will make decisions about our product offerings for 2018 once we have more information about any legislative or regulatory changes that will be made impacting the individual health insurance markets.

Health care providers, meanwhile, worry what will happen if hundreds of thousands of Texas residents lose insurance. Katy Caldwell, executive director of Houston’s Legacy Community Health, which serves many low-income patients, said fewer insured patients will mean longer wait times as clinic staff become overwhelmed. But a jump in the uninsured rate would create more than inconvenience, she said.

“The thing that really concerns me is people foregoing their medication. I hear it all the time now: ‘I have to choose between food and my medicine’ or ‘I cut my pill in half because I can make a 30-day supply last 60 days,'” Caldwell said. “This has every potential to get worse.”

Honestly, I think that half million estimate is very much on the low end, possibly the optimal scenario under the Ryan bill, which to be sure has no obvious path forward at this time. The provision that would not only freeze Medicaid enrollments but prevent anyone who fails to re-enroll for any reason from ever re-enrolling would surely force many more people off, just as the six-month re-enrollment period for CHIP that was passed by the 2003 Legislature contributed to so many more children going without health insurance. And all that is before we consider the possible chaos in the broader healthcare market. So yeah, if a few years from now we come out of this with only a half million people having lost coverage, I’d consider that to be better than I expected.

Yet another record year for Obamacare signups in Texas

It’s like a trend or something.

It's constitutional - deal with it

It’s constitutional – deal with it

A record 1.3 million Texans signed up for health coverage during the 2016 Affordable Care Act’s enrollment period, topping last year’s number by more than 100,000, according to the U.S. Health and Human Services Department final tally released Thursday.

Houston enrolled 346,822 for 2016 during the three-month sign-up period which began Nov. 1 and ended Jan. 31. Dallas-Forth Worth enrolled 382,669 and San Antonio enrolled 120,351.

Texas has long been the focus of concentrated outreach efforts by federal officials as the state continues to lead the nation in both the number and rate of uninsured. There were an estimated 5 million uninsured Texans when enrollment began, or roughly 20 percent of the state’s population.

In the final week of enrollment the pressure was on in the state, especially in south Texas. Health and Human Services officials said Thursday the blitz of marketing appeared to pay off as eight of 10 markets in the nation that had the fastest rate of growth were in Texas. Those markets are Corpus Christi, Harlingen, Laredo, El Paso, Odessa-Midland, San Antonio, Abilene-Sweetwater, and Lubbock.

[…]

Health and Human Services Secretary Sylvia Burwell said Thursday during a press call that she was especially pleased not only with the increase but that the numbers included about 4 million new customers. Prior to enrollment kickoff, Burwell had tamped down expectations, saying that 2016 might prove difficult to reach those still uninsured.

Adding new customers, especially younger ones who presumably are healthier, “refreshed the risk pool,” said Kevin Counihan, CEO of Health Insurance Marketplace during the same call.

And just remember, Greg Abbott and Dan Patrick and Ken Paxton and Ted Cruz and John Cornyn would like nothing more than to take that health insurance away from all 1.3 million Texans. Remember also that we could double the number of people who are finally able to get affordable health care if we expanded Medicaid. And even though not many people talk about it, we could then double THAT number if the Affordable Care Act were extended to include all people, including undocumented immigrants. If you think that’s a bridge too far, then you need to work on your bridge-building. Trail Blazers has more.

One million plus Texas Obamacare enrollments

It keeps going up.

It's constitutional - deal with it

It’s constitutional – deal with it

Just over one million Texans had signed up on the federal health insurance exchange as of last Saturday, signaling a steady drumbeat of interest and giving local advocates a chance for some celebration.

“I will take it,” Ken Janda, president and CEO of Community Health Choice, a Houston-based non-profit health plan offering insurance plans through the Affordable Care Act’s federal marketplace, said Tuesday when he heard the numbers.

The 1,040,246 Texas enrollees included those signing up for the first time and people renewing existing coverage, according to U.S. Department of Health and Human Services statistics released Tuesday.

Nationally, 8.2 million had signed up as of last week, topping last year’s numbers for the same time period by about 2 million, she said, the agency announced.

“We have never seen this level of activity,” HHS Secretary Sylvia Burwell said during a conference call with reporters and community groups across the country. Calling the demand “unprecedented,” she added: “This is what we wanted to see.”

For comparison, the numbers were 734K in 2014, and 850K for 2015. They won’t change the mind of anyone whose mind needs to be changed, but this law has made a big difference in a lot of people’s lives. People can believe whatever BS they want to believe, but a million people who can see a doctor and who can not have to worry about being bankrupted by an illness know better. Kevin Drum, who looks at the national numbers, has more.

Health insurance exchange open enrollment, Year 3

The challenge, in a nutshell.

It's constitutional - deal with it

It’s constitutional – deal with it

In rural Borden County, 12 people signed up for Obamacare this year.

Livid over the government telling them they must buy something and loath to take anything that looks like a “handout,” the uninsured here are likely to stay that way. As Obamacare’s third open enrollment season began Sunday, this rock-solid conservative community of about 650 people offers a window into the challenges health law advocates face to expand coverage around the country.

“Health care is fine, if you can afford it,” said Brenda Copeland, a middle-aged woman who works at the Coyote Country Store and café, along with her two grown daughters, all of whom are uninsured. Copeland has had health insurance only once in her life, and opted to pay Obamacare’s tax penalty earlier this year rather than buy a plan.

“I hope Obamacare goes down the toilet,” she added.

