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Medicaid

Where best to attack Culberson?

Flooding is an obvious issue, but it’s hardly the only one.

Lizzie Fletcher

After Hurricane Harvey flooded much of Houston – including the hotly contested Seventh Congressional District – Republican incumbent John Culberson used his position on the House Appropriations Committee to stamp his name on billions of dollars in disaster recovery funds.

By February, he could claim a leading hand in securing $141 billion in congressional appropriations to help the victims of the 2017 hurricanes in Texas, Florida and Puerto Rico.

But as the nine-term congressman faces an unusually tough reelection against Democratic challenger Lizzie Pannill Fletcher, the city’s troubled history of flooding and the federal government’s long backlog of flood control projects has come under sharp political attack.

Fletcher, a Houston attorney making her first run for office, argues that Houstonians are paying the price for Culberson’s small government philosophy and a Republican-led Congress that she says has been slow to fund critical improvements to the Addicks and Barker dams, both aging structures that were deemed to be at “high risk” of failure as early as 2004.

She also has homed in on key votes cast by Culberson, who she labels a climate change skeptic, saying that they undermined flood prevention efforts in Texas and across the country.

“We can’t just look at the last nine months,” she said in an interview. “We need to look at the last nine terms.”

It’s a long story and I encourage you to read the whole thing. Culberson has done some things and was the only Texas Republican to avoid making himself a sniveling hypocrite when he supported federal relief funds for New York and New Jersey following Superstorm Sandy, but the fact that the rest of his caucus opposed such funds, and the fact that his party has so greatly prioritized cutting taxes and slashing spending over investing in infrastructure and solving problems just highlights why he doesn’t deserve a pass for a handful of decent votes. He’s part of the problem regardless, and the only way forward is a change of leadership in Congress. He can push the occasional bill and make the odd budget appropriation, but as long as he’s a vote for a Republican Speaker and a body in the count for a Republican House majority, nothing’s going to get done.

All this said, health care was the issue everyone was talking about earlier on, when the House – including John Culberson – was trying to kill the Affordable Care Act. That battle has shifted from Congress to the courthouse again, and that should bring this issue, on which Democrats enjoy an electoral advantage, to the fore. It’s never going to be a bad idea to remind people that Culberson has worked tirelessly to take their health care away. And since we’re only ever allowed to talk about mental illness when there’s another mass shooting, it’s also always a good time to remind people that the single biggest thing Texas can do to boost mental health care is to accept Medicaid expansion, which again John Culberson opposes with every fiber of his being. Flooding is a great and vital issue, with lots to talk about, but it’s not the only one.

Health care needs to be a twofer

Lt. Governor candidate Mike Collier is on the right track here, but he needs to keep going.

Mike Collier

Lieutenant governor hopeful Mike Collier announced his health care reform plan Tuesday, which aims to reduce costs and increase access to health care in Texas.

“Achieving these goals will not be easy,” Collier said in a statement. “But it’s time to get cracking. Doing nothing — the only skill our current governor and lieutenant governor seem to possess — is no longer acceptable.”

Colliers faces incumbent GOP Lt. Gov. Dan Patrick in November’s general election. Patrick has been a fierce opponent of the Affordable Care Act and any move to expand Medicaid, the health care program for the poor and disabled, to include the working poor.

Collier said Texas’ decision not to pay for health care costs for Texans who cannot afford health insurance is “unbelievably stupid,” and said that using federal dollars to close the coverage gap will bring Texas an estimated $9 billion per year in federal dollars and create as many as 250,000 jobs.

Collier said his plan also includes deploying state money to encourage Texans to buy insurance, which he said will drive down the cost of health care.

Additionally, Collier emphasized price transparency and a “Patient Financial Bill of Rights,” which would require insurance companies to provide health care prices in advance, show the availability of less expensive drugs and procedures, and itemize bills “in plain language,” among other requirements.

This is all good, but it’s missing an opportunity. You’ve heard me say this before, but it bears repeating – over and over and over again – that if we’re really going to talk about improving mental health care, which is all we ever talk about after another mass shooting, then we have to talk about expanding Medicaid, because it’s by far the biggest and best way to pay for mental health care for the people who need it. If we’re not talking about expanding Medicaid, then we’re just flapping our lips when we bring up the “mental illness” shibboleth. We need to keep saying this until it starts to sink in. You took a good first step, Mike Collier. Now please take the next steps.

Senate considers mostly symbolic ideas on school safety

Once again, see if you can tell what’s missing from this discussion.

Nearly three weeks after a shooter killed 10 people at a high school southeast of Houston, lawmakers gathered at the Texas Capitol on Monday to discuss new school safety measures that might prevent another tragedy — and stopped short of rallying behind ideas like adding metal detectors to schools or updating school architecture.

“It’s going to be very difficult to stop every incident,” said state Sen. Larry Taylor, R-Friendswood, discussing the variety of situations in which students could be harmed.

Monday’s meeting came after Lt. Gov. Dan Patrick, a Republican, created the Senate Select Committee on Violence in Schools & School Security to study ways to limit violence in Texas public schools before they reopen in August. Prior to those orders, Abbott had released a 40-page school safety plan with dozens of proposals of his own in response to the shooting at Santa Fe High School.

Lawmakers studied many of Abbott’s ideas Monday, including ensuring that teachers are trained through Mental Health First Aid, a day-long course that trains individuals on how to spot and respond to mental illness and substance abuse. State Sen. Charles Schwertner, R-Georgetown, said around 25,000 school staff members in Texas have already been trained through the program.

[…]

In addition to metal detectors, lawmakers discussed designing schools to prevent threats, like by keeping administrative offices at the front of schools. Legislators also briefly discussed monitoring cameras, limiting school access points and improving locks.

It’s better than blaming everything on doors and video games, but not much more productive. I will take all the usual mutterings about mental health seriously when there’s a real proposal on the table to expand Medicaid, since expanding Medicaid will be by far the single most effective thing we can do to actually help many of the people who have mental health issues in Texas. As for the rest of it, I’m sure they could have some marginal benefit, but it all has the feel to me of talking about installing new windshield wipers when there’s smoke coming from the car engine and you have two flat tires. When are we going to address the real problems?

It’s hard being pregnant in Harris County

We need to figure this out.

Life-threatening, pregnancy-related complications — the iceberg beneath the surface of the U.S. maternal health crisis — are on the rise in Harris County, according to a new report.

The report not only confirmed the Harris County rate is worse than that of the state and nation, it found that it increased more than 50 percent between 2008 and 2015. Texas’ rate of life-threatening, pregnancy-related complications went up 15 percent in the same time period.

“In subtle and unintentional ways, women’s health in Harris County has been subjugated to the health of babies so profoundly that the health of women of childbearing age is often not prioritized,” says the report, a project of the Houston Endowment.

Dr. Lisa Hollier, a Houston obstetrician-gynecologist and a co-chair of the task force that produced the report, said Harris County’s high rates “point to the need for greater intervention to promote safety around the time of delivery. Such complications are 50 times more common than pregnancy-related deaths, but don’t get near the amount of attention.”

Hollier and Dr. Cecilia Cazaban, the report’s principal investigator, said it is unclear why Harris County’s rate is increasing at such a high rate. They said that analysis is next on tap for the task force.

[…]

The new report focuses on severe maternal morbidity, the term for conditions that require such treatment as a respirator or blood transfusions or hysterectomy during delivery or in the immediate hours thereafter. It can lead to maternal death, but even when the patient survives, it can cause damage, such as kidney or heart failure, sometimes requiring lifelong treatment. It also is costly to the patient and health care system.

Harris County’s rate of severe maternal morbidity in 2015 was 2.4 percent, meaning there were 238 cases for every 10,000 deliveries. The 2015 rate was 1.97 in Texas and 1.46 in the United States.

See here for some background. The task force website is here, though I don’t think this report is on there. I hope there’s no need for me to say anything more than we really need to understand this problem so we can solve it.

Texas’ maternal mortality rate not as bad as previously reported

Good news, if a bit puzzling.

Several of the state’s top health experts released a report in the medical journal Obstetrics & Gynecology on Monday showing that by using the new method, the number of women who died dropped from 147 to 56.

The study uses an enhanced method of counting maternal deaths that involves cross-referencing birth certificates, death certificates, hospital discharge data and medical records to confirm that a woman who died was pregnant before she died. The state’s current method of calculating maternal deaths includes using specific medical codes and requiring officials to check a box on death certificates indicating whether a woman was pregnant before she died.

The study said the state’s 2012 maternal death numbers inflated the number of women 35 and older who were classified as a maternal death and included reporting errors in which women who had not been pregnant were reported as maternal deaths. The researchers said they also found 2012 deaths that were not included in the state’s original maternal death numbers.

The authors noted that other states have used the same methodology to calculate maternal deaths. They said they chose 2012 for the new analysis because it was the year when maternal deaths peaked in Texas.

The study’s authors said they plan to use the new method to confirm maternal deaths and calculate maternal mortality rates for additional years.

See here for the background. The story notes that even with the revision, which the authors of the new study attribute to “data error” in the initial report, the mortality rate for black women was still double what it was for white women. There are still other serious concerns as well, as expressed by Lisa Falkenberg:

“I would hate to see us lose the momentum that we’ve gained,” said Dr. Lisa Hollier, an obstetrician and gynecologist at Texas Children’s Hospital.

“We still have women dying of preventable causes,” she said. “We still have a two-fold, a doubling, in the risk of death for African-American women. Those things need to change. I don’t think we should accept where we are.”

Hollier, who co-authored this week’s report and also chairs the Texas Maternal Mortality and Morbidity Task Force, points out that deaths aren’t the only measure of the problem. For every maternal death, Hollier says there are 50 women who experience severe complications that can lead to hysterectomies, breathing problems requiring ventilator support and kidney failure, to name a few.

“If there are 50 women who die in a particular year, there are 2,500 women who had severe complications,” Hollier said. “There are so many more women who are affected than just that tiny tip of the iceberg which is mortality.”

All this happens in a state where as Falkenberg reminds us our Republican leadership has refused to expand Medicaid – something like half of all births in Texas are paid for by Medicaid – and have cut back on access to healthcare for women by gutting Planned Parenthood. The definition of “pro-life” in this state is so narrow you could slide it under a lobbyists’ door. So go ahead and be happy that things aren’t as bad as we feared, but don’t be satisfied with it.

UPDATE: Sophie Novack in the Observer makes a lot of really good points about this revised study. Go read what she says.

From the “Grab that cash with both hands and make a stash” files

Same song, second verse.

If budget writers don’t come up with money to address a state employee pension shortfall and mounting needs for public schools, health care and transportation, credit agencies are likely to downgrade Texas’ AAA rating in the near future.

