Most of this should be familiar to us by now.
Deep spending cuts in the recently passed House budget would profoundly change the state’s medical system, placing tens of thousands of Texans in the difficult position of finding alternate care from a dwindling list of prospects, health care advocates warn.
Much of the impact would be on elderly Texans, adults with disabilities, those in need of mental health care and low-income families in search of obstetricians, pediatricians and general practitioners. Private insurance rates and hospital-provided care also might be affected.
Even the still-developing Senate budget, which seeks to mitigate many of the deepest cuts, carries a measure of pain that several Republicans rue but feel powerless to prevent.
They control every statewide office, they have a supermajority in the House, and they feel powerless? Even if I believed that, I’d feel no sympathy for them. They made this mess, and it is entirely within their power to fix it. But they don’t want to, and they also don’t want to be held responsible for that. Sorry, but you can’t have it both ways.
Keeping up with population growth and maintaining current health and human service programs would have cost about $31 billion in state money in 2012-13.
The House set aside $22 billion.
About $1.6 billion was saved with a 10 percent cut in Medicaid reimbursement rates for doctors, hospitals and nursing homes that serve 3.5 million Texans with disabilities or low incomes.
An additional $4.3 billion was cut from projected cases. But because Medicaid-eligible patients cannot be turned away, the Legislature is expected to return in 2012 or 2013 to pass a supplemental budget to fill the gap.
This is an important fact to keep in mind. Much like the payment-delaying accounting tricks, making cuts to Medicaid doesn’t mean those obligations go away. They’re just being deferred. The bet is that sales tax revenue will exceed expectations, and the extra money will be there to take care of this. Sales tax revenues are up, but not nearly to the point where they were before 2008. Expect there will be the need to scrape up more funds in a year’s time or so.
A study by the conservative Texas Public Policy Foundation projects unsustainable growth for Medicaid, which might consume almost 47 percent of the state budget in 2014-15, up from 28 percent in 2008-09.
“We have some hard choices to make,” said Arlene Wohlgemuth, executive director of the foundation. “But we also have a responsibility to keep our economy in as healthy a shape as we can. That affects all Texans.”
Already-struggling families cannot be asked to pay more taxes, said Wohlgemuth, a former House member. “I have a lot of sympathy for our legislators, but the message last November continues to be strong that people want reduced spending.”
Still, Sen. Bob Deuell, R-Greenville , said recently that “even in my very Republican, conservative district,” he’s heard support for tapping the state’s rainy day fund and raising the gas tax and state fees to cushion the impact of health care cuts.
I’ll take Sen. Deuell’s word for it over that of a lobbyist. As noted before, that’s what the 2012 election will be all about. Or at least, that’s what it needs to be all about. It’s up to the candidates and the party to figure out how to make the case in an effective manner.
Other effects of Medicaid cuts/changes: moving pharmacy delivery under managed care will actually reduce choice of and access to pharmacy services; force some local pharmacies out of business; and cost Texas jobs and output. Economist Ray Perryman did a great study (for Pharmacy Choice and Access Now (PCAN), which I represent) highlighting the negative impact of these legislative proposals: http://www.rxchoiceandaccess.com/information-center/