This comes with a huge “but” attached to it.
It’s constitutional – deal with it
More than 60 percent of Texans support an expansion of Medicaid here and plan to take those views into the voting booth in November, a new survey commissioned by the Texas Medical Center Health Policy Institute finds.
The survey results, unveiled Wednesday at the annual Medical World Americas convention in Houston, show the public at odds with the state’s Republican leadership, which has steadfastly refused to consider such an expansion, calling it wasteful and a bad solution.
“I understand people in Austin have been reluctant, but I believe what this survey demonstrates is that people want something done to improve access,” said Dr. Arthur “Tim” Garson, director of the Health Policy Institute. “People are looking for help and their choice seems to be Medicaid expansion. A uniquely Texas solution would be best, but we have to do something.”
The findings further resonate in a state that continues to lead the nation in the number of uninsured. Texas remains one of 19 states that has chosen not to expand Medicaid under the Affordable Care Act.
The second annual Medical Center study gauging public opinion on health care issues covered topics ranging from access to health care to the wisdom of raising the price of foods that contribute to obesity.
Of the 1,000 people polled by Nielsen in five states, close to 100 percent said they feel it is deeply important to have insurance for themselves and their family. In Texas, 96 percent value health insurance.
The study’s margin of error is 3 percentage points overall and close to 5 percentage points in Texas.
Beyond self-interest, 91 percent of respondents in Texas, California, New York, Ohio and Florida said it was important to them that everyone in the nation have health insurance.
The sticking point has always been how to get there.
In Texas, 63 percent of those polled said they support an expanded Medicaid program. Similarly, 68 percent in Florida also favored a Medicaid expansion. These numbers are significant because of the states surveyed, only Florida and Texas did not expand the safety-net program, which is jointly paid for with federal and state dollars.
I couldn’t find a copy of the poll googling around, so you’ll have to take the story at its word. The caveat over this, of course, is that none of it matters until someone loses an election over it. Let me say that again in capital letters, for emphasis: NONE OF THIS MATTERS UNTIL SOMEONE LOSES AN ELECTION OVER IT. Greg Abbott doesn’t care what opinion polls say, and there’s not nearly enough support in the Legislature to push the issue. Various county-level Republicans, who feel the effect of paying for health care for a substantial uninsured population directly, support Medicaid expansion, but again, Greg Abbott doesn’t care what they think. Until someone loses an election because they oppose expanding Medicaid – and by this I mean someone who was otherwise expected to win, not someone who was vulnerable because of varying turnout patterns or other exogenous factors – nothing will change.
Let’s put some numbers on this ghastly situation. From the journal Health Affairs–” In Texas, the largest state opting out of Medicaid expansion, 2,013,025 people who would otherwise have been insured will remain uninsured due to the opt-out decision. We estimate that Medicaid expansion in that state would have resulted in 184,192 fewer depression diagnoses, 62,610 fewer individuals suffering catastrophic medical expenditures, and between 1,840 and 3,035 fewer deaths.”
This is for one year.
Here’s my problem with Medicaid, and thus, Medicaid expansion: Those folks have no skin in the game. If I think I need to go to the ER, for example, it’s an agonizing decision, because, while I have private insurance, the deductible is so high that I am paying for the entire visit myself anyway, and the question is, do I pay $1,500 that I will no longer have to pay my medical insurance premium, property taxes, etc. or do I just try to limp along and take care of my other obligations.
For our Medicaid recipients, hey, no problem. When they feel poorly, there is ZERO expense involved in visiting an ER. They have no such decision to make. Why not just go when the mood strikes them? If they had to pay something in addition to the taxpayers footing the bill, it would be better.
Additionally, when you look at who is on Medicaid, it isn’t just the traditional poor and downtrodden. I personally know someone who has a professional job, lives in a nice house, yet her kids are on Medicaid, even though insurance for those kids would be available for purchase through that person’s government job.
@Bill, there are a couple of points to make here. One, deductibles are a product of the insurance industry. Your real point is that some people are getting goods and services for free that you and I have to pay for. Let me ask, do you give to charity? Contribute to food banks? If so, then you really can’t complain about people getting free stuff. I don’t begrudge poor people whatever paltry assistance they do get. As far as the kids care, if you really do know such a person, then the government knows how much they make and also about the benefits, so they probably qualify under the strict guidelines. The reason that you have seen Texas advertising on TV about the CHIP children’s health insurance program is that it is very under-enrolled, many more kids qualify than are in the program.
Every year Texans are paying taxes that go to fund health care in other states, while rejecting the best health care solution we currently have for poor adults just for some highly questionable political reasons. On top of the tax money we send to other states we are paying more taxes for county hospital care of the poor. The answer is to expand Medicaid. Whatever political gains were to be had from fighting the expansion have evaporated.