That was the warning Comptroller Glenn Hegar gave lawmakers at a Tuesday hearing of the Senate Finance Committee in Austin. Though the Texas economy is growing at a healthy pace, Hegar said, the state’s budget is riddled with enough unfunded liabilities to worry credit rating agencies such as Moody’s and Standard and Poor’s.

“We’re not at a crisis,” Hegar said, but “we’re going in the wrong direction.”

A downgrading of Texas’ credit rating would make it more expensive for the state to borrow money — and perhaps damage state leaders’ credibility when advertising Texas as “open for business.”

“I want to avoid that, because I think that’s a black eye on the state of Texas,” Hegar said.

Rebounding oil prices, natural growth and migration to Texas have led to an increase in tax collections, according to the comptroller’s office. But much of that new revenue is already dedicated to historically underfunded programs such as the state highway fund, meaning that Texas lawmakers likely won’t have more money at their disposal in 2019 when crafting the next two-year budget.

At the same time, lawmakers will need to plug holes in the pension system for state employees, and they’ll face pressure to make solvent a health insurance program for retired teachers. On top of that, big bills coming due for Medicaid, the federal-state health insurance program for the poor and disabled that is perennially underfunded by the Legislature, could put the state budget $2.5 billion in the red before lawmakers even convene in 2019. (The state’s current two-year budget is about $217 billion.)

In addition, state leaders will have to tackle the bills from Hurricane Harvey recovery.

I’ll just say again here what I said in January: The vast majority of these issues are the result of deliberate choices made by our Governor, our Lieutenant Governor, and our Republican-controlled Legislature. Instead of seriously addressing the needs of the state, current and future, our Republican leaders have been obsessed with trivia, from bathrooms to plastic bags to trees. We have gotten by and done all right because times have been good, but we are in a far more precarious position for when the economy goes south than we should be. In the meantime, we are squandering this opportunity to ensure a better future for all of us by making such cavalier and ill-advised fiscal choices. Every Democratic candidate running for state office needs to internalize and articulate that message going forward.

From the “Nothin’ but good times ahead” department

Given the good economic conditions in Texas right now, you’d think the budget outlook would be better than it is.

The Texas economy is growing healthily, but that doesn’t mean state budget writers will have more money at their disposal next year, state officials said Tuesday.

In fact, though unemployment is low and tax revenue is on the rise, big bills coming due for the state’s highways and health care programs are giving Texas lawmakers reason for concern.

“I would like to offer a few words of caution for reading too much into the positive recent economic numbers,” Texas Comptroller Glenn Hegar told lawmakers at a Senate Finance Committee hearing.

As they often do, state budget writers last year underfunded Medicaid, the federal-state insurance program for the poor and disabled, which, alongside public education, makes up one of the largest shares of the state’s $217 billion two-year budget.

Then, during a special session called by Gov. Greg Abbott over the summer, state lawmakers shifted another $500 million away from the Texas Health and Human Services Commission to pay for public education programs.

As a result, lawmakers could face a $2.5 billion Medicaid bill shortly after they reconvene in Austin in 2019. Then there are the additional drains on Texas coffers from Hurricane Harvey recovery efforts, Hegar said.

That’s bad news for lawmakers given the comptroller’s prediction that the state will only have a $94 million “beginning balance” when lawmakers convene in 2019. By comparison, lawmakers had an $880 million beginning balance in 2017, which was ultimately a tight year for the state budget. Two years before that, lawmakers enjoyed a $7.3 billion beginning balance.

[…]

Another source of heartburn for budget writers is the ravenous state highway fund. In 2015, amid complaints of a highway system in disrepair, Texans voted to amend the state Constitution to require that up to $2.5 billion in sales tax revenue be dedicated to the highway fund.

That means that even as Texas collects more money from sales taxes — Hegar testified that sales tax revenue grew by an average of 10.3 percent over the last three months — the rest of the state budget will not benefit from that revenue since it is earmarked for the highway fund.

That was also an issue for budget writers in 2017. Last year, in order to free up some of that money for other purposes, Senate lawmakers pushed for an accounting trick that delayed a payment to the state highway fund into the next two-year budget cycle. That freed up about $1.6 billion for lawmakers last year, but it means there will be another bill to pay in 2019.

“In short, despite a strong economy and positive outlook for revenue growth in this biennium, it seems likely the next budget will be much like the one crafted in 2017, having to contend with restricted revenue relative to the spending trends of the state,” Hegar said.

Just a reminder: Underfunding Medicaid was a choice. Shifting money away from HHSC was a choice. The amendment to require all that highway spending was ratified by the voters, but it was there to be ratified because the Lege chose to put it there. Deferring that payment to the highway fund was a choice. And though the story doesn’t include it in its litany, spending nearly a billion dollars on boondoggle “border security” stunts was a choice, too.

We’ll probably be fine in the 2019 session, though the potential for shenanigans is always high. But remember, winter is coming, because it always does. When it does, we’re going to have a mess to clean up, one that was caused by the Republicans in charge of our state, one that could have been mitigated in many ways. I hope we’re ready for it.

(Note: This is the inspiration for the post title.)

State of the County 2017: Ed Emmett versus state leadership

That sound you heard was a fight breaking out.

Judge Ed Emmett

Harris County Judge Ed Emmett on Tuesday used his annual State of the County speech to blast state leaders who he said attack local governments and seek to cut needed taxes but offer no real solutions to the myriad problems Texas’ large urban counties face.

Before a crowd of hundreds at NRG Center, Emmett called on state officials to invest roughly $500 million in a third reservoir and dam to boost area flood control efforts, fund a beleaguered indigent health care system, and revamp “broken” tax policies that force the county to rely on property taxes to serve an unincorporated area that, on its own, would be the fifth-largest city in the country.

In addition to helping with the county’s flood control efforts, Emmett called on the state to contribute more for mental health care and transportation improvements, citing the need for an Interstate 69 bypass on the east side of the county and renewed emphasis on railroads and technology to move freight from area ports.

He also reiterated his call for state leaders to accept increased Medicaid funding from Washington.

“The next time a state official makes a big deal about a fraction of a cent cut in the property tax rate, ask them why they won’t help Harris County property taxpayers fund indigent health care,” the judge said. “State leaders who are eager to seek for disaster relief should also be willing to accept federal dollars to provide health care for poor people. That would be real property tax relief.”

The state, he said, should treat the county more like a city, which by law can levy a sales tax and pass ordinances. The county is an arm of state government and relies on property taxes for most of its revenue.

“The whole point of today’s speech was to say ‘enough is enough,'” Emmett said afterward. “We need to be able to provide the services and the government that people expect in an unincorporated area.”

[…]

Emmett criticized the bills that would have forced the county to get voter approval on taxes and spending.

“Such a populist approach might sound reasonable, but the late British Prime Minister Margaret Thatcher, who nobody ever accused of being a liberal, described direct referenda as ‘a device for dictators and demagogues'” he said.

He also lit into lawmakers’ attempts to limit property tax collections during the last legislative session, saying leaders “attacked counties and cities and other local governments, all the while offering no real solutions.”

“County government relies almost completely on property tax revenue, but the property tax is widely hated, and wholly inadequate as a means of financing the unique urban government that we have. Unfortunately, narrow-minded politics has pushed unfunded mandates from the state onto county government,” Emmett said.

“It is just pure ugly politics. And, by the way, the portion of county taxes paid by business is, I don’t need to tell the business community in this room, growing. We are reaching the point where tax policies are a drag on economic development.”

You can read the whole speech here. Most of the criticisms Emmett made about state leadership and recent political actions are in the story, but the whole thing is worth a read. Oh, and he was introduced by outgoing House Speaker Joe Straus, which was a further provocation. Like the useless demagogues they are, Dan Patrick and Paul Bettencourt responded petulantly in the story. This is another skirmish in the culture wars of the Republican Party, and Republicans who are in the Ed Emmett/Joe Straus camp – including Emmett himself – are going to have to decide next year if they really want the likes of Greg Abbott and Dan Patrick dictating to them. A vote for the status quo is a vote for four more years of the things that Emmett was railing against in his speech.

2017 results: National

Here’s a pretty good indicator of what kind of day it was yesterday for Democrats:

Big win in the Virginia Governor’s race (and the other VA statewide races), despite a couple metric tons of pearls being clutched going into Tuesday. A minimum of 14 seats picked up in the VA House of Delegates, moving that chamber from 66-34 GOP to no more than 52-48, with chances for further gains. Oh, and the single best election result of the day:

Democrat Danica Roem will become the first openly transgender person to be elected and serve as a state legislator, after ousting one of the country’s most anti-LGBT lawmakers in a closely watched Virginia House of Delegates race Tuesday. Her opponent, GOP Delegate Bob Marshall, has served in the state legislature for 26 years. He’s known for writing Virginia’s constitutional amendment banning gay marriage. This year he introduced a “bathroom bill”—intended to prohibit transgender individuals from using the restroom matching their gender identity; his own party killed that proposal in committee.

Roem isn’t the first transgender candidate to win a legislative race, but she will be the first to actually take office. Her campaign focused on issues like fixing the “miserable” traffic on local highways, increasing teacher pay, and bringing jobs to the region. When I asked her last week about the historic nature of the race, Roem said that the truly historic development was that Route 28 will finally be fixed.

“Tonight voters chose a smart, solutions-oriented trans leader over a divisive anti-LGBTQ demagogue—sending a powerful message to anti-trans legislators all across the nation,” Aisha C. Moodie-Mills, President & CEO of the Victory Fund, an organization dedicated to electing LGBT lawmakers that supported Roem’s campaign, said in a statement. “Danica defeated ‘Bigot Bob’ Marshall not because she is transgender, but because she presented a positive vision for her constituents that will improve their lives.”

Virginia isn’t Texas, and that was a district that Hillary Clinton carried in 2016, but I have to think that a few anti-trans Republicans, maybe even here in this state, will take a look at that result and have a second thought or two. We need a whole lot more people to lose elections over being anti-LGBT.

Meanwhile, New Jersey elected a Democratic Governor and made gains in that state’s legislature (both chambers of which Dems already controlled) as well. The state of Maine voted to expand Medicaid over the strenuous objections of their troglodyte governor. And there’s this:

Pushback against Donald Trump helped lift Democrats to governorships in the two highest-profile U.S. elections since the 2016 presidential contest. In Virginia, voters by a 2-1 margin said they were casting their ballot to show opposition to Trump rather than support for him. In New Jersey the margin was nearly 3-1. And Trump’s weak approval rating among voters in Virginia, 40 percent, was weaker still in New Jersey, a dismal 34 percent.