[…]

Outreach workers who are supposed to educate people here and in other parts of west Texas must travel huge distances to find small pockets of the uninsured — people like Copeland and her daughters, Becky Justice and Rika Law, both married women with children. And all of them think the Affordable Care Act is anything but affordable.

Copeland said her income fluctuates but she made about $19,000 last year; she didn’t know that she would have qualified for significant subsidies to lower her monthly insurance premiums, as well as for lowered co-pays and out-of-pocket costs. A plan for the coming year in the mid-priced, most popular tier would cost about $200 a month, after subsidies are figured in.

When she did learn about the subsidies, she softened her stance slightly and said she might look into it. But she said she’s done just fine without health insurance most of her life and is still angry that the federal government can mandate she has to buy it.

“At this point, I don’t mind them penalizing me,” she said.

Law, her daughter, did take a look at the federal enrollment website HealthCare.gov, but said the plans cost too much for her family of four. She too was unaware that she might qualify for tax credits to lower her premiums.

Her family previously had job-based coverage that cost about $1,000 a month — her husband works in the oil fields, but when oil prices dropped, his hours were cut and the Laws decided they didn’t have the money to cover premiums. The plans she looked at on HealthCare.gov cost even more, about $1,350 a month.

“I understand the benefit of having it,” she says of health insurance. “When you’re trying to juggle everyday bills, that’s when it becomes a problem.”

Her sister Becky Justice, who owns this one-room store on the only road through town, said she had health insurance until mid-2014. She doesn’t agree with Obamacare and, unlike her sister, never even window-shopped for plans. If she needs to see a doctor, she says she’ll go to a community health clinic outside the county and figure out how to pay the bill.

On the one hand, it’s hard to feel sympathy for people who refuse to help themselves. On the other hand, when people’s heads get filled with poison for a long time, it’s hard to overcome that. Keep this in mind when you hear poison producers like the shills at the TPPF talk about the “failure” of Obamacare to cover as many people as it should, as if they had nothing to do with it.

But challenge or no, the work proceeds, and as we go forward I do expect the uninsured rate in Texas to continue to decline. Of course, what could make it take a huge step down remains off the table, at least for now.

The uninsured rate in Texas is 19 percent. There are multiple reasons: the number of low-wage jobs in Texas that don’t offer benefits, cultural and language barriers, and political opposition to health reform. Another reason is that Republican leaders have not expanded Medicaid to more poor people, as 30 other states have done. That part of the law is optional, but by declining the expansion, Texas loses out on billions of dollars in federal funds every year.

There is growing pressure for Texas to expand Medicaid, and supporters are now looking for the right political message that could bring the parties together.

For the moment, Republicans still consider the Affordable Care Act to be political kryptonite. Senator Ted Cruz continues to criticize it. Attorney General Ken Paxton just filed another lawsuit attacking part of it. Governor Greg Abbott has said he won’t consider the Medicaid expansion, because he considers Medicaid a dysfunctional entitlement program that should not be allowed to expand.

In Houston, local leaders want the expansion. Harris County Judge Ed Emmett, a moderate Republican, has supported it for years. The CEO of the taxpayer-supported Harris Health System, George Masi, says he needs the revenue that Medicaid expansion would bring. He’s had to lay off more than 100 employees, and cut back on charity care.

“What is even more profound is that money is going to other states that expanded Medicaid, like New York, California, Connecticut,” Masi said. “And so the taxpayer of Texas is being penalized, if you will, for not taking advantage of that option.”

By emphasizing the impact on taxpayers, Masi and others are framing the issue in terms of economics rather than humanitarian concerns.

“We call it a paradigm shift,” Masi added. “It’s a different way of thinking.”

[…]

In 2013, the Texas legislature took no action on Medicaid expansion. The same thing happened this year.

But more voices are starting to push for change, according to Ken Janda, who runs Community Health Choice, a not-for-profit insurance company in Houston.

Janda said the Texas Medical Association and the Texas Hospital Association are both being more vocal on the issue, as is the Texas Association of Business. The federal Medicaid funds would help the state budget, and inject revenue into the medical sector of the economy.

“Doctors’ offices are able to hire more people. Pharmacies are able to hire more people. That becomes an economic multiplier,” Janda said.

County budgets would benefit as well, because they support safety-net clinics and public hospitals such as Ben Taub, part of the Harris Health system.

“If Texas expanded Medicaid, we would be able to look at reducing local property taxes across the board in all counties, or use those dollars for something besides healthcare,” said Janda.

Janda says the new emphasis on economics could eventually bring the parties together.

“There is some interest now by some Republican state senators because of the potential to reduce local property taxes,” he added.

Janda isn’t naming names yet. He also says don’t expect to see any movement on this issue until after the 2016 presidential election. But he says he is “guardedly optimistic” that Republicans will be willing to discuss a possible Medicaid expansion after that.

Color me very skeptical of that. The Senate has gotten worse, from a problem-solving, get-things-done perspective, in the past couple of elections, and I’m hard-pressed to think of any Republican Senators that will be in the Lege in 2017 that I can imagine having interest in Medicaid expansion. I’d be delighted to be wrong about this, but I sure wouldn’t bet on it. I’ve said this about multiple issues, from things like equality to immigration and Medicaid expansion – things won’t change until someone loses an election over it. I’m sure Ken Janda knows that the Texas Medical Association and the Texas Hospital Association both endorsed Greg Abbott and Dan Patrick in 2014. I know why they did, and I know why the Texas Association of Business did as well, but this is as clear an example of the canonical definition of insanity you’ll ever see. Nothing will change until someone loses an election over this sort of thing. In the meantime, other states will continue to receive the money that we’re turning away in the name of ideology.