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Robert Wood Johnson Foundation

More kids in Texas have health insurance now

Thanks, Obama!

It's constitutional - deal with it

It’s constitutional – deal with it

The number of uninsured children in Texas fell by almost 100,000 during the first year of full implementation of the Affordable Care Act, signalling a potential trend across all age groups, a new study by the Robert Wood Johnson Foundation finds.

The findings were welcomed in a place with stubbornly high uninsured rates, particularly among the poor and racial and ethnic minority groups.

“This is good news. Texas is a state with a comparably young population, so the more of them that are insured the bigger the impact for the entire population,” said Elena Marks, president and CEO of Houston’s Episcopal Health Foundation.

The thought is that as parents find coverage options for their children they are more likely to learn about coverage options for themselves, which will lead to higher overall coverage rates.

In 2013, as the health-care law took hold, 977,000 Texas children were without coverage, the new research shows. That equates to 13.2 percent of the state’s under-18 population. By 2014, that uninsured rate had fallen to 11.8 percent.

[…]

Typically children are insured in greater numbers than adults since states, including Texas, offer safety net coverage through the Children’s Health Insurance Program, also known as CHIP, which provides low-cost insurance for children whose parents earn too much to qualify for Medicaid or do not have other coverage.

“Despite the politicking around health policy lately, I think we can all agree that coverage for kids is essential for their healthy development and to get a healthy start in life,” Katherine Hempstead, who directs health insurance issues for the Robert Wood Johnson Foundation, said in an interview Monday.

Despite the gains, 880,000 Texas children – the highest number nationally – still have no coverage.

That includes 533,000 Hispanic children, Guerra-Cardus said. She added that 94 percent of those are U.S. citizens.

The Robert Wood Johnson study shows nearly half of the nation’s 5 million uninsured children live in Texas and five other states: California, Florida, Georgia, Arizona and New York.

The research provides a baseline to track future children’s coverage trends, Hempstead said, adding that the report will be duplicated next year.

I couldn’t find a copy of the study when I looked, but there was a lot of news coverage of it out there when I googled around. It goes without saying that having healthy children is one of the best investments that a society can make, but then our state government threw 250,000 kids off of CHIP in 2003 in the name of “fiscal conservatism”, so I guess it doesn’t go without saying. There’s a reason why the reforms of the Affordable Care Act have had such a profound impact in Texas – there was so, so much that needed to be done. And as long as the current crew is in charge, there’s still so much more left to do.

Just a reminder: Medicaid expansion is still a great deal

But only if you do it.

It's constitutional - deal with it

It’s constitutional – deal with it

We learned late last week that the decision by 24 states to reject Obamacare’s Medicaid expansion comes as a startling cost — $423.6 billion in lost federal funds from 2013 to 2022, according to researchers at the Urban Institute.

So how are states justifying their decisions to leave that much federal money on the table? One of their main arguments is that the federal government will eventually renege on its generous funding commitment to the Medicaid expansion. But based on the 49-year history of the Medicaid program, that claim doesn’t hold up, according to Urban Institute researchers in a finding that hasn’t received as much attention.

Here’s how Medicaid funding works: The federal government on average pays 57 percent of the traditional Medicaid program’s costs, while the states finance the rest (though the federal reimbursement rate varies by state). The federal match just for the Medicaid expansion population, however, is significantly more generous. The feds pay 100 percent of those costs through 2016, and the federal match rate is gradually lowered to 90 percent by 2020 and is supposed to stay there.

States opposing the Affordable Care Act have expressed skepticism that the federal government will be able to maintain such a high funding level amid future budget pressures. But the Urban researchers found that of the 100-plus cuts the federal government has actually made to the Medicaid program since 1980, lawmakers just once reduced the federal share of Medicaid financing — and that was in 1981. Other federal cuts have been to services, payments to providers, or in program eligibility.

“More recent budget bills actually raised the federal Medicaid share, even while making other federal Medicaid cuts,” Urban researchers wrote in the study, which was funded by the Robert Wood Johnson Foundation.

Further, lawmakers won’t find much to cut if they looked to federal funding for the Medicaid expansion. Less than 7.4 percent of federal Medicaid spending over the next decade comes from the bonus federal match for the expansion population, according to Urban researchers’ calculations based on Congressional Budget Office projections.

Via Forbes, you can see that Urban Institute report here. Ed Kilgore adds a bit of extra context.