Relatedly, a surge in turnout by politically liberal voters boosted Virginia Lt. Gov. Ralph Northam, as did a broad advantage on health care, which voters by a wide margin identified as the top issue in the vote.

So, maybe being against Trump can be a winner? Just a thought. Yes, of course, you have to stand for something, and the Democratic brand needs some work on that. But Dems are really mad about what happened last year, and that was clearly enough to help push a bunch of them to the polls. I can’t wait to see all the hot takes on this one.

The “death by a thousand cuts” strategy

How To Kill A Health Insurance Market, Non-Legislative Division:

It’s constitutional – deal with it

The move by the White House to quietly end the contracts of two companies key to assisting people enrolling for insurance under the Affordable Care Act caught Houston health advocates off guard – but not by surprise.

Given the temperature in Washington these days and efforts by Congress and President Donald Trump’s administration to let the law fail, they said it was just the latest in a string of actions to sabotage the law known as Obamacare.

“It’s clearly by design,” said Elena Marks, president and CEO of Episcopal Health Foundation and proponent of the ACA and its impact on the uninsured and health access for Texans.

Last week, contracts for Cognosante LLC and CSRA Inc., which helped in signup efforts for the past four enrollment periods in 18 cities, including Houston, were not renewed for a final option year, the Associated Press reported.

[…]

Tiffany Hogue, policy director for Texas Organizing Project, an advocacy group for low- and moderate-income Texans, said she had not heard about the contract cancellations but felt, “in the scheme of things it’s not really a surprise.”

“The intent is to let the law die,” she said.

She said the administration from its first day has seemed determined to undercut the law. Hours after inauguration, the new president signed an executive order directing federal agencies to loosen any regulations surrounding the law that were considered “burdensome.”

Days later, as the 2017 enrollment period was coming to a close, the new U.S. Department of Health and Human Services withdrew funding for the final advertising push traditionally aimed to lure a surge of last-minute enrollees.

Additionally, the 2018 enrollment period is being shortened, cut in half to run from Nov. 1 to Dec. 15 instead of until Jan. 31.

The idea is to push enrollment down so that when it does go down you can point at it and say “look, see, it’s in a death spiral” and then take more obvious action to finish the job. Which may not be necessary now, but it’s Plan B as needed. And all those people who will be sicker and poorer as a result? Just a bit of collateral damage. I’m sure they’ll understand.

Trumpcare would be a hospital killer

This is hardly a new problem, but it’s yet another aspect of Trumpcare that gets too little attention.

Texas hospitals stand to lose billions under the Republican-backed health plan, as federal Medicaid dollars shrink, leading to a rise in uncompensated care, according to a new analysis by the Commonwealth Fund, a national health policy foundation.

The study looked only at the U.S. House plan passed last month. It has not yet examined the impact of the U.S. Senate’s version unveiled late last week, which experts have predicted will bring even deeper cuts to Medicaid.

In Texas, uncompensated costs in the state’s 304 acute care hospitals could increase by 7 percent, rising to $38.4 billion over the next decade, the study found.

That compares with an estimated $35.8 billion over the next decade under the current Affordable Care Act.

At issue is a spike in the number of the nation’s uninsured whose care is often absorbed by hospitals. As many as 23 million Americans could become uninsured over the next decade under the House bill because of cuts to Medicaid, and the recalculation of insurance plans and how people afford them, the Congressional Budget Office estimated late last month.

[…]

Texas already leads the nation in the number of uninsured and hospital executives have cautioned that their institutions would be hard pressed to take a bigger hit should the uninsured rate go higher.

“If people think Harris Health can absorb this, that is a miscalculation,” said George Masi, president and CEO of Harris Health System, in a January interview with the Chronicle.

This is basically what the world was like before the Affordable Care Act. People who had no insurance would use hospital emergency rooms for care when they really needed it, which is inefficient and dangerous and super expensive and many other negative things, all of which get picked up by local taxpayers. There are so many things that are wrong with and bad about the GOP’s “health care” plan that it’s hard to focus on any one thing and even harder to prioritize, but this one is really big. And it will hurt rural areas at least as much as urban areas. Not that the Republicans who represent rural areas care, and it’s not clear that the voters who would be affected have figured it out, or if they have if they’re capable of getting past their faith in the Charlatan in Chief. But the facts are stubborn things. The Rivard Report has more.

State seeks Medicaid money it gave up over Planned Parenthood ban

Ugh.

Right there with them

Four years after Texas gave up millions of dollars in federal Medicaid funds so it could ban Planned Parenthood from participating in a family planning program for low-income women, the state is asking the Trump administration for the money back.

The request presents an important early test for the administration of President Trump, who recently appointed an anti-abortion official to oversee federal family planning programs. Under President Obama, federal health officials would not allow Medicaid funds to flow to the Texas program after it excluded Planned Parenthood, because federal law requires states to give Medicaid beneficiaries their choice of “any willing provider.”

If the administration agrees to restore the funding for Texas, it could effectively give states the greenlight to ban Planned Parenthood from Medicaid family planning programs with no financial consequences.

“They’re asking the federal government to do a 180 on its Medicaid program rules,” said Elizabeth Nash, a policy analyst at the Guttmacher Institute, a research center that supports abortion rights. “And depending how this shakes out, you could see a number of other states follow suit.”

[…]

In its draft waiver application, the state said it hoped that by turning Healthy Texas Women back into a Medicaid waiver program, it would improve access and participation. The application noted that Texas had the nation’s highest birthrate, with more than 400,000 births in 2015, more than half of which were paid for by Medicaid. It also noted than more than one-third of pregnancies in the state were reported as unintended, and that Texas had one of the highest teen birthrates in the country.

On Monday, at a public hearing on the plan in Austin, several women and representatives of health advocacy groups expressed concern about the request.

“A strong Healthy Texas Women program should include Planned Parenthood,” said Blanca Murillo, 25, who said she relied on Planned Parenthood for contraception that helped treat her polycystic ovary syndrome when she was a student at the University of Texas. “I’m asking the state to choose the health of Texas women — which it has a duty to protect — over scoring political points.”

Stacey Pogue, senior policy analyst at the Center for Public Policy Priorities, a liberal research group, pointed to the so-called freedom of choice provision in Medicaid and said she was concerned that “submitting the waiver as is would invite litigation.”

A spokeswoman for the Centers for Medicare and Medicaid Services, or C.M.S., which oversees Medicaid waiver programs, declined to comment.

Carrie Williams, a spokeswoman for the Texas Health and Human Services Commission, said, “We’re been encouraged to present new and innovative ideas to C.M.S. for discussion for possible funding. This is a new administration, and we’re looking at what funding opportunities may exist for us.”

Texas is also seeking to cut off all Medicaid funding to Planned Parenthood; a federal judge blocked the effort earlier this year, but the state is appealing the decision.

It’s for stuff like this that Republicans have remained loyal to Trump regardless of the disaster he creates everywhere. They want their shiny ideological objects, and it doesn’t get much shinier than shivving Planned Parenthood. Who cares if some of the money winds up going to frauds? It’s not like they actually cared about women’s health in the first place. So yes, I expect this request to be granted in short order, and then replicated in other states. The only way to undo that is going to be to undo who is in charge of the government. The Associated Press, the Trib, and the Current have more.

House passes its budget

Mostly shenanigan-free, with a nice little side order of shade for a few people who deserve it.

After 15 and a half hours of debate on hundreds of amendments to the Texas House budget, lawmakers in the lower chamber passed the two-year, $218 billion document, with 131 votes in favor and 16 votes against.

The House vote included using $2.5 billion from the state’s savings account, colloquially known as the Rainy Day Fund. State Rep. John Zerwas, R-Richmond, thanked lawmakers for exhibiting “true leadership” with their willingness to tap the fund, “instead of electing to use an unconstitutional transfer from the transportation funding.”

That was a jab at the Senate, which last week approved its version of the two-year budget using a $2.5 billion accounting trick to free up funds dedicated to highway spending. The House must now work with the Senate, which is under the leadership of Lt. Gov. Dan Patrick, who vehemently opposes using the Rainy Day Fund, to reconcile their budget differences.

House lawmakers, debating the budget late into Thursday night, took several jabs at Patrick and other statewide elected officials throughout the evening.

Included in the fray were Gov. Greg Abbott, who saw one of his prized economic development programs defunded; Patrick, who heard a resounding “no” when his favored proposal to subsidize private school tuition with public funds was put to a vote; and Attorney General Ken Paxton, who lost more than $20 million from his agency’s budget for lawsuits.

On the winning side of the House budget debate were child welfare advocates, who saw funding for foster care and Child Protective Services tentatively boosted; social conservatives, who scored $20 million for the Alternatives to Abortion program; and the lieutenants of House Speaker Joe Straus’ leadership team who, in a display of unity, easily brushed aside most challenges from far-right Republicans.

Statewide GOP leaders took some of the heftiest blows in the House chamber. Lawmakers there voted to strip $43 million from the governor’s Texas Enterprise Fund, the “deal-closing” fund the state uses to lure businesses from elsewhere, and divide it into two equal pots: one for Child Protective Services and foster care funding, the other for a program that pays for disabled children’s physical, occupational and speech therapy services. Both are hot-button issues that have dominated the House’s budget negotiations during this legislative session.

[…]

Private school subsidies, a pet issue of Patrick and his Senate, also suffered a perhaps fatal wound on Thursday. House lawmakers voted 103-44 to prevent state money from being spent to subsidize private school tuition in the form of vouchers, education savings accounts or tuition scholarships. The proposal’s author, state Rep. Abel Herrero, D-Robstown, said it was “in support of our public schools and our neighborhood schools.”

[…]

Paxton’s attorney general’s office also saw funding gutted by House lawmakers who opted to instead fund programs that serve vulnerable children. Foster care funding would receive $21.5 million that was previously intended to pay for Paxton’s legal services budget under a proposal by state Rep. Ina Minjarez, D-San Antonio, that passed 82 to 61.

See here for more on the Enterprise Fund de-funding, which made me smile. Despite promises of shenanigans and roughly a gazillion amendments filed, there was more good done to the budget than bad. Which is not to say it’s a good budget, but it’s far from the worst we’ve ever seen. Take your positives where you can.

Especially when they involve Dan Patrick getting pwned.

In late March, lobbying group Texans for Education Opportunity used an online campaign to generate thousands of letters to 29 state representatives lobbying them to back education savings accounts, one of the subsidy programs in SB 3. Though the group claimed the letters were credible, the letters stirred up suspicion after no representative could find a constituent who remembered adding their name to that correspondence.

