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U.S. Centers for Medicare & Medicaid Services

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.

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.

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.

Texas vs Planned Parenthood, part one million

This was going to happen sooner or later.

Right there with them

Right there with them

Texas health officials say they are kicking Planned Parenthood out of the state Medicaid program entirely over what they called “acts of misconduct” revealed in undercover videos filmed earlier this year.

Republican state leaders, who vehemently oppose abortion, have worked for years to curb taxpayer funding of Planned Parenthood — despite the fact that its clinics may not receive such funding if they perform the procedure.

Monday’s decision means even Planned Parenthood clinics that only provide well-woman care, like cancer screenings, pregnancy tests and birth control, will also be cut out of receiving dollars from Medicaid, the joint state-federal insurer of the poor.

The vast majority of Medicaid funding for Planned Parenthood clinics in Texas comes from the federal government. Texas spent just $310,000 from its own coffers on the women’s health organization in 2015, but it also dispersed $2.8 million in federal dollars to those clinics. A spokesman for the federal Centers for Medicare and Medicaid Services did not immediately respond to a request for comment.

[…]

On Monday, the Texas Health and Human Services Commission’s inspector general, Stuart Bowen, wrote to Planned Parenthood Gulf Coast that the women’s health provider had violated state Medicaid rules and put Texans at risk of infection. Citing the sting videos, Bowen said Planned Parenthood officials disregarded federal law by agreeing to change the timing or method of abortions in order to procure fetal tissue for medical research.

As a result, the state will no longer allow any Planned Parenthood clinics in Texas to receive Medicaid funding. Last year, Planned Parenthood clinics in Texas received $3.05 million in federal funds through Medicaid for family planning services like birth control and pregnancy tests.

Planned Parenthood Gulf Coast spokeswoman Rochelle Tafolla described the state’s efforts to block Medicaid patients from receiving care from any of the organization’s clinics as “politically motivated.” Planned Parenthood Gulf Coast does not currently participate in fetal tissue donation, the organization says, but did in 2010, in conjunction with a University of Texas Medical Branch study on miscarriage.

“Tens of thousands of women are already going without care after years of policies aimed at blocking access to care at Planned Parenthood,” Tafolla said. “Now Texas politicians are using a thoroughly discredited, bogus attack against Planned Parenthood as a shameful excuse to attack Texas women’s health yet again.”

This has been the end goal for Texas Republicans for several years now, so like I said, no surprise, and one excuse is as good as another. I would point out that multiple states have investigated these videos and found nothing – Texas, as well as Harris County, is doing its own investigation, and one presumes they have nothing worthwhile to show for it as yet. As such, this may be their consolation prize, since coming away empty-handed was not an option. What comes next is almost certainly a lawsuit, since Texas doesn’t exactly have the authority to do this. If they could have, they would have done this much earlier than this. In the meantime, still more women will lose their access to healthcare. That’s the reality we unfortunately live in, and much as I hate to say it, nothing will change until our state leadership does. BOR, Newsdesk, and the Observer have more.

No, seriously, expand Medicaid or else

Bring. It. On.

It's constitutional - deal with it

It’s constitutional – deal with it

The federal government is officially holding state leaders’ feet to the fire, hoping to get Texas to expand its Medicaid program to provide health insurance to more low-income Texans.

Federal officials called the state’s health agency this week to say that Texas’ reluctance to expand Medicaid — a key tenet of President Obama’s signature health law — will play into whether his administration extends a waiver that helps the state’s hospitals cover uninsured patients.

The development follows news from Florida, where a similar tug-of-war is playing out between the federal government and a Republican-controlled statehouse that opposes Obamacare but hopes to renew billions of dollars in hospital funding. This week, federal officials sent a letter to Florida lawmakers that said Medicaid expansion “would reduce uncompensated care in the state,” making it “an important consideration in our approach regarding extending” the state’s hospital waiver.

Linda Edwards Gockel, a spokeswoman with the Texas Health and Human Services Commission, confirmed Friday that federal health officials called the Texas agency Thursday afternoon to relay a similar message.

Officials from the federal Centers for Medicare and Medicaid Services “said they recognize each state is different, but they intend to use the same three principles outlined in their letter to Florida as they evaluate uncompensated care funding pools in all states,” Edwards Gockel said in an email. “We don’t have more details than that at this point.”

Tom Banning, chief executive of the Texas Academy of Family Physicians and an advocate for Medicaid expansion, said in an email that the call “should be a wake up.” Annually, Texas hospitals receive billions of dollars combined by way of the federal “transformation waiver.” Losing that money “will have a crippling effect throughout Texas,” Banning added.

The Texas hospitals waiver runs through September 2016, but the 2015 legislative session is the last chance for state lawmakers to negotiate a renewal before then. The current session is slated to wrap up on June 1, barring a governor-called special session.

Estimates for the value of that waiver vary. The Texas Hospital Association, which supports some form of Medicaid coverage expansion under the Affordable Care Act, estimates the waiver’s five-year value at $29 billion.

See here for the background. As noted in the story, the feds are similarly putting the screws to Florida. There’s basically zero chance that anything will get passed this session – Sen. Rodney Ellis tried to get a Medicaid expansion amendment through during the budget debate and failed, while Greg Abbott is holding firm and whining about how mean the feds are being to him – so it’s just a matter of whether the feds follow through in 2016 and if enough pressure can be brought to change things in 2017. Anyone want to place a bet on that? The only semi-retired Burka has more.

Texas Obamacare enrollments top 850K

And counting.

It's constitutional - deal with it

It’s constitutional – deal with it

Officials at the Department of Health and Human Services Wednesday announced nearly 860,000 Texans so far have enrolled in health insurance marketplace coverage with a month left still left to go until the 2015 open enrollment period ends.