It should be mentioned that the 1981 match-rate cut (technically, a reduction in federal reimbursement for a limited period of time, not an actual change in the underlying match) was at the insistence not of deceptive liberals but of the sainted Ronald Reagan. Indeed, liberals, led by Henry Waxman, engineered a long series of “super-matches”–increases in the federal match rate for Medicaid coverage of specific services or populations–during the 1980s and 1990s.

The big thing to remember here is that liberals want expanded Medicaid coverage, and are willing to pay for it at the federal level. The whole bait-and-switch meme behind Republican resistance to the expansion at the state level lacks logical as well as historical support.

And that’s exactly why this isn’t a question of economics, where the answer is clear, but of politics, where it’s equally clear in the other direction. Like I said, just a reminder in case you still needed one.

We’re #12!

The twelfth most obese state in the country, that is.

They say everything’s bigger in Texas — and apparently, that includes the people. Texas ranks as the 12th most obese state in the U.S., according to a new study by Trust for America’s Health and the Robert Wood Johnson Foundation.

The study found that — not surprisingly — obesity rates are skyrocketing. In 2007, only one state had an obesity rate above 30 percent, but in 2011 more than 12 states, including Texas, have obesity rates above 30 percent. More than 20 percent of adolescents (ages 10-17) are considered obese.

In Texas 38.5 percent of blacks and 36 percent of Latinos are considered obese. Rich Hamburg, deputy director for Trust for America’s Health, said Texas’ obesity rates are directly linked to poverty, which unfortunately correlates with race.

Somewhere, the editor of Men’s Health magazine is nodding his head and saying “I told you so”. The report can be found on the Trib’s story page, or you can go to the source for more info. Needless to say, there’s a direct link between this problem and the rising costs of health care. Good luck getting that message through to our Republican leadership.

“The information in this report should spur us all – individuals and policymakers alike – to redouble our efforts to reverse this debilitating and costly epidemic,” said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. “Changing policies is an important way to provide children and families with vital resources and opportunities to make healthier choices easier in their day-to-day lives.”

I laugh the bitter laugh of a man who knows that his Governor will be seen wearing an “I {Heart} Socialism” T-shirt at a gay pride rally in San Francisco before he lifts a finger to do anything about this.

The cost of doing nothing

Just a reminder, as the health care reform battle lurches towards the finish line, that doing nothing is not a viable option.

A week after a Texas agency reported health care reform legislation would cost the state’s Medicaid program an extra $20 billion over the next 10 years, a non-partisan foundation says inaction will exact a greater price.

In a study [issued Tuesday], the Robert Wood Johnson Foundation projects that by 2019, Texas’ ranks of uninsured, public program spending and individual and employee health care expenses will balloon if reform isn’t passed.

“People worry about losing what they have now, but they need to remember that what they have now is likely to change,” said Bowen Garrett, a senior researcher with the Urban Institute’s health policy center, which conducted the study for the foundation. “Many who have employee-sponsored insurance will lose it as health care costs go up, and those fortunate enough to keep their plans will pay higher out-of-pocket costs or earn smaller wages as employers decide whether to cut on wages or benefits.”

The study, which estimates how coverage and cost trends would change from now to 2019 if health care isn’t reformed, found out-of-pocket expenses could increase by more than 35 percent in every state. It found middle-class working families would be hardest hit.

The full report is here. The Contrarian sums it all up.

I pointed out last week the flaw in this argument. Yes, expanding health coverage for millions of Texans will cost the state a lot of money — but it will also save a lot of money for county governments, which are paying much of the $7 billion a year in uncompensated care for Texas’ uninsured. (A lot of the cost for uncompensated care arises from people who lack health insurance showing up at emergency rooms in public hospitals — the single most expensive place to receive treatment.)

So health reform isn’t really new spending. It’s a cost shift: state government spends more, counties spend less.

[…]

If those projections are correct, maintaining our current health care system would cost Texans (especially local governments) a total of roughly $100 billion worth of uncompensated care for the uninsured in the next decade.

For the moment, let’s leave out the moral issue of providing Texans with health insurance and adequate health care.

Looking strictly at the economics: doing nothing would cost us roughly $100 billion.

So even if Perry is correct — that the Baucus plan would cost the state $60 billion by 2019 — doing nothing would be more expensive.

Seems like a pretty simple choice to make. Unless of course you’re one of those politicians who claims to be concerned about costs while doing nothing to address them.