Of the 29 representatives targeted in the campaign, 26 voted Thursday to block money from funding “private school choice” programs.

RG Ratcliffe called it a “mugging”. As former Houston Rockets radio announcer Gene Peterson used to say, how sweet it is. Also, too, going back to the first story, there’s this:

Stickland had filed an amendment defund a state program for the abatement of feral hogs, which he’s become known for championing at the Legislature each session. Stickland railed predictably against the program, calling it “ridiculous” and a waste of money.

“It has not worked, and it never will work,” Stickland said, his voice rising.

That apparently offended rural lawmakers, notably state Rep. Drew Springer, R-Muenster. In response, Springer attached an amendment to Stickland’s proposal that would cut the same amount of funding for the Texas Department of Transportation, but only for roads and highways in Stickland’s hometown of Bedford.

Stickland took to the back microphone to cry foul.

“Someone else has chosen to make a mockery of this system and play gotcha politics,” he said before being interrupted. Laughter had erupted in the gallery.

“It’s funny until it happens to you,” he continued.

Springer and Stickland then confronted each other on the middle of the House floor and had to be separated by colleagues. Springer’s amendment ultimately passed, 99 to 26, forcing Stickland to withdraw his own proposal to which it had been attached.

What is best in life is to crush your enemies, see them driven before you, and hear the lamentations of Jonathan Stickland. And Briscoe Cain, too, the Chester to Stickland’s Spike, except without the victorious denouement for Chester. Look, just because the House passed a budget doesn’t mean this is the budget we’ll get. The Senate passed a budget, too, and there are lots of differences to be worked out between the two. The final version will be different, and some of the things we are cheering now may be undone in that. But that’s no reason not to cheer for the things that deserve it now. The Observer and the Press have more.

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.

House considers a bigger ask from the Rainy Day Fund

Needs must, as they say.

The proposal from state Rep. John Zerwas, a Richmond Republican and the House’s chief budget writer, would withdraw about $2.4 billion from the Rainy Day Fund as part of a supplemental budget to pay bills coming due for programs like Medicaid, the federal-state insurance program for the poor and disabled, and to pay for repairs to state-run institutions including mental hospitals and the School for the Deaf.

Previously, Zerwas advocated spending about $1.4 billion from the fund, which holds about $10 billion currently. He updated his proposal at Thursday’s meeting of the House Appropriations Committee, saying that without making a “modest withdrawal” from the savings fund, budget writers would be forced to make draconian cuts to public programs.

Entities that face budget cuts absent a cash infusion include the state’s public education system, pensions for retired teachers, and the Texas child welfare and foster care system charged with protecting vulnerable children from abuse and neglect, Zerwas said.

“Some members of our body have said publicly that our situation isn’t really that bad,” he said. “I can’t disagree more with that.”

Most legislative sessions, the Texas Legislature does not fully fund the cost of state programs, so lawmakers must typically pass a supplemental bill to cover the rest. Zerwas’ proposal would net some matching federal dollars, bringing the total value of the bill to $5.2 billion, officials said. About $3 billion would plug funding holes left by lawmakers in 2015, mostly in Medicaid and in a health care program for the state prison system.

The rest would go toward current needs, such as “deferred maintenance” costs at state-run institutions including mental hospitals, many of which are in disrepair.

See here for the background. I approve of Zerwas’ approach and appreciate what he is saying, but I would be remiss if I didn’t point out that a big part of the problem he is trying to solve is self-inflicted. As the story notes, tax cuts passed in the last session, at a time when oil and gas prices were low and the state’s economy wasn’t doing so well, cost $4 billion this biennium, while the referendum to dedicate a portion of sales tax revenue to the state highway fund has taken $5 billion out of the general fund. Zerwas had to file a separate bill to claw some of that money back. These were choices made by the leadership and the Legislature, the former because tax cuts are Republican crack, and the latter because we absolutely, positively refuse to consider raising the gas tax to meet our road needs. Budget gimmicks are just that, and whatever they purport to do, there’s always another gimmick to undo it. As a certain former President once said, reality has a way of asserting itself.

This is why you leave women’s health to the professionals

Because amateurs and zealots do a lousy job.

Right there with them

In pushing a replacement for the Affordable Care Act that cuts off funds for Planned Parenthood, Republicans are out to reassure women who rely on the major health care organization that other clinics will step up to provide their low-cost breast exams, contraception and cancer screenings.

Texas is already trying to prove it. But one big bet is quietly sputtering, and in danger of teaching the opposite lesson conservatives are after.

Last summer, Texas gave $1.6 million to an anti-abortion organization called the Heidi Group to help strengthen small clinics that specialize in women’s health like Planned Parenthood but don’t offer abortions. The goal was to help the clinics boost their patient rolls and show there would be no gap in services if the nation’s largest abortion provider had to scale back.

The effort offered a model other conservative states could follow if Republicans make their long-sought dream of defunding Planned Parenthood a reality under President Donald Trump. Several states are already moving to curtail the organization’s funds.

But eight months later, the Heidi Group has little to show for its work. An Associated Press review found the nonprofit has done little of the outreach it promised, such as helping clinics promote their services on Facebook, or airing public service announcements. It hasn’t made good on plans to establish a 1-800 number to help women find providers or ensure that all clinics have updated websites.

Neither the group nor state officials would say how many patients have been served so far by the private clinics.

The Heidi Group is led by Carol Everett, a prominent anti-abortion activist and influential conservative force in the Texas Legislature.

In a brief interview, Everett said some of the community clinics aren’t cooperating despite her best efforts to attract more clients.

“We worked on one Facebook site for three months and they didn’t want to do it. And we worked on websites and they didn’t want to do it,” Everett said of the clinics. “We can’t force them. We’re not forcing them.”

Everett said that advertising she planned was stalled by delays in a separate $5.1 million family planning contract.

Everett proposed helping two dozen selected clinics serve 50,000 women overall in a year, more than such small facilities would normally handle. Clinic officials contacted by the AP either did not return phone calls or would not speak on the record.

The Texas Health and Human Services Commission, which awarded the funding to the Heidi Group, acknowledged the problems. Spokeswoman Carrie Williams said in an email that the agency had to provide “quite a bit” of technical support for the effort and make many site visits. She disputed that the contract funding has been as slow as Everett alleged.

“The bottom line is that we are holding our contractors accountable, and will do everything we can to help them make themselves successful,” she said.

See here and here for some background on the Heidi Group. I’m thinking that maybe the reason these clinics didn’t want Carol Everett’s help is because she’s incompetent. Nothing in her history suggests she has any of the relevant skills, and clearly promoting women’s health isn’t her main focus. Anti-abortion activists tend to be pretty hostile to things like contraception, and often are quite ignorant of basic biology, so who can blame the clinics for keeping her at arm’s length. But let’s let Carol Everett herself sum this up:

Asked whether the Heidi Group would meet the patient targets in her contract, Everett said her own goal was to serve 70,000 women.

However, “it’s not as easy as it looks because we are not Planned Parenthood. We are working with private physicians and providers,” Everett said after leaving a committee hearing this week at the Texas Capitol. She said the clinics she is working with are busy seeing 40 to 50 women a day. “They don’t have time to go out and do some of the things that we would really like to help them do. But we’re there if they want to. And we’re there when the need it. And we’re in their offices and we’re helping them.”

Emphasis mine. No, you’re not. And you never will be. Link via the Current.

Texas cannot bar Planned Parenthood from Medicaid

Good.

Right there with them

U.S. District Judge Sam Sparks ruled Tuesday afternoon that Texas clinics affiliated with Planned Parenthood can continue to care for patients under the state’s Medicaid program, a phew-worthy victory for reproductive rights advocates and a loss for the state’s GOP leaders.

In a 42-page ruling, Sparks wrote that the state’s arguments in the case were “the building blocks of a best-selling novel rather than a case concerning the interplay of federal and state authority through the Medicaid program.”

“After reviewing the evidence currently in the record, the Court finds the Inspector General, and thus [the Texas Health and Human Services Commission], likely acted to disenroll qualified health care providers from Medicaid without cause,” the ruling read. “Such action would deprive Medicaid patients of their statutory right to obtain health care from their chosen qualified provider.”

[…]

In court, Planned Parenthood attorneys argued that not allowing the reproductive health provider to stay in the Medicaid program, which is largely funded by the federal government, would severely curb access to care for poor Texas men and women seeking preventive and sexual health services. The attorneys also argued that the state did not have the capacity to deliver these services in the same way Planned Parenthood does and reiterated that state and federal law already prohibit taxpayer dollars from being spent on abortion services.

State attorneys, meanwhile, leaned heavily on the web video throughout court proceedings, pointing out various clips as part of their evidence. While the video appeared to back up their claims, Planned Parenthood attorneys forced several of the state’s witnesses to concede that no employees were seen committing illegal acts in the undercover video.

Throughout the ruling, the phrase “no evidence” appears multiple times. Sparks said Texas Health and Human Services Commission Inspector General Stuart W. Bowen Jr. “did not have prima facie of evidence, or even a scintilla of evidence” for the termination. He cited that the Center for Medical Progress video, the evidence against Planned Parenthood Gulf Coast and dragging in other Planned Parenthood affiliates were “three overarching bases for termination.”

Sparks said that “for those not blessed with eight free hours to watch” the video, it mostly contained a Planned Parenthood Gulf Coast employee and Center for Medical Progress representatives talking in “unclear and ambiguous dialogue” that was open to interpretation. He said the Texas Health and Human Services Commission did not provide evidence that they had authenticated the video before going forward with termination efforts.

While state attorneys tried to show that the reproductive health organization had “a willingness” to profit from procuring fetal tissue, Sparks said he did not find evidence of that.

“The Court is unconvinced mere willingness, without any evidence of attempt, is enough to deprive a Medicaid beneficiary of the right to her otherwise qualified provider,” the ruling read.

See here for the previous update. Shockingly, the fraudulent anti-PP videos made by the lying liars at the Center for Medical Progress turned out to have no evidentiary value for the state. Who’d a thunk it, am I right? I presume the state will appeal from here, and if the Trump scandal machine ever lets up enough to allow legislation to be passed by Congress, a federal bill could be passed to change the law that PP relied on here to get this action overturned. It’s a little premature to celebrate, is what I’m saying. Still, this is a big deal, and it’s always nice to see Ken Paxton lose in court. The Chron, the AusChron, and Trail Blazers have more.

Planned Parenthood still in Medicaid

For now, pending judgment.

Right there with them

U.S. District Court Judge Sam Sparks on Thursday delayed Planned Parenthood’s ouster from the state’s Medicaid program until Feb. 21.