It’s unclear how many of those signups are new marketplace customers. Last year, nearly 734,000 Texans, many of whom had never been insured, signed up for coverage. About 198,000 of them were in the Houston area.

“As of Jan. 9, 859,377 Texans have access to quality, affordable health coverage for 2015 through the Health Insurance Marketplace,” said Health and Human Services Secretary Sylvia Burwell in a written statement.

Good to hear. National enrollments have been strong as well. It seems eminently reasonable to me that Texas could top one million signups by February 15, given the likelihood (as was the case last year) of some number of people waiting till the last minute to get it done.

There’s also an intensified focus on the Latino community.

Officials plan more than 600 enrollment events nationwide, including a few in the Houston area, that target Hispanics in an effort to get more signed up for coverage under the Affordable Care Act. In the meantime, grass-roots organizations and the Department of Health and Human Services are spreading the word about the marketplace by using webinars, Twitter, advertising and Spanish television telethons.

“We’re doubling down,” Health and Human Services Secretary Sylvia Burwell told reporters Wednesday, noting that the agency has dedicated a third of its advertising budget to Spanish speakers. “The Latino community is one of the fastest growing communities in the country. We’re specifically focused on this community because of the health disparities that exist for them and we think having insurance will help.”

[…]

Researchers have found Texas Latinos were more than twice as likely as Anglos to enroll in marketplace coverage. They also discovered Hispanic adults in Texas have more difficulty affording health care and are three times as likely to be uninsured.

Burwell repeatedly has said Spanish speakers would be targeted for more outreach this enrollment period. Insurers and enrollment organization trained more application assisters to accommodate Latino applicants and marketplace officials simplified the insurance application process, expanded the number of documents people could use to verify their identities and income and made it easier for applicants to use hyphenated names, which are common in Latino communities.

“We’re working to meet Latino consumers where they are, whether that’s online, over the phone or in person,” Burwell said.

There’s a lot of potential there, and one thing we learned from the first round of enrollments was precisely that these customers needed more engagement to get signed up. I hope this has the desired effect, and that we can learn more for the next time.

What would happen to all these people if SCOTUS takes the opportunity to gut subsidies for the national exchange? My guess is that as are the million or so folks that would qualify for Medicaid under a normal expansion plan, they’d be SOL. Oh, I’m sure that Rep. John Zerwas will put forth a bill to create a Texas state exchange, as he has done before. He’ll have the support of all the Dems, a few honorable Republicans, every non-crazy local official, and the business establishment, but it won’t be enough. Nothing will change till we start to win more elections. I wish I had a sunnier outlook than that, but I don’t. Sorry.

Does any of this sound like “Medicaid Expansion” to you?

So Wonkblog, TPM, and BOR, all riffing off the same news story in which Greg Abbott had a clandestine meeting with Houston-area legislators and may have said some things that made them think he might be open to “Medicaid expansion”, are all talking about it as though it’s a thing that could happen. Here’s Wonkblog, which had the most detailed report:

It's constitutional - deal with it

It’s constitutional – deal with it

If Abbott did back Medicaid expansion funding, worth about an estimated $100 billion to the state over 10 years, it would be arguably the biggest “get” for the Obama administration since the Supreme Court made the expansion voluntary more than two years ago.

As Texas attorney general, Abbott joined the lawsuit against Obamacare that reached the Supreme Court in 2012. His predecessor, Gov. Rick Perry, has been one of the most outspoken opponents of the Medicaid expansion, and Abbott campaigned against the Medicaid expansion leading up to the November election.

According to the Texas Tribune report, he’s interested in the expansion deal Utah Gov. Gary Herbert struck with the Obama administration after months of negotiations. Herbert’s plan would use Medicaid expansion dollars to buy private coverage for low-income adults earning below 138 percent the federal poverty level, or about $16,100 for an individual, with some cost-sharing requirements.

Of the 23 states that haven’t expanded Medicaid, Texas by far has the most low-income adults living in the “coverage gap” – people who earn too much to currently qualify for Medicaid but don’t earn enough to receive subsidies to purchase health insurance through Affordable Care Act exchanges. About 948,000 adult Texans fall into this category, or about 25 percent of all Americans in the coverage gap, according to the Kaiser Family Foundation.

It’s still not clear whether Abbott’s thinking on Medicaid has changed. He’s recently called for a block grant of current Medicaid funding, which would be a lump sum to run the health-care program with far less oversight from the federal government — an idea that doesn’t sit well with Democrats. And Abbott has said Texas couldn’t afford the expansion when the federal funding match drops to 90 percent of the program’s cost in a few years.

The expansion issue is far from dead in Texas. A legislative health committee earlier this month rejected the traditional expansion but left the door option for future waiver negotiations with the federal government. A separate federal Medicaid waiver, worth close to $30 billion, could provide a major leverage point for the Obama administration when the waiver expires in 2016.

I’ve linked to it before, but here’s that Senate interim committee report, which covered other topics including Medicaid. The sum total of what they wrote about Medicaid is only nine pages, beginning on page 22, so you can read it all yourself if you want, but I’ll save you some time and reprint the recommendations here:

1. Texas should encourage congressional action to operate Medicaid as a block grant program and should simultaneously continue to pursue a waiver from the Centers for Medicare and Medicaid Services (CMS) to allow the state increased flexibility in the operation of our Medicaid program. While the delivery of Medicaid funds through a block grant is ultimately a decision of the U.S. Congress, the state should actively urge such action at the national level. Additionally, HHSC should continue to seek a waiver from CMS that will allow Texas to contain costs and increase personal responsibility by enacting cost sharing requirements, tailoring benefits to more closely align with individual needs, enhancing efforts to prevent fraud, waste, and abuse, and eliminating unnecessary administrative costs.