God forbid houston city council members and harris county commissioners put on their platforms that they’ll advocate for medicaid expansion, single payer or some form of universal healthcare.
Hell, even Ted Cruz thinks employers based healthcare is dumb.
How many morons do we have to elect to city council and county court that don’t have any ideas in writing on their website.
For the 4th largest city and a Fortune 500 capitol, houston politicians are a joke.
Here’s my problem with Bill Daniels: he shows up in comments with half baked ideas and no facts to back up his assertions.
First off, the lack of widespread insurance coverage/medicaid expansion means that your copay, premiums, and property taxes are higher to offset uncompensated care. Why you want to pay more to punish poor people is beyond me.
Secondly, in Texas the people with Medicaid are individuals with disabilities, the elderly, children, and pregnant women. I don’t care about the copay with my insurance, my skin in the game is the health and well being of my kid.
Next, RAND and others have done studies that show that cost-sharing for poor people in poor health (such as many of the elderly and disabled on Texas Medicaid) resulted in worse health
outcomes (e.g., high blood pressure, anemia), reduced use of preventive care, and delayed medically necessary treatment. If you want to pass copays on poor people you’re going to drive them away from healthcare and make them sicker (and more expensive to treat when they finally seek coverage).
Regardless of that, the Obama administration has been willing to let Republican states implement copays if it means they’ll expand Medicaid. The bills that have been proposed by Republicans in Texas to expand Medicaid include similar provisions. I hope this means that you’ll support Medicaid expansion now.
Finally, your friend who has kids on Medicaid: she makes at maximum $1,354 a month, $16,245 a year. HHSC is very strict about this. I think you are either mistaken, or lying.
@Joe:
Yes, I really do know a married woman of 4 kids (one adult child in the service), and the 3 kids under 18 are on Medicaid. I’m guessing no child support from deadbeat dads, but she is married to a man (not the father that makes way more than the figure you quoted. Between the two, they have 3 cars and a nice, reasonably modest, brick home.
Now, here’s the part of your post I really like:
” cost-sharing for poor people in poor health (such as many of the elderly and disabled on Texas Medicaid) resulted in worse health
outcomes (e.g., high blood pressure, anemia), reduced use of preventive care, and delayed medically necessary treatment.”
Uh, hello, this is what everyone the next rung up the ladder faces, cost sharing in the form of deductibles and copays. My health outcome would probably be better if I didn’t have to weigh paying for health care vs. buying groceries and gasoline, but that’s the choices people have to make that don’t get Uncle Sugar to pay for everything. I should be getting a colonoscopy every few years, for example. How many have I had? Zero, because the full couple thousand dollar bill would be left for me to pay. That’s just one preventative test I can’t pay for that the Medicaid set don’t think twice to have.
I object to paying taxes for people to have better access to healthcare than I have. How is that half baked?
Yes, of course Bill knows this woman. She’s Ronald Reagan’s mythical Welfare Queen, who sucked up all the tax money in the eighties, living high on the hog on welfare with five kids while working whites suffered. Then in 2002 she had 4 more kids, using WIC and food stamps to buy a Lexus. Now she’s back, with another 4 kids, this time as a Medicaid Queen, using up all the health services for free while working whites suffer. And the amazing part of all of this is she is personally known by every right wing commenter/whiner on the net.
@Jen:
The facts are as I described them. Working mother of 3 under aged children on Medicaid. The 4th child in the military overseas. One child feeling poorly? No problem, visit the ER, because, it’s totally free to the mother. No reason NOT to go to the ER.
I’m not tossing out the “food stamp recipient driving off in a new Cadillac” meme, nor am I claiming she has 9 total children. Believe, or don’t. Truthfully, I was surprised when the husband (not the kids’ father) told me the kids were on Medicaid. I work with the husband.
But why can’t she take them to a regular doctor instead of to the ER?
Aren’t colonoscopies covered by insurance?
Colonoscopies are covered, the amount depends on your insurance. More details here http://www.cancer.org/cancer/colonandrectumcancer/moreinformation/colonandrectumcancerearlydetection/colorectal-cancer-early-detection-screening-coverage-laws
If you are putting off a colonoscopy for monetary reasons, that is penny wise pound foolish. The recommended interval is 10 years unless you have polyps. Call your insurance company and ask them how much you will have to pay.
Ross,
Grandfathered plans don’t exempt a colonoscopy from the deductible, in my case, the first $6K of medical care is all on me, despite the fact that I carry an insurance policy. I’ve had my plan for almost 20 years. I realize that as you get older, it gets more expensive