[…]

During closing arguments Thursday hearing, attorneys from both sides cited clips from the video. Sparks said he wanted all involved to review the video footage and present their findings to him Jan. 30.

“I don’t know if I’ll be able to give an opinion [without further review of the video],” Sparks said.

During the final day of testimony, the state continued to make its case that Medicaid patients would still have access to health services without Planned Parenthood’s help.

Jami Snyder, associate commissioner for Medicaid and CHIP, said on the stand that there were 141,000 providers available in the program, including 29,000 primary care physicians and 3,300 OBGYNs. She said the program has “a very robust network” thanks to strict network adequacy requirements for the managed care organizations that help with Medicaid and patients have a variety of tools to help them find a new doctor. She said the available providers dwarf Planned Parenthood’s presence.

“What we know to be true is that a variety of providers in our network offer family planning services,” Snyder said.

But Planned Parenthood lawyers pressed Snyder on provider availability, forcing her to admit she was unsure if all of the Medicaid providers offer weekend hours or walk-in appointments like the reproductive health organization does. Snyder also admitted Medicaid providers do not necessarily offer the exact same services as Planned Parenthood.

Snyder also elicited gasps in the courtroom when she admitted she did not know about surging maternal mortality rates in Texas.

See here and here for the background. The video in question is of course the bullshit Center for Medical Progress video. Way to be on top of breaking women’s health news there, Jami Snyder! With skills like that I don’t know how you weren’t picked to head up HHS in Washington. Trail Blazers, the Current, Newsdesk, and the Chron have more.

Here we go again with Planned Parenthood and Medicaid

Rooting for another injunction.

Right there with them

Texas officials are back in federal court this week over abortion-related policy, this time to defend efforts to oust Planned Parenthood from Medicaid.

Planned Parenthood has asked U.S. District Judge Sam Sparks to block the ouster as illegal, unjustified and unfair — an improperly political move that could deprive about 11,000 low-income Texans of access to contraceptives, cancer screening, breast exams and testing for sexually transmitted infections.

Lawyers for Texas argue that a 2015 video, shot by abortion opponents using a hidden camera, showed a pattern of “gross violations of medical and ethical standards” — as well as human decency — in the fetal tissue donation practices of a Planned Parenthood clinic in Houston.

“The state should not have to wait until it is too late before it can act to protect Medicaid recipients and taxpayers,” lawyers for Attorney General Ken Paxton told Sparks in a legal brief.

Sparks will hear three days of testimony beginning at 9 a.m. Tuesday in his Austin courtroom in a case with a tight deadline. Planned Parenthood is scheduled to be dropped from the Texas Medicaid program Saturday.

One option for the judge is a temporary order blocking the ouster — keeping the status quo until he can research and write an opinion.

That’s what Sparks did when abortion providers sued to block a state rule requiring clinics and hospitals to bury or cremate fetal remains from abortions or miscarriages. After hearing two days of testimony earlier this month, Sparks promised a ruling by the end of next week.

No matter how Sparks rules — in either case — the losing side is expected to appeal, meaning it could be months before the fate of Planned Parenthood or the fetal burial rule is determined.

See here for the background. Yes, the state is actually using those utterly fraudulent Center for Medical Progress videos as evidence for tossing Planned Parenthood from Medicaid. This is basically the equivalent of arguing that because you found a dollar under your pillow this morning, the Tooth Fairy must really exist. I don’t think there’s anything one can add to that. The Trib has a first day of testimony report, and Trail Blazers and the Texas Standard have more.

Back to court for Planned Parenthood

Here we go again.

Right there with them

Planned Parenthood late Friday asked a federal judge in Austin to block plans by Texas officials to kick the organization out of Medicaid.

Calling state plans “nothing more than a politically motivated witch hunt,” Planned Parenthood asked U.S. District Judge Sam Sparks to issue an injunction or temporary restraining order allowing an estimated 11,000 Texans to continue receiving contraceptives, well-woman exams and screenings for cancer and HIV from the organization.

Planned Parenthood received $4.2 million in Medicaid funding in fiscal year 2015, the latest information available, to provide the services to low-income Texans.

A hearing in the case had previously been set for 9 a.m. Jan. 17 in Sparks’ Austin courtroom.

Citing undercover videos shot by abortion opponents and made public last year, Texas officials announced Dec. 20 that Planned Parenthood would no longer be an approved Medicaid provider as early as Jan. 21.

[…]

Planned Parenthood also argued that Medicaid, a joint federal-state program, operates under U.S. rules that allow patients to receive care from the qualified provider of their choice.

Similar efforts to oust Planned Parenthood from Medicaid programs in Louisiana, Alabama, Arkansas, Kansas and Mississippi have all been blocked by courts for violating the federal provider-choice rule, the organization’s lawyers said.

See here for the background. The video is bullshit, produced by known liars, but it’s sufficient as a pretext for the state to do what it has wanted to do for over a year. The only question is whether they’ll get away with it or not. The DMN has more.

Texas follows through on threat to pull Medicaid funds from Planned Parenthood

More than a year after the initial threat was made. Clearly, you can’t rush these things.

Right there with them

After more than a year of delays, Texas is officially kicking Planned Parenthood out of the state’s Medicaid program.

In a move that could affect thousands of low-income women, state health officials on Tuesday delivered a final legal notice to defund the organization from the Medicaid program through which it provides family planning and women’s health services to the poor. Planned Parenthood had previously received $3.1 million in Medicaid funding, but those dollars will be nixed in 30 days, according to the notice which was obtained by The Texas Tribune.

That cut-off day will only be delayed if the organization appeals the state’s decision in the next 15 days by requesting an administrative hearing with the Texas Health and Human Services Commission. But Planned Parenthood officials say they will instead turn to the courts to block the cuts.

“Planned Parenthood continues to serve Medicaid patients and will seek a preliminary injunction in an ongoing lawsuit filed in November 2015, following the state’s original threats to take action against Planned Parenthood’s patients,” said Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes, the organization’s political arm.

[…]

In the final notice, Texas Health and Human Services Inspector General Stuart Bowen said the undercover videos — which depicted Planned Parenthood officials discussing the use of fetal tissue for research — showed “that Planned Parenthood violated state and federal law.”

Bowen claimed in the letter that the videos revealed Planned Parenthood has a history of “deviating from accepted standards” to procure tissue samples for researchers and a “willingness to charge more than the costs incurred for procuring fetal tissue,” among other violations.

“Your misconduct is directly related to whether you are qualified to provide medical services in a professionally competent, safe, legal and ethical manner,” Bowen wrote in the letter. “Your actions violate generally accepted medical standards, as reflected in state and federal law, and are Medicaid program violations that justify termination.”

Planned Parenthood has vehemently denied those claims, and it has criticized the videos the state is pointing to as evidence as being heavily edited to imply malfeasance. Its health centers in Texas have also said they do not currently donate fetal tissue for research. Their Houston affiliate did participate in a 2010 research study with the University of Texas Medical Branch.

State health officials initially alleged they also had “reliable information indicating a pattern of illegal billing practices” by the organization. But Tuesday’s letter made no mention of billing fraud.

The “videos” in question are the ones made by the fraudsters in Houston, who wound up being indicted themselves before those charges were dropped in an oddly-timed fashion. The fact that the state is still citing these fraudulent videos and still making the same wild claims they have never even tried to back up tells you everything you need to know about the strength of their case. There’s already been a lawsuit filed over this, and now that the state has sent a final letter it will move forward, which among other things means the state will have to produce whatever evidence it has. Good luck with that. I should note also that multiple other states have tried this in the recent past, and all of them have lost in court. Some lessons have to be learned the hard way. The Austin Chronicle has more.

An awful lot of Texans could lose health insurance

It sure will suck to be them.

It's constitutional - deal with it

It’s constitutional – deal with it

New public-health studies warn that hasty congressional action toward repealing the Affordable Care Act could have dire consequences for the poor and uninsured both in Texas and nationwide.

The dismantlement of portions of the law, known as Obamacare, without a comparable substitute could mean 2.6 million more Texans would be uninsured, raising the total to 6.9 million by 2019, the Urban Institute, a Washington, D.C.-based think tank for economic and social policy, said Wednesday in a new report.

Texas already leads the nation in the number of uninsured.

“There is good deal of fear,” said Vivian Ho, a health economist at Rice University’s Baker Institute of Public Policy, who has tracked the health care law’s implementation in Texas. “The uninsured rate will be going up under any scenario.”

The fallout from even a partial congressional repeal through a process known as budget reconciliation could also nearly double the national uninsured rate to 21 percent by 2019, the report found. That would be higher than the rate before the ACA went into effect.

[…]

“The rush for repeal, certainly without replacement, is a huge risk for the health and financial stability for Texas. Not just for the poor but for everyone,” said Stacey Pogue, a senior policy analyst for the Center for Public Policy Priorities.

“We don’t just go back to the uninsured rate before the Affordable Care Act,” she said, “the entire individual market becomes destabilized.”

There are two things you can be sure of. One is that any replacement scheme will cover fewer people than are covered now. That’s because Republicans want to cut taxes, and if that means a bunch of people lose access to health care, well, too bad for them. And two, our state government does not care at all about the uninsured population. They’ve had fifteen years to do something about it, and the only thing they have ever done is make cutbacks. If this is what you voted for, then congratulations, you’re gonna get it.

Obamacare: Still working

Down doobie doo down down

It's constitutional - deal with it

It’s constitutional – deal with it

Texas’ rate of uninsured people fell to 17.1 percent in 2015 as part of a steady decline in the share of uninsured residents following the implementation of the Affordable Care Act, according to new Census estimates released Tuesday.

The state’s rate of uninsured fell two percentage points from 2014 to 2015, but Texas still has the highest percentage of people without health insurance in the country. Texas is also home to the largest number of uninsured people in the country with about 4.6 million uninsured residents.

About 5 million Texans were uninsured in 2014, or 19 percent. That’s down from 5.75 million the year before. The 2014 rate — part of the first comprehensive Census data to include a full year of enrollment under President Obama’s signature health law — marked the first time Texas’ uninsured rate fell below 20 percent in more than a decade.

Advocates for the uninsured have argued that Texas could grant insurance coverage to more than 800,000 adults living in poverty here if the state were to expand Medicaid — an optional tenet of the federal health law. But the state’s Republican leadership remains vehemently opposed to any sort of expansion. They’ve criticized Medicaid, the federal-state insurer for the poor and disabled, as an inefficient and broken program.

Also, too:

The number of Americans without health insurance declined to 9.1 percent last year, according to federal data released Tuesday. A set of maps released by the Census Bureau suggests an obvious way to decrease the uninsured rate even more: expand Medicaid in the 19 states that haven’t.