2. Support successful programs and entities that have local buy-in and include local funding sources.

  • Successful programs that serve the uninsured and are funded through state and local sources, such as mental health services offered through Local mental Health Authorities (LMHAs) and county indigent programs, should be supported and potentially expanded by the Legislature.
  • Programs that enable low-income families to access private market health coverage such as the Health Insurance Premium Payment (HIPP) program should be promoted and expanded. This program reimburses families of Medicaid-eligible clients for their share or a portion of their share of an employer-sponsored health insurance premium, only in cases when the state has determined that paying the premium is more cost-effective than enrolling the Medicaid-eligible family member in the Medicaid program. In Fiscal Year 2013, there were 7,194 active HIPP cases serving 9,657 Medicaid-eligible individuals and 26,409 total clients. Expansion of the HIPP program should be considered as a way to connect family members of Medicaid-eligible individuals to affordable private health insurance.
  • Texas should support settings that serve high numbers of uninsured Texans, such as Federally Qualified Health Centers (FQHCs). FQHCs provide a medical home for many Texans without health insurance. FQHCs are facing a “fiscal cliff” in 2016, when the federally-funded FQHC Trust Fund is expected to be discontinued. Texas should advocate for continued funding for the Trust Fund and supply state funds, as available, to support this vital part of our safety net.

So I ask again, does any of that sound like “Medicaid expansion” to you? Some of these may be good ideas – I’m not enough of a wonk to say – but it’s not clear to me how expansionary any of them are, or what any of them have to do with “Medicaid”. I get that there’s an aversion to using the term “Medicaid” in any policy description, but either the goal is to provide health insurance to most if not all of the people who would be eligible for Medicaid under an ACA-style expansion or it’s not. I don’t see anything that points in that direction, and until I hear Greg Abbott use words that signal an intent to, you know, EXPAND health insurance coverage in some form, then I say deep skepticism is the rational response.

Now, I do appreciate some journalistic attention to this, however thin the reed is that we’re all hanging on, so let me suggest a couple of questions that could be asked the next time Abbott deigns to talk to the press about this, or anything else.

1. Is your primary goal still to seek block grants for Medicaid? How will that meet the goal of covering more Texans?

2. What prompted your change in thinking on this?

3. How will you overcome the opposition of your Lieutenant Governor, many of the Republicans in the Legislature, and your ideological allies Such as the TPPF?

Those last two questions are on the assumption that Abbott is indeed interested in pursuing something other than block grants. Which, to be clear, I still think is what he intends to do. As such, those questions are likely moot, but let’s keep them in our back pockets just in case. I don’t expect to need them, but what the heck. In the meantime, as I’ve said before, let’s keep our eye on the ball.

Obamacare 2.0

The open enrollment period for the Obamacare insurance exchanges is going on right now. This year, the feds are taking a more direct approach to getting people to enroll.

It's constitutional - deal with it

It’s constitutional – deal with it

Secretary for Health and Human Services Sylvia Burwell, whose appearance at Monday’s news conference [in San Antonio] is part of a national tour to talk up marketplace successes, reported that of those who signed up during the first enrollment period this year, 7 out of 10 had premiums under $100. Nationwide, 65% of applicants qualified for subsidies, she said. In Texas, 84% of Texans got financial help, according to the Center for Public Policy Priorities in Austin.

“We as a people have a moral obligation to see that everybody has access to quality and affordable health insurance,” said Mayor Ivy Taylor who joined Burwell at the news conference. “A community prospers when its citizens are healthy.”

Burwell urged people without insurance to visit HealthCare.gov, choose the best plan among many options, and sign up by Dec. 15 to have coverage starting Jan. 1. Enrollment for 2015 will remain open until Feb. 15.

To those who signed up last time, Burwell emphasized that even if they are happy with the plan they already have, they need to re-enroll. About 90% of the information entered last time will appear on the form so people don’t have to re-enter it. Burwell said it’s important to make sure the information remains accurate and that the plan individuals previously chose is still the best one to meet their needs; 25% more plans were added this time.

The Health Insurance Marketplace enrolled 734,000 Texans in 2014. Bexar County accounted for 77,000 of those newly insured, a number that far exceeded the goal of 46,000, which remains the goal for the current enrollment period. Bexar County Judge Nelson Wolff, in attendance on Monday, has helped lead this effort, but in Bexar County, 27% of the population remains uninsured. Of those, 75% identify themselves as Hispanic, according to Andrea Guajardo, speaking for Enroll SA, a coalition of 40 organizations and 176 trained volunteers in Bexar County trained to help people sign up for insurance.

Asked about HHS’s outreach to Hispanic uninsured residents, Burwell pointed to several initiatives.

  • Spanish language call service. “In the early days of enrollment, out of 200,000 calls to our call center, 20,000 were using our Spanish-speaking call service.”Burwell said.
  • Spanish language equivalent of HealthCare.gov: CuidadodeSalud.gov.
  • Increased the number of Spanish speakers providing in-person assistance to help with online sign-up.
  • Improved interface for mobile users. “The Latino population has a deeper penetration of mobile use than the population as a whole.”

“One of the things we learned from the initial enrollment was the importance of trusted voices,” Burwell said. “I’ve had a chance today to talk with the leadership of the community and the stakeholders about their work and to hear their feedback, so we can make things better.”

Secretary Burwell was in Houston the week before that.

With some 6 million Texans still uninsured, Burwell’s early appearance this go-round shows a renewed fight to increase the health care law’s impact in Texas, where the governor’s office has refused to create a state-run marketplace or accept billions of dollars in federal funding to expand Medicaid to extend coverage to millions more people.