[…]

The report notes that the uninsurance rate decreased among poor people in both kinds of states. The drops in the uninsured rate were bigger for people who made below the poverty level or up to 399 percent of the poverty level in states that expanded Medicaid. Not all the uninsured in each state would qualify for insurance, but a Kaiser Family Foundation analysis, based on last year’s data, found that 19 percent of the population of those states that haven’t expanded Medicaid — close to 3 million people — fell in the coverage gap and would be eligible if Medicaid were expanded.

If it seems like I post this same basic story – with slightly different numbers – every few months, it’s because I do. That’s because the uninsurance rate continues to decline, and the lack of Medicaid expansion is the main reason why it hasn’t declined further than it has. Some 800,000 more Texans could have access to health care if we expanded Medicaid, and that would bring along a long list of other benefits as well. But we haven’t and we won’t, at least not with our current leadership, because they just don’t care about these people. So I’ll keep repeating myself, if only to serve as an ongoing reminder of this.

Oh, and one last thing:

A federal judge faulted the state Medicaid program in a strongly worded order, ruling the program had improperly denied 2,000 out-of-network emergency claims submitted by a nonprofit health care provider that treated indigent children.

U.S. District Judge Keith Ellison ruled last week that the state had failed its obligation to reimburse out-of-network services under the Medicaid Act.

“Without intervention from the Court, the State will continue to refuse to reimburse Legacy for such services,” he wrote.

In May, Ellison found the state had unlawfully handed off in-network reimbursement duties to a managed care organization. The latest ruling came on the second set of arguments by Legacy Health.

Maybe the reason our state leaders hate Medicaid so much is because they’re so lousy at it.

Black women face much higher risk of pregnancy-related death in Texas

Any time you’re being compared to a third world country, it’s not a good thing.

Black women bear the greatest risk for pregnancy-related death in Texas by far, according to a much-awaited new report, commissioned because the state rate resembles that of many Third World countries.

The report, which follows the publication of a national study that found Texas’ maternal mortality rate has doubled since 2011, ranked heart conditions, overdose by legal or illegal drugs and high blood pressure of pregnancy as the leading causes of such deaths.

“This confirms what we feared – that many of these deaths could be prevented,” said state Rep. Armando Walle, D-Houston, the House author of the 2013 bill that created a Department of State Health Services maternal mortality task force and charged it with producing biennial reports and recommendations. “It’s a travesty that this is happening.”

[…]

Marian MacDorman, the University of Maryland-based lead author of the Obstetrics & Gynecology study said she applauds the Texas team for “looking into the deaths in greater detail.”

“Although the Texas Department of Health study uses different methods and data sources from mine, I think we both agree that maternal mortality is a serious problem in Texas,” said MacDorman. “I especially appreciate their policy recommendations for how to reduce it.”

The Texas report found most of the state’s maternal deaths – 60 percent – occurred between 42 days and a year after delivery. MacDorman’s study identified 262 Texas deaths in the same two-year period based only on those who died within 42 days.

Walle said he is hopeful the report makes an impression on the 2017 Legislature.

“I’m not naïve to the fact we haven’t expanded Medicaid, but something needs to be done to increase access to pregnant women,” said Walle. “We can’t keeping letting federal dollars go to other states while these women are dying.”

See here for more about the previous study that showed an overall rise in maternal deaths in Texas. The story lists a number of things that could be done to help this situation, all of which involve expanding access to health care, most of which could be accomplished by expanding Medicaid. Since we know that won’t happen under the current leadership, none of whom has been quoted in a story I’ve seen so far, the question is what if anything they would propose to do about it. My guess is it would involve tort reform and high-deductible health plans, because we know those fix everything. Pro Publica has more.

The Latino health insurance enrollment gap in Texas

We have made great strides in reducing the uninsured rate in Texas thanks to the Affordable Care Act, but there’s still a lot of work to do.

It's constitutional - deal with it

It’s constitutional – deal with it

The percentage of Hispanics in Texas without health insurance has dropped by 30 percent since the Affordable Care Act (ACA) went into effect, but almost one-third of Hispanic Texans ages 18 to 64 remain uninsured.

That’s one of the conclusions of a new report released today by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

The report found the uninsured rate among Hispanics ages 18 to 64 in Texas dropped from 46 percent in September 2013 to 32 percent in March 2016. But even with those gains, researchers estimate approximately 2 million Hispanics remain uninsured across the state. However, nearly half of uninsured Texas Hispanics are currently eligible to get health insurance through ACA plans or other private health insurance, the report said.

“We estimate 920,000 Hispanics are eligible for coverage now, even without Medicaid expansion or any other widespread change in coverage,” said Elena Marks, EHF’s president and CEO and a nonresident health policy fellow at the Baker Institute. “This report clearly shows the need for outreach and enrollment efforts to continue to focus on Hispanic Texans who are uninsured but eligible for coverage.”

[…]

“After three open-enrollment periods of the ACA marketplace, the uninsured rate among Hispanics is still three times that of whites,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute and director of the institute’s Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “The disparity between the two groups remains striking. The Hispanic population is growing at a faster rate than the state average, which makes it increasingly important to the entire state that Hispanics gain affordable health insurance coverage.”

The report shows that although more Hispanic Texans remain uninsured, they enrolled in ACA health insurance plans at twice the rate of whites. Researchers found 21 percent of all insured Hispanics in Texas are covered by ACA plans, compared with only 11 percent of whites across the state.

“This shows that the ACA marketplace is an important source of affordable health insurance for Hispanics,” Ho said.

The report is only nine pages, so go take a look at it. I can tell you that the main reasons for the gap are the failure to expand Medicaid, and a still-significant number of people who have not yet enrolled in any plan. The authors recommend more outreach to the latter subgroup, but that’s easier – and a lot cheaper – said than done. There are numerous community and national organizations that have done a ton of hard work informing people about their health insurance and subsidy options, but they do so in an environment where the state government is actively hostile to them. There’s a reason why some states have lowered their uninsured rates a lot more than some others.

Let’s please get the children covered

Surely that’s not too much to ask.

It's constitutional - deal with it

It’s constitutional – deal with it

Five nonprofit organizations and community groups in Texas, including three in the Houston area, have been awarded a combined $4.78 million by the Centers for Medicare and Medicaid Services to boost efforts to enroll the state’s nearly three-quarters of a million uninsured children, the federal agency announced on Monday.

Texas leads the nation not only in the number of overall uninsured but also in the number of children under age 18 who lack health insurance coverage. More than one in 10 Texas children 18 and younger remain uninsured, according to an U.S. Census analysis and other studies.

The awards to Texas organizations are designed to get more eligible children enrolled in Medicaid and the Children’s Health Insurance Program, commonly known as CHIP.

The Texas groups receiving funds are Gateway to Care, a Houston-based collaborative assisting in access to health care; Lone Star Legal Aid, also of Houston; Children’s Defense Fund-Texas in Bellaire; the Bexar County Hospital District’s University Health System in San Antonio; and the Community Council of Greater Dallas.

Surely we can all agree that having healthy children is in everyone’s best interest. That means ensuring that all children have access to health care, including dental care, which in turn means getting all eligible children enrolled in CHIP. The return on the investment is pretty good, but beyond that, it’s just the right thing to do. This is a concrete and relatively inexpensive thing we can do for the children that we claim as a society to value. You would think that for the political party that is obsessed with “unborn” children and imaginary predators in public bathrooms, that enrolling as many eligible children as possible in CHIP would be a no-brainer. Sadly, that self-proclaimed concern form children never seems to extend that far. It’s a good thing we have the federal government and a passel of caring non-profits to step in and fill the gap.

What do you get when you cut off funds for HIV testing?

You get no HIV testing, of course.

Right there with them

Right there with them

When Texas abruptly ended its $600,000 HIV prevention contract with Planned Parenthood’s Houston affiliate in late December, state health officials promisedthat there would be no interruption in services. The Department of State Health Services parceled the money out to three county health departments in the Houston area and insisted at the time that the counties would have the capacity to pick up where Planned Parenthood left off.

But the Observer has learned that as of early June, Harris County’s health department has yet to perform a single HIV test with the money.

So far, the department has received about $250,000 in state funding but is still in the planning stages for its program. The Fort Bend and Galveston County health departments also received smaller portions of the money — Galveston began providing testing in March; Fort Bend hired its staff and began testing in May.

In the five months since losing its contract, Planned Parenthood Gulf Coast (PPGC) estimates that it would have provided 2,900 HIV tests and distributed around 165,000 condoms. Rochelle Tafolla, PPGC’s spokesperson, said most of its testing was conducted in Harris County, the most populous in Texas and home to nearly 23,000 Texans living with HIV. According to state data, Harris County is home to one in four new Texas HIV cases every year and its diagnosis rate is nearly double the state average. Among the state’s five largest urban counties, only Dallas County has a higher new diagnosis rate.

Martha Marquez, spokesperson for the Harris County Public Health and Environmental Services Department, told the Observer that the department plans to hire three staff members and begin testing “in the coming weeks.”

[…]

Testing individuals at risk for HIV as quickly as possible is “key” for reducing new infection rates, said Daniel Williams, policy and regional field coordinator atEquality Texas.

“It’s unfortunate that an organization that had a proven track record in doing exactly what this contract was intended to do was removed from it,” he said. “It’s doubly unfortunate that the contract was then sent to an agency that doesn’t have the resources to pick it right up without the delay.”

Williams pointed to other organizations in the Houston area that provide HIV testing and might have been better prepared than the county health department to pick up where PPGC left off, such as Legacy Community Health or The Montrose Center.

“Harris County has lagged behind the rest of the state in reducing its HIV infection rate, and this six-month gap in performing testing and getting people into treatment is making the situation worse,” he said.

See here for the background. You know who doesn’t care about any of this? Greg Abbott and Dan Patrick, that’s who. I guarantee, we’ll never hear them talk about this in any way that suggests they recognize there was a problem. They really do care about the sanctity of life, don’t they? Slate has more.

Another story on how Texas’ uninsured rate has fallen under Obamacare

Same book, next chapter.

It's constitutional - deal with it

It’s constitutional – deal with it

A study released Tuesday shows that the rate of Texans without insurance has dropped to its lowest point since the late 1990s because of the Affordable Care Act, Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation reported.

Prior to the implementation of the ACA in September 2013, the uninsured rate in Texas was about 26 percent – more than one in four. By this March, that rate had dropped to about 18 percent, the study said.

Researchers found declines in every age group, ethnic and racial demographic, and across income levels. Texans between the ages of 50 and 64 showed the steepest decline, dropping to 10 percent from 21 percent during that time period.