State and local organizers say the first insurance sign-up period helped them become more organized and strategic as they prepared for the 2015 open enrollment period.

They intend to hold multiple enrollment events, provide additional one-on-one application assistance opportunities and include more grass roots organizations and community leaders in educating the uninsured about marketplace coverage. They have data showing where the uninsured live. The key is deploying the appropriate organizations and people to reach target areas and groups, including Hispanics and young people.

“We learned about the importance of follow-up and the need for a lot of outreach,” said Mimi Garcia, the Texas state director for Enroll America, a national insurance advocacy organization. “There’s a lot of work to do in Houston. That’s going to be a big focus area.”

Organizers learned from last year’s open enrollment that the more conversations they have with uninsured residents, the more likely they are to convince someone to buy health coverage, Garcia said by telephone from a conference in New Orleans. She said the goal is for people to view purchasing health insurance as routine a practice as paying taxes or auto insurance.

[…]

The state’s uninsured rate dropped about 2 percent this year, but Elena Marks, president and CEO of Houston’s Episcopal Health Foundation, a philanthropy that will fund health care providers, said many Texans gained employer-based insurance as the economy created more jobs.

In comparison, California’s uninsured rate dropped nearly in half, from 22 percent to a little less than 12 percent, in large part to the state’s decision to expand Medicaid coverage to cover more of its low-income, working residents.

Marks said it makes sense for Burwell and other officials to bypass Texas’ political leadership and instead work with local governments, agencies and organizations, including those in the Houston area, to find the uninsured and enroll them in health coverage.

“Having her show up brings attention to the issue,” said Marks, who also is a non-resident health care fellow at Rice University’s Baker Institute.

Marks, who did not attend Burwell’s news conference, said new carriers are making the Texas marketplace more competitive this year.

Risha Jones, deputy director of Houston’s Department of Health and Human Services, said her agency’s goal is to directly contact 100,000 uninsured residents and reach another 400,000 through community and educational outreach. She said federal officials recognize the Houston area needs assistance in reaching its uninsured residents and has pledged to help. They haven’t yet set an enrollment goal.

“They are making us a priority,” Jones said, who introduced Burwell at the news conference. “We’re on the radar.”

It was a nice surprise seeing my friend David Ortez in the story, as an example of someone who was able to get health insurance through the Affordable Care Act and the exchanges. Ortez is a recent law school graduate and one of many people under the age of 30 who stands to benefit from the ACA. There’s a separate effort to get those folks, known as the Young Invincibles, to enroll. Unlike last year with the healthcare.gov meltdown, the first week of the enrollment period saw half a million people sign up, with about that many fill out applications. About half of those enrollees are first-timers. It would be awesome if this year Texas could top the one million mark for coverage. Imagine what it could be if anyone in state leadership had any interest in helping make this happen. Daily Kos has more.

Expand Medicaid or else

Turns out the federal government has more leverage over Texas than you might think.

It's constitutional - deal with it

It’s constitutional – deal with it

If Texas wants to keep receiving billions of federal dollars to help hospitals care for uninsured patients, state lawmakers may have to look again at expanding Medicaid coverage for impoverished adults, some political observers say.

That’s because in 2016, Texas will have to ask the federal Centers for Medicare and Medicaid Services to renew a five-year waiver to pump $29 billion into state health care coffers.

Since landing its first such waiver in 2011, Texas leaders have defiantly refused to expand Medicaid as envisioned under the Affordable Care Act, leaving more than 1 million impoverished Texans with no health insurance.

With the waiver renewal nigh, observers said, there’s some expectation that the federal agency will hold the waiver approval hostage in exchange for Medicaid expansion.

“CMS is going to hold that over Texas’ head to say, ‘You want this money? You do the expansion,’” said Matt Salo, executive director of the National Association of Medicaid Directors. “It’s one of the points of leverage that CMS now has.”

Texas received the 2011 Medicaid waiver in part to reimburse hospitals for care provided to patients who couldn’t pay. Two years later, state leaders under Gov. Rick Perry declined to expand Medicaid, criticizing the program as inefficient.

That left a “coverage gap” of more than 1 million Texans too poor to receive federal subsidies for private health insurance but too rich to qualify for coverage under Texas’ current, restrictive Medicaid requirements.

Now, policy analysts on the left and right say, the feds are likely to be less sympathetic to Texas’ request for another waiver to help pay for uncompensated care.

A similar tug-of-war is playing out in Florida, said Joan Alker, executive director at the Center for Children and Families at Georgetown University. In May, the federal government renewed Florida’s waiver to reimburse hospitals for just one year, rather than the standard three, “which was very unusual,” Alker said.

[…]

State Rep. John Zerwas, R-Richmond, one of the lawmakers who advocated for the “Texas solution,” said the Legislature would revisit coverage expansion during the session.

“It still behooves us as a Legislature to figure out, what’s the policy going to be around these people?” he said. “I’ll be the first to say that finding a solution for these million and a half people is important.”

And the transformational waiver from 2011 is already a source of some conflict with the federal government. CMS is currently withholding $75 million in waiver money that Texas used to reimburse private hospitals while federal officials review whether any rules were broken.

Tiffany Hogue, policy director for the Texas Organizing Project, which has worked to get Texans to sign up for health coverage on the exchange, said Medicaid expansion would be a top priority for her group during the legislative session.

“It’s absolutely going to be a battle cry for us,” she said. “The sheer number of uninsured — that’s daunting.”

Still, Alker said she was skeptical that Texas would expand Medicaid anytime soon.

“I remind myself when the Children’s Health Insurance Program was passed in 1997, Texas was the last state in the country to pick up the program,” she said. “That may be instructive moving forward.”

It’s always a safe bet to assume that the Legislature will fail to do the right thing when given the chance. I for one will be rooting for the feds to apply the screws as hard as they can in pursuit of a Medicaid expansion deal that would do untold amounts of good for more than a million people, not to mention be a nice bit of stimulus for the Texas economy. Making Ted Cruz’s head explode would be the cherry on top. Against that, when the Republicans from Greg Abbott on down (with the honorable exceptions of Zerwas et al) dig their heels in, perhaps this will finally be the impetus to get the Texas Medical Association to quit trying to placate the bullies and start working to actually further their own and their patients’ best interests.

And the first open enrollment period comes to an end

Lots of people signed up in the last few days of enrollment. Some tried but came away empty.

It's constitutional - deal with it

It’s constitutional – deal with it

Some of the hundreds of Houstonians who sought last-minute help enrolling for the Affordable Care Act on Sunday left thrilled to have health insurance for the first time in their lives, while others walked away frustrated by high prices, long waits and computer glitches.

“The lowest price plan for me was $387 per month and included a $6,000 deductible. Is this what they think people can afford who are unemployed? This is outrageous,” said Lupe Escalante, 63, a recently laid-off office administrator who attended an enrollment event Sunday at Community of Faith church in north Houston, one of a bevy of events held to help people meet the Monday deadline.

Under the law, uninsured people will be subject to fines of $95 per adult and $47.50 per child – a $285 family maximum – on next year’s income taxes. However, individuals who earn less than $10,150 and married couples earning less than $20,300 will be exempt from the penalty.

Extensions can also be granted for people who started, but did not finish enrollment, by the deadline.

For reasons unclear, the story fails to explain why Ms. Escalante did not get a quote for a policy she could afford. The simple answer is that she almost certainly falls into the coverage gap, earning too much money to qualify for Medicaid but not enough to receive a subsidy. The reason for the existence of the gap is that Texas was one of many states to not expand Medicaid, for which Ms. Escalante would surely now qualify if Rick Perry and the Legislature had done so. Alec MacGillis spells it out.

In Texas, parents can only qualify for Medicaid if they earn less than 19 percent of the poverty level—that is, below $4,531. In Alabama, it’s even lower—16 percent of the poverty level. It’s barely higher than that in Louisiana, Georgia, Missouri, and Mississippi and Florida, all of which have their eligibbility threshold set below 40 percent of the poverty level—that is, below $9,540 for a family of four. In other words, one must be subsistence-level indigent in these states to even think about qualifying. And that’s only if one has kids—if one is a non-disabled adult without dependent children, forget it: no matter how poor you are, you don’t qualify for Medicaid.

So: right now, we have passed a law meant to expand coverage to all Americans, and yet it does not reach the poorest of our fellow citizens in nearly half the states in the country. That, on its face, is a major policy failure. No one really wanted to say this during the law’s drafting, but its underlying goal was to get coverage to people in red states where there was no local political will to address the problem. It’s generally preferable to let states address their own needs, but in this realm, only Massachusetts and a few others had even attempted to bring about near-universal coverage. The only way people in Birmingham or Brownsville were going to get covered was if the federal government saw to it that they did.

We know how that worked out. Despite all the obstacles here and in other states, many people tried to enroll over the weekend and on Monday, pushing the total signup number up towards 7 million, the number that had been originally floated around before the healthcare.gov site took the month of October off. Even more people than that now have insurance because of Obamacare, and there may be many more that are not being counted by current metrics. We’ll know what the final Texas number is soon, but we won’t really know what the national numbers are for months. Whatever they wind up being, the reality is that they could and should have been a lot more. All we needed was state leaders who cared about solving a problem more than they cared about making fools of themselves on Facebook. You wouldn’t think that would be so hard to do. Wonkblog and Jonathan Bernstein have more.

ACA enrollments top 200K in Texas

Despite continued fierce resistance from state leadership, people keep signing up for health insurance in Texas via the Healthcare.Gov exchange.

It's constitutional - deal with it

It’s constitutional – deal with it

Enrollment in the federal health insurance marketplace continued to steadily climb in January, according to data the U.S. Department of Health and Human Services released Wednesday. In January, another 89,500 Texans selected a health plan on the insurance marketplace created by the Affordable Care Act, the department reported.

“Today’s enrollment figures are more proof that Texans are ready and willing to push past the barriers that Gov. Perry has put in the way of the new Health Care law,” Ginny Goldman, executive director of the Texas Organizing Project, which is assisting enrollment efforts across the state, said in a statement.

As of Feb. 1, the total number of Texans who have enrolled in a health plan jumped to 207,500 from 118,000 at the end of 2013. Across the nation, enrollment grew to 3.3 million, a 53 percent increase over enrollment in the previous three months.

“These encouraging trends show that more Americans are enrolling every day, and finding quality, affordable coverage in the Marketplace,” U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement.

[…]

Texas has been a priority state for enrollment efforts, said Julie Bataille, communications director for the Centers of Medicaid and Medicare Services, and they’re working closely with local organizations and government officials to assist enrollment efforts.

“A lot of the activities that we’re doing in Texas in particular, understandably, are focused on reaching citizens who speak both English and Spanish,” she said.

John Davidson, a health policy analyst at the conservative Texas Public Policy Foundation, said enrollment was strikingly low, given the total number of uninsured Texans.

“In a state with more than 6 million uninsured, you would expect more than 207,546 people would have bothered to sign up after four months of open enrollment,” he said in an email. “This suggests that many Texans do not think the exchanges plans are all that good of a deal after all.”

But Phillip Martin, deputy director of the left-leaning Progress Texas, said that it took Texas four years, from 2006 to 2010, to achieve a similar spike in enrollment on its own — 232,000 children — in the Children’s Health Insurance Plan.

“In the past, it took years to see the kind of health coverage expansion in Texas we’ve seen in the last few months thanks to the Affordable Care Act,” he said in an email.

Davidson’s criticism is kind of hilarious. Why aren’t there more of those benighted suckers signing up for this horrible, fascistic failure of a system that’s totally going to doom us all to a fate worse than not having health insurance in the first place? Don’t you people listen to me when I tell you what’s good for you? Never mind all of the barriers that Rick Perry, David Dewhurst, Greg Abbott, and all the legislators that listen to people like Davidson put in place to keep millions of people off of health insurance. All these people that we’re prevented from getting health insurance still don’t have health insurance – see, it’s a failure, just like I said it would be!

Anyway. Davidson’s BS aside, the pace of enrollments in Texas mirrored the national trend, which showed stronger numbers in January than originally projected. Part of that is catchup from the first two months, but it’s still positive, and portends the likelihood that final signup numbers will be pretty close to what was expected in the beginning. Texas ought to exceed half a million, which is less than ten percent of our shameful total number of uninsured people, but will still be a half million more than Perry and his crew ever helped. And the push continues:

On Saturday, February 15, several community organizations will come together to host a bilingual community event to help Latinos learn about and enroll in new health care plans available under the Affordable Care Act (ACA) . Attendees will learn about new insurance plans, discover what financial help may be available to them, and work with trained experts one-on-one to enroll on site.

The event, celebrating Heart Health, will be hosted by Dia de la Mujer Latina, a national nonprofit organization focusing on Latino health since 1997. Planned Parenthood Gulf Coast and Get Covered America will be providing an opportunity for many underserved populations to learn about insurance options and enroll. Certified ACA navigators will be on hand to provide in person assistance. On the day of the event, attendees interested in enrolling will need to provide an email address, social security number, proof of legal residency (residence card or citizenship certificate), and income verification in order to apply.

Most eligible, uninsured Latinos don’t know how the health care law will affect them. Fifty-three percent of Latinos in Harris County had no health insurance coverage at the time of the 2010 American Community Survey; and in the state of Texas, there are 5.7 million Latinos without insurance. This information session will better inform people in the community about their benefits under the Affordable Care Act.

That’s from a media advisory I got about an event occurring tomorrow at the Hiram Clarke Multi Service Center, 3810 West Fuqua, from 11 to 3. There are a lot of groups out there doing this hard work, all over Texas. Imagine what kind of results they could be getting if people like John Davidson would just get out of their way. Wonkblog and BOR have more.

Arkansas will expand Medicaid

If they can do it

It's constitutional - deal with it

It’s constitutional – deal with it

[Friday], the Center for Medicaid and Medicare Services notified state officials in Arkansas that it has approved the states’ Medicaid expansion plan. And this is not any old expansion plan: Arkansas will be the only state in the country that will use Medicaid dollars to purchase private health insurance for its new public program enrollees.

“CMS is pleased to approve Arkansas’s Medicaid 1115 Waiver application,” Medicare spokeswoman Emma Sandoe said in a statement. “Arkansas and CMS worked together to find flexibilities that gave the state the tools to build a program that worked for them and their residents. We appreciate the collaboration with Arkansas throughout the process and applaud their commitment to providing Arkansans with access to high-quality health coverage.”

There are about 200,000 Arkansans who qualify for the Medicaid expansion. Instead of having them enroll in the public program, like other states will do, Arkansas will send them to their new health insurance marketplace to buy individual plans. When they get to the point of purchase, the Medicaid agency will foot the tab for their health insurance coverage.

The Arkansas expansion will start open enrollment just five days from now, on Oct. 1, alongside the 25 other states planning to expand the program. Benefits will begin Jan. 1.

The idea of using Medicaid expansion funds to pay for private insurance for those that would have qualified for Medicaid under Affordable Care Act expansion guidelines was proposed earlier this year, while the Lege was in its first session. House Speaker Joe Straus seemed open to this kind of idea, but he had precious little company on his side of the aisle. The quasi-Medicaid “expansion” bill that made it out of the House before withering on the vine insisted on asking for a block grant first, as that is Rick Perry’s obsession, but maybe – MAYBE – once that door is slammed shut again there will be some willingness to look at this plan again, however imperfect it is.

An awful lot of people tried to sign up for insurance exchanges on Tuesday

That’s a very good thing, even if technical difficulties prevented many of them from completing the job.

It's constitutional - deal with it

It’s constitutional – deal with it

On the first day of sign-ups for President Barack Obama’s health care reform, a wave of consumers across the nation, including many Texans, sought Tuesday to enroll in online health care marketplaces, but glitches with the federal website prevented them from obtaining information about coverage plans and rates.

“I wanted to get in and see what my options are to get signed up,” said Suezen Salinas, 31, who sought help at Legacy Community Health Services in Houston. “Apparently, there are a few glitches in the system, so it’s not letting us get past a certain place to be able to set up my profile and begin.” Salinas described herself as “disappointed, but I’m still excited.”

By midafternoon the Obama administration sought to quell the complaints from across the country.

Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services, contended problems were resolved and that consumers were, in fact, able to enroll. But during a telephone conference with reporters she refused to disclose a number, saying “we decided not to release that yet.”

Tavenner said 2.8 million people visited the federal healthcare.gov website since it opened Tuesday morning, but that it was unclear how many of those were repeat users.

“This is day one of a six-month process,” Tavenner noted, adding that people have until March 31 to enroll for insurance. Those who enroll by Dec. 15 will begin coverage on Jan. 1.

As the story notes, five times more than have ever been on the Medicare.gov website at one time were on healthcare.gov trying to use the exchanges. That’s truly incredible, and speaks very loudly to the deep, abiding need for this service. Just imagine for a minute how many more people could be getting coverage right now if the Republican Party hadn’t been engaged in a four year jihad to sabotage and undermine it at every step.

The Trib has a report that was updated a couple of times during the day that reported on some of the experiences folks had in Texas. This bit from their most recent update was really annoying to read.

The Brownsville Community Health Center had 50 people show up on Tuesday ready to sign up for health coverage — many even brought pay stubs and income documentation — but not a single one of them had an email address.

“If you don’t include an email address, they won’t let you through,” said Christela Gomez, the special projects coordinator and lead certification application counselor at the center. Although the center considered helping people sign up for an email account, Gomez said many weren’t comfortable with the idea because they did not have a computer to access the email address later. “Quite a few didn’t even know what an email address was,” she added.

The center’s certified application counselors helped the patients fill out paper applications, but they’ll have to wait for a written response from the federal government to find out whether additional documentation is needed or whether those applicants qualify for tax credits.

Some of the questions on the paper application were difficult for patients to answer, said Gomez. One man who came in to receive assistance finding health coverage currently works as a truck driver, she said. He earns 30 cents per mile, and his income can range from $50 to $100 a week.

“We didn’t really know how to fill in the income part with him,” she said, adding, “We kind of just wrote it in on the side, his situation.”

Paula Gomez, the executive director of the center, said her patients are mostly adults who are too young to qualify for Medicare. Although most of her patients have jobs, pay taxes and want to cooperate with the health care system, there are extenuating circumstances like language barriers that make it difficult.

“I’m sure there are pockets like ours all over the country,” Gomez said. She added that the federal government should be more flexible and consider the different situations people are facing across the country. “They think in terms of everything that’s going on in Washington, D.C., but they don’t look at the reality of the rest of the world in the United States,” she said.

You know what might have addressed that problem? If the state of Texas had created its own exchange, since the whole idea behind state-based exchanges was that local folks would know their interests and their population better than a bunch of distant bureaucrats in DC. If we lived in a state whose leaders cared about its people, that’s what we would have gotten. Instead, we’re stuck with the likes of Rick Perry, David Dewhurst, Greg Abbott, and the like, and this is the result. The fact that we’re using the federal exchanges here in Texas doesn’t mean that people won’t get signed up, and it doesn’t mean that they won’t be able to buy quality plans. But the experience could have been better, and it could have been more Texas-oriented, if Perry et al gave a damn. I understand politics, and I get doing what you can to screw your enemies. I don’t get screwing your own people.

Premiums for insurance exchange plans released

Guess what? They’re pretty darned affordable.

It's constitutional - deal with it

It’s constitutional – deal with it

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

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

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

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

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

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

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

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

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

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

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

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

Premiums after tax credits

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

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

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

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

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

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

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

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

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

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

Perry keeps asking for the same Medicaid waiver he hasn’t gotten in the past

Same as it ever was.

Corndogs make bad news go down easier

Free corndogs with every approved treatment!

Gov. Rick Perry is preparing for yet another battle in his war against Obamacare.

In a letter to the state’s health agency on Monday, the governor laid out his plan to request a federal waiver to reform Medicaid as Texas sees fit — without expanding eligibility.

“Seemingly, the president and his administration are content to simply throw money at a problem and hope that any problems will resolve themselves,” Perry wrote in a Monday letter to Kyle Janek, the executive commissioner of Texas’ Health and Human Services Commission. “My response, and the response of the Texas Legislature, has been crystal clear: Texas will not expand Medicaid under Obamacare.”

Instead, Perry has asked that the agency request flexibility in the form of a block grant — a fixed amount of money, rather than matching dollars for Medicaid services — from the federal government to fundamentally reform Medicaid. Specifically, Perry requested that the agency seek a waiver that allows the state to make changes to the program without receiving federal approval, continue asset and resource testing to determine eligibility, and initiate cost-sharing initiatives, such as co-payments, premiums and deductibles, among other reforms.

The waiver “should give Texas the flexibility to transform our program into one that encourages personal responsibility, reduces dependence on the government, reins in program cost growth and efficiently improves coordination of care,” Perry wrote.

[…]

In a second letter sent to HHSC on Monday, Perry requested that the agency develop a mechanism to continue collecting and analyzing income, asset and resource information on Texans who apply for Medicaid benefits. That’s despite a provision in the Affordable Care Act — one that takes effect on Jan. 1 — that requires the state to stop asset testing to determine Medicaid eligibility.

A copy of the letter requesting the block grant is here, and a copy of the letter on asset testing is here. Texas has been asking for a Medicaid block grant since at least 2008, when the Bush administration rejected the request. Perry knows full well what the answer will be, he’s just going through the motions out of spite and the continued delusion that he’ll be appealing to Iowa voters in 2016. If the CMS assigned me the task of writing the response, I’d start out by noting that in any negotiation, there must be good faith and a willingness to give something to get something. As the primary purpose of block granting Medicaid is the limit services, and the primary purpose of the Affordable Care Act is to enroll more people in health insurance plans, Perry’s proposal demonstrates neither of those things. Just this week, we’ve seen two examples of other Republican governors agreeing to expand Medicaid. They both wrung some concessions out of the feds in doing so, but the end result will be more people getting access to health care. And Lord knows, we need a commitment to providing access to health care in Texas.

Texas continued to have the highest rate of people without health insurance in 2012 at 24.6 percent, according to the Current Population Survey estimates released by the U.S. Census Bureau on Tuesday.

“Texas has often had the highest uninsured rate throughout the country,” said David Johnson, chief of the Census Bureau’s Social, Economic and Housing Statistics Division. He added that additional data from the American Community Survey that the Census Bureau plans to release later this week would provide more specific information on health insurance rates in states and metropolitan areas.

The Current Population Survey estimates revealed that the national uninsured rate declined in 2012, to 15.4 percent from 15.7 percent in 2011. The national real median income and official poverty rate were not statistically different in 2011 and 2012, according to the estimates.

Thanks to the insurance exchanges and the ACA subsidies, Texas’ unacceptably high level of uninsured people will decline, though as always Perry is doing everything he can to keep as many Texans as possible sick and unable to do anything about it. Perry and his fellow Republicans just don’t give a damn about the problem. Until they do, I see no reason for the feds to waste any time on these pointless requests.

People who don’t know about Obamacare can’t benefit from Obamacare

One suspects that’s the point.

It's constitutional - deal with it

It’s constitutional – deal with it

Texans, and in particular the state’s Hispanic population, might remain in the dark on the benefits of the new federal health care law because outreach efforts are largely focusing on the 24 states participating in the Medicaid expansion and state-based insurance exchanges, officials with the Centers for Medicare and Medicaid Services said [last] Monday.

Texas is not among those states; Gov. Rick Perry and Republican leaders have argued federal health reform would eventually bankrupt the state. But Dr. Olveen Carrasquillo, a member of the U.S. Health and Human Services Department’s Advisory Committee on Minority Health, said at a Monday meeting that just because a state like Texas isn’t expanding Medicaid or implementing a state-based health insurance exchange doesn’t mean it should be excluded from federal marketing aimed at Hispanics.

“We can’t pretend all is rosy,” he said. “I don’t think this communication plan is working.”

Two-thirds of Hispanics in the U.S. say they do not have enough information about the health reform law to understand how it will affect them, according to the Kaiser Family Foundation’s Health Tracking Poll. Texas has more Hispanic residents than any state but California, and without the Medicaid expansion, 22 percent of them will remain uninsured, according to the Urban Institute’s American Community Survey.

[…]

Special federal funding known as navigator grants, which require at least one community-based nonprofit to operate as a health reform outreach provider, will become operational in Texas around September or October, according to Kelly Dinicolo, technical adviser at CMS. These nonprofits will provide in-person enrollment assistance to help people buy insurance — in Texas, it will be via a federal health insurance exchange — or direct them to Medicaid, if they qualify.

Dinicolo and other government officials said they have launched some limited advertising in Texas, but mainly through online marketing because it is easier to target a younger demographic. For those who do not have access to online information, CMS has announced a partnership with libraries to help people navigate the health reform changes.

The newly launched informational website about health care reform, Healthcare.gov, has also launched a Spanish version, CuidadoDeSalud.gov.

There’s also Be Covered Texas, in English and Spanish, which is a statewide campaign launched in March by Blue Cross Blue Shield Texas to help enroll Texans in the exchange, and Get Covered America, launched in June, aimed at informing people about the October 1 enrollment period opening. Hopefully, they can help to fill the gaps. But let’s be clear here: The reason we’re in this position is because 1) Rick Perry and most of the Republicans in the Legislature refused to expand Medicaid; 2) Perry and the Lege refused to do a Texas insurance exchange and have not lifted a finger to abet the federal effort; and 3) the Republican-controlled Congress has refused to appropriate any more money for the federal information program about exchanges. If people remain uncovered or uninformed despite the hard work of the people and groups heroically trying to overcome these obstacles, it’s not their fault.

What Obamacare will do for Texas

Even without Medicaid expansion, the Affordable Care Act will help millions of Texans get access to health care.

It’s constitutional – deal with it

Nearly 2.6 million Texans could qualify for tax credits to purchase health insurance in 2014, according to a report released Thursday by Families USA, a nonprofit that advocates for health care consumers.

The tax credits will be offered through the health insurance exchange — an Orbitz-style online marketplace for health insurance — that the federal government plans to launch as part of the Affordable Care Act in October. Beginning in January, families with an income of up to 400 percent of the federal poverty line, between $47,100 and $94,200 for a family of four, will be eligible for a tax credit subsidy to purchase insurance through the exchange. The tax credits will be offered on a sliding scale, so that lower-income families will receive larger credits.

“These are typically the families where folks are working, sometimes more than one job,” U.S. Rep. Pete Gallego, D-Alpine, said of the report. “Regardless of where you are on the political spectrum, I think that’s something we can all support.”

Nearly 5.8 million Texans — nearly a quarter of the state’s population — are uninsured. The Health and Human Services commission estimates the tax credits offered through the health insurance exchange and other provisions in the Affordable Care Act will lower that rate to 16 percent. If Texas also expanded Medicaid — an unlikely scenario given Gov. Rick Perry’s opposition — the uninsured rate could be lowered to 12 percent.

“Given the large number of people in Texas that are uninsured, many of whom are poor, this is an extraordinary opportunity,” said Ron Pollock, executive director of Families USA. He said it was “short-sighted” for the state’s leadership to oppose Medicaid expansion, as it would bring billions of federal dollars to the state, and increase job opportunities.

You can see the report for Texas here, and for other states here. That still leaves about a million people who would be able to get Medicaid if the state agrees to expand it, but we know how little Rick Perry cares about these people. Trail Blazers has more on the Families USA report.

Elsewhere on the Medicaid front, HHSC Commissioner Kyle Janek has been given the go-ahead to negotiate with the U.S. Centers for Medicare & Medicaid Services. At the time, he wasn’t given any direction about what to negotiate for or toward, but perhaps now that the Zerwas bill has been discussed in committee there’s something tangible for him to talk about. We’re unlikely to hear much about his effort and any progress he may make since apparently talking about it in public spooks people, the way saying the name “Voldemort” does in the Harry Potter books. Lord only knows what might happen, but hey, at least they’re talking. EoW has more.