Those with low to modest incomes of $16,000 and $47,000 also showed big gains in coverage. Their rate of uninsured is now about 13 percent compared to 23 percent in 2013.

“For more than a decade prior to the ACA, the uninsured rate remained above 20 percent and was rising. It’s now clear that it’s moving in the opposite direction and the ACA deserves the credit,” Elena Marks, president and CEO of Episcopal Health Foundation, said in a statement Tuesday.

Despite progress, Texas continues to lead the nation in the number and rate of the uninsured.

In fact, the new study shines a light on a gaping hole in coverage across the state. Nearly half, or 46 percent, of Texans earning less than $16,000 per year remain uninsured, the report shows.

A copy of the report is here, and a compendium of Baker Institute research on the topic of health insurance under the ACA in Texas is here. Another recent study, by the U.S. Centers for Disease Control and Prevention, had Texas’ rate of uninsured residents below 17%, somewhat lower than what this one has. That may reflect a slight difference in methodology or definitions, it’s hard to say. The trend is clear, and so is the fact that by any measure, Texas is still the worst at getting its residents covered. Even among states that did not expand Medicaid, Texas’ uninsured rate is higher than average, as you can see on that first link. And yes, you can make less than $16K a year but not qualify for Medicaid in this state. Basically, unless you’re a child or you’re disabled, you’re SOL as far as that goes. But don’t worry, you can always go to the emergency room and get some service at a much higher cost to a much smaller tax base. That’s how Greg Abbott and Dan Patrick want it to be. Forbes has more.

Texans say they favor Medicaid expansion

This comes with a huge “but” attached to it.

It's constitutional - deal with it

It’s constitutional – deal with it

More than 60 percent of Texans support an expansion of Medicaid here and plan to take those views into the voting booth in November, a new survey commissioned by the Texas Medical Center Health Policy Institute finds.

The survey results, unveiled Wednesday at the annual Medical World Americas convention in Houston, show the public at odds with the state’s Republican leadership, which has steadfastly refused to consider such an expansion, calling it wasteful and a bad solution.

“I understand people in Austin have been reluctant, but I believe what this survey demonstrates is that people want something done to improve access,” said Dr. Arthur “Tim” Garson, director of the Health Policy Institute. “People are looking for help and their choice seems to be Medicaid expansion. A uniquely Texas solution would be best, but we have to do something.”

The findings further resonate in a state that continues to lead the nation in the number of uninsured. Texas remains one of 19 states that has chosen not to expand Medicaid under the Affordable Care Act.

The second annual Medical Center study gauging public opinion on health care issues covered topics ranging from access to health care to the wisdom of raising the price of foods that contribute to obesity.

Of the 1,000 people polled by Nielsen in five states, close to 100 percent said they feel it is deeply important to have insurance for themselves and their family. In Texas, 96 percent value health insurance.

The study’s margin of error is 3 percentage points overall and close to 5 percentage points in Texas.

Beyond self-interest, 91 percent of respondents in Texas, California, New York, Ohio and Florida said it was important to them that everyone in the nation have health insurance.

The sticking point has always been how to get there.

In Texas, 63 percent of those polled said they support an expanded Medicaid program. Similarly, 68 percent in Florida also favored a Medicaid expansion. These numbers are significant because of the states surveyed, only Florida and Texas did not expand the safety-net program, which is jointly paid for with federal and state dollars.

I couldn’t find a copy of the poll googling around, so you’ll have to take the story at its word. The caveat over this, of course, is that none of it matters until someone loses an election over it. Let me say that again in capital letters, for emphasis: NONE OF THIS MATTERS UNTIL SOMEONE LOSES AN ELECTION OVER IT. Greg Abbott doesn’t care what opinion polls say, and there’s not nearly enough support in the Legislature to push the issue. Various county-level Republicans, who feel the effect of paying for health care for a substantial uninsured population directly, support Medicaid expansion, but again, Greg Abbott doesn’t care what they think. Until someone loses an election because they oppose expanding Medicaid – and by this I mean someone who was otherwise expected to win, not someone who was vulnerable because of varying turnout patterns or other exogenous factors – nothing will change.

The latest good news/bad news on Texas uninsured numbers

Good news: Texas’ percentage of uninsured residents continues to drop. Bad news: It’s still higher than what the national average was in 2010, the year before the Affordable Care Act was passed.

It's constitutional - deal with it

It’s constitutional – deal with it

The percentage of Texans without insurance has dropped dramatically since the launch of the Affordable Care Act, the U.S. Centers for Disease Control and Prevention reported Tuesday. In 2015, the uninsured rate fell to 16.8 percent.

While the state continues to lead the nation in the rate of people who are not covered, advocates for the health care law who have watched its implementation say the headway is undeniable. Prior to the law’s passage in 2010, the Texas rate of uninsured hovered around 25 percent, or one in four.

“This is indeed significant progress,” said Elena Marks, president and CEO of Episcopal health Foundation in Houston. She is co-author of a separate series of ACA tracking reports issued through Rice University’s Baker Institute for Public Policy.

Nationally, the rate of uninsured fell to a historic low of 9.1 percent last year, the National Health Interview Survey released Tuesday found. That translates to about 7.4 million people gaining coverage last year on top of the 8.8 million who signed up in 2014. It is the first time the uninsured rate has slid into the single digits.

In 2010, the national rate of uninsured was 16 percent.

“The historically low rate of uninsured in America reflects people’s desires for health coverage. Americans like having access to health care,” said Ken Janda, president and CEO of Community Health Choice, a nonprofit managed-care organization serving Harris and 19 other Texas counties.

[…]

The CDC study shows that last year adults in states that expanded Medicaid were less likely to be uninsured. In those states, the percentage of un-insured decreased to 9.8 in 2015 from 18.4 percent two years earlier. By contrast, the uninsured rate in states like Texas that chose not to expand the program decreased to 17.5 percent last year from 22.7 percent in 2013.

Raise your hand if you’re surprised that the states that have refused to expand Medicaid had the highest rates of uninsured residents pre-Obamacare. I’ve pretty much run out of things to say with these news stories, so fill in your own snarky/heartfelt/cynical comment as appropriate.

Feds grant 15 month Medicaid waiver extension

I sure hope they keep the pressure on to expand Medicaid during this time.

It's constitutional - deal with it

It’s constitutional – deal with it

The Obama administration has agreed to temporarily keep some federal Medicaid money flowing into Texas to help hospitals treat uninsured patients, a relief to health care providers that feared losing the funds over state leaders’ refusal to provide health insurance to low-income adults.

State health officials said Monday they have struck a deal with the federal Centers for Medicare and Medicaid Services to keep the program going for another 15 months, with hospital reimbursements remaining at their current level.

Those were the exact terms the Texas Health and Human Services Commission asked for last month. Agency leaders said the negotiations were a “big win for Texas.”

“We’re pleased these innovative programs will have the opportunity to continue,” Chris Traylor, the agency’s executive commissioner, said in a statement. “These programs are improving health care for Texas’ Medicaid clients and creating cost-savings for taxpayers.”

[…]

The 15-month extension also includes an additional $3.1 billion for DSRIP initiatives.

The Obama administration had previously signaled it was likely to stop footing the bill for at least some of Texas’ uncompensated care costs. Under the Affordable Care Act, the president’s signature health law, Texas was encouraged to expand its Medicaid program to cover nearly 1 million additional adults living in poverty — a move that would have given more poor patients a means to pay for care. The state’s Republican leadership hasvehemently opposed that option, criticizing Medicaid as an inefficient government program.

Federal health officials were unswayed by that argument, repeatedly telling state leaders they had no desire to use waiver funds to pay for costs that would otherwise be covered by a Medicaid expansion.

[…]

Texas health officials say they will continue negotiating a longer term extension of the funding over the next 15 months.

Those negotiations will likely be influenced by a study of the effectiveness of the uncompensated care pool, which the federal government asked Texas to commission. The Texas Health and Human Services Commission contracted with outside firms Health Management Associates and Deloitte to submit the study by the end of August. It will address questions such as how hospitals’ uncompensated care costs would be reduced under a Medicaid expansion.

If Texas and the federal Centers for Medicare and Medicaid Services do not reach an agreement at the end of the 15-month extension, in December 2017, the Obama administration said it “expects” that uncompensated care funding would be reduced after that.

“Specifically, the reduction will limit the size of the Uncompensated Care pool to the costs of uncompensated and charity care for low-income individuals who are uninsured and cannot be covered” under a Medicaid expansion, wrote Vikki Wachino, a senior federal health official, in a letter to the Texas Health and Human Services Commission.

Additionally, the DSRIP pool would be reduced by 25 percent in 2018 and by an additional 25 percentage points each year after that, according to federal officials.

See here, here, and here for some background, and here for a copy of the letter CMS sent to Texas. I don’t really have anything to say that I haven’t said before. Texas needs to expand Medicaid, and if the state continues to refuse to do so, the federal government should not take any steps to mitigate the consequences of that decision. It’s up to the next Legislature now. State Rep. Garnet Coleman, Trail Blazers, and the Austin Chronicle have more.

Two Medicaid stories

From the Trib:

It's constitutional - deal with it

It’s constitutional – deal with it

State health officials confirmed Tuesday they have asked the Obama administration to keep a 15-month lifeline of federal Medicaid money flowing into Texas to help hospitals treat uninsured patients.

That money would offer temporary relief to health care providers who face losing the funds — some $3.1 billion annually — over state leaders’ refusal to provide government-subsidized health coverage to low-income adults under the Affordable Care Act, President Obama’s signature health law.

Federal officials previously signaled they would stop footing the bill for at least some of Texas’ costs for “uncompensated care” — the burden on hospitals when patients can’t pay for their visits. Under the Affordable Care Act, Texas was encouraged to expand its Medicaid program to cover nearly 1 million additional adults living in poverty — a move that would have given more poor patients a means to pay for care. The state’s Republican leadership has vehemently opposed that option, criticizing Medicaid as an inefficient government program.

[…]

First created as a $29 billion pot of money paid to Texas health care providers over five years, about 40 percent of that money came from local funds — mostly property tax dollars — and 60 percent from the federal government. The Obama administration approved the program in 2011, and it was set to expire in September.

By asking for the program to be renewed for a significantly shorter timeframe, state health officials indicated that they expect the federal government will be reluctant to continue handing out cash to reimburse hospitals for patients who can’t pay for their visits. Federal health officials have repeatedly told state leaders they have no desire to use waiver funds to pay for costs that would otherwise be covered by a Medicaid expansion.

In Florida, the Obama administration recently agreed to extend a similar source of hospital funding in that state, but only for two years and at a significantly reduced rate. That arrangement diminished the state’s low-income pool by about 50 percent for the first year and 70 percent for the second.

See here and here for some background, and here for a copy of the letter. This is the 1115 waiver, and I’ve been rooting for the feds to tell Texas to go pound sand unless they expand Medicaid. This is at least a step in that direction.

And from Think Progress:

The Obama Administration just sent a strong signal to states trying to defund Planned Parenthood, warning all 50 states that attempts to strip Medicaid funding from the women’s health care provider is most likely illegal.

The letter, sent to each state’s Medicaid director, cautions lawmakers that “providing the full range of women’s health services… shall not be grounds for a state’s action against a provider in the Medicaid program.” In other words, the fact Planned Parenthood provides abortion services in addition to other women’s health services is not legal grounds to cut it off from Medicaid funding. It stipulates that the only justifiable reason to remove a provider’s Medicaid funding is if that provider isn’t able to bill for or perform covered medical services.

“Once again, the Centers for Medicare and Medicaid Services has made it clear that it’s illegal for politicians to tell women where they can and cannot go for care,” said Cecile Richards, President of Planned Parenthood, in a statement.

[…]

The Obama Administration has warned specific states before that cutting off Medicaid funding for Planned Parenthood may violate federal law, but this is the first time that they have sent a letter to every state in the country.

As we know, Planned Parenthood has filed a lawsuit against Texas after it announced it was cutting PP out of any program it hadn’t already cut them out of as punishment for those faked videos by the fraudsters Daleiden and Merritt. I don’t know what effect, if any, this federal action will have on that, but I do know we could easily solve all these problems (and more) if Texas would expand Medicaid and obey the law. It’s all so simple, really.

Weekend scandal news roundup

If anything comes from the Texas Rangers investigation into his questionable expenditures, Ag Commissioner Sid Miller would be prosecuted in Travis County.

Sid Miller

If embattled Texas Agriculture Commissioner Sid Miller is prosecuted for misusing government funds, his trial would be in Travis County, officials said Friday, despite a new law that sends some corruption cases against state officials and employees to their home counties.

Before December, the public integrity unit in the Travis County district attorney’s office investigated and prosecuted alleged corruption by state officials and employees. House Bill 1690 changed that, moving investigation of accusations such as bribery, gifts to public servants, perjury and tampering with government records to the Texas Rangers, a division of the Texas Department of Public Safety. Under the new law, charges can be brought in the official or employee’s home county.

The Rangers are investigating Miller for two February 2015 trips he reportedly took on the state’s dime. Liberal advocacy group Progress Texas requested an investigation into Miller’s state-paid trips, following reports that he participated in a rodeo and received an injection called the “Jesus Shot” while he was supposed to be on the job.

But if Miller’s case leads to a prosecution, it wouldn’t be heard in his home county of Erath because the events in question occurred before the new law took effect in December, officials from DPS and the Travis County district attorney’s office told the Tribune.

See here for an apparently inoperative discussion of the issue. I’m sure Miller would prefer it that way, since it will be much easier for him to complain about political motivations if it’s the Travis County DA and not the Erath County DA prosecuting him.

In the meantime, the Travis County DA already has an investigation going on.

The Texas state auditor’s office has referred its investigation into possible misuse of state workers by state Rep. Dawnna Dukes to Travis County prosecutors, the Austin American-Statesman reported late Friday.

The Texas Tribune reported in February that the auditor’s office was investigating Dukes’ use of state workers for her personal project, the African American Heritage Festival, a nonprofit event Dukes has overseen for 17 years.

The auditor’s investigation was prompted by complaints from Dukes’ former chief of staff, Michael French, who approached House officials in January with concerns about the legality of the staff’s work on the festival.

Dukes acknowledged her staff worked on the festival but said their role was minimal. A Jan. 12 email obtained by the Tribune shows Dukes directing her staff to make the festival a priority.

“Festival is all hands on priority,” Dukes wrote in the email. “I don’t want any delays or fall throughs.”

Two members of Dukes’ staff also expressed concerns over personal errands the lawmakers asked them to run, a list that included smoothie runs, vet visits and babysitting. One staffer moved in with Dukes for three months last summer in exchange for helping the Austin Democrat care for her daughter.

Something to keep in mind amid all the calls for Ken Paxton and Sid Miller to resign. Want another reason to be wary of such an outcome? Here you go.

Texas doesn’t have a cabinet form of government, but in Gov. Greg Abbott’s case, it might soon have the next best thing.

Two of the state’s relatively new elected officials — Attorney General Ken Paxton and Agriculture Commissioner Sid Miller — are in deep political trouble at the moment. If worst comes to worst for either or both of those fine gentlemen, Abbott would appoint their replacements.

That’s a lot more say than he had when they won the positions in 2014.

Yeah, I don’t want that. From a purely partisan perspective, it’s much better for Paxton and Miller to stay where they are and be embarrassments to the rest of the GOP than to let Greg Abbott swoop in and clean up the mess.

And finally, let’s get back to Ken Paxton for a minute.

The state is paying thousands of dollars in salaries and benefits to at least two former high-level staffers in Attorney General Ken Paxton’s office who haven’t worked there for over a month.

Charles “Chip” Roy resigned as first assistant attorney general March 9 but remains on the state’s payroll. He received his full month’s salary of $16,220.62 on April 1, according to the state comptroller, and remains on the payroll as an employee of the state even while working a new job for a national political committee.

Roy declined to comment about the payment arrangement, which the agency confirmed Wednesday after The Dallas Morning News raised questions. Despite its earlier public statement that Roy resigned, an agency spokeswoman said Thursday that he’s also on “emergency leave.”

“Roy resigned on March 9th. He is currently on emergency leave through June 10th,” spokeswoman Cynthia Meyer said late Thursday.

If Roy’s arrangement continues until then, he will make $48,660 for the three months of emergency leave.

The agency at first offered no further explanation of the reason for the leave. When asked to clarify the emergency, Meyer said: “I’m not sure the answer.”

Texas’ “emergency leave” law says a state employee who has experienced a death in the family can take time off without seeing his or her pay cut. Agency heads also can approve other reasons for emergency leave if the employee “shows good case to take emergency leave.”

Employment law prohibits state workers from pulling down full-time salaries if they don’t work at least 40 hours a week for a public entity. There is no severance for workers who leave state employment, and the law that gives agency heads discretion in granting administrative leave also caps such time at 32 hours per year.

Austin-based campaign finance and ethics attorney Buck Wood questioned the arrangement.

“So, the emergency wasn’t so great that this person can’t work, or has any problems working? They just want to give her or him the money,” said Wood, who was not told the name of the individual or the agency in question. “This person obviously didn’t provide ‘good cause’ because they’re working. They’re just feeding you a line.”

So what was the emergency? Chip Roy needed health insurance.

Former First Assistant Attorney General Chip Roy on Friday defended receiving thousands of dollars in salary and benefits after leaving the attorney general’s office to join a pro-Ted Cruz super PAC.

[…]

Roy’s statement indicates that he will receive much less than that because he took the leave option partly for medical reasons that were resolved Thursday.

“The terms of my resignation included from the OAG [office of the attorney general] an option for leave beyond my earned vacation and holiday time,” Roy said in the statement. “The primary benefit to me would have been healthcare coverage in light of being in the five-year window after Stage 3 Hodgkins Lymphoma. My plan has been to go off payroll at OAG using only my earned vacation and holiday time unless it were absolutely necessary to stay on pending the uncertainty of medical tests and subsequent employment. Yesterday I was blessed to receive an all-clear from my Oncologist and my complete departure from the OAG is effective at the time of the expiration of only earned vacation and holiday time.”

So a former top lieutenant of the Texas Attorney General’s office is worried about not having health insurance. Let that sink in for a minute. Then go read what Lize Burr has to say.

Let me put it this way:

Chip Roy was given the option to keep his state-paid health insurance past the normal point of his compensation because he was facing health uncertainty.

Now we come to the genuinely important news this week from the Center for Public Policy Priorities. It’s very simple and completely awful: 1.7 million Texas children live in poverty. 1.7 million children. That means 1.7 million children being raised by adults living in poverty. Mothers, fathers, grandparents, guardians. All in poverty.

And what is one of the greatest threats facing Texas families living in poverty? The cost of health care. Not just the kids’ health care–the parents’ health care. Texas has both the highest number and rate of adults with no medical insurance. These Texans live with an uncertainty that borders on a form of terror. And that is fear is shared by everyone in the home.

Chip Roy probably understands that fear. It’s probably the reason his employer was willing to place him on a special type of leave that continued his state-paid insurance while he was facing health unknowns. That was a humane act that I can understand. However, for a Republican office holder who is committed to the overturning the ACA and is against Medicaid expansion for low income Texas–the rejection of which costs the state of Texas $6 billion in uncompensated care a year–making that gesture isn’t a sign of compassion. It’s hypocrisy of the highest order.

I can’t say it any better than that.

If we really cared about improving mental health in Texas

We would have expanded Medicaid at our first opportunity.

It's constitutional - deal with it

It’s constitutional – deal with it

Federal health officials say people with mental illness and addictions are being left behind in Texas because the state hasn’t expanded Medicaid to more low-income adults.

The health care program for the poor is controversial for many Republicans. The U.S. Supreme Court ruled that expansion was a voluntary part of the Affordable Care Act, and 19 states have declined to expand it.

A new federal report estimates that expanding Medicaid in Texas could help 406,000 mentally ill and uninsured Texans get treatment, according to Richard Frank, an Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services.

“If states are serious about addressing mental illnesses, opioids, and other substance use disorders, expanding Medicaid offers a unique opportunity to do so,” Frank said in a national conference call with reporters. “It will bring people into effective treatment and is fully paid for under the Affordable Care Act.”

The new federal report discusses how untreated mental illness affects homelessness, job productivity, and jails and prisons. The report says states that did expand Medicaid were able to save money on programs for mental health or the uninsured, or divert the money to other programs.

A copy of the report is embedded at the link above. This is the same song we’ve been singing since 2011, with this being roughly the 1000th verse. The positive effect of getting access to reliable mental health care for these people cannot be overstated – among many other things, it would keep a lot of so-called frequent flyers out of jail – but the state Republican leadership does not care and will not hear it. You know how whenever there’s another gun massacre, the only thing we’re all allowed to say is that we should do more to promote mental health as a way to maybe not have so many gun massacres? The part we’re not allowed to say is that the Republicans in this state won’t do a damn thing to actually promote mental health. It’s the same old story, and the only way it ends is with electing different leaders. The Statesman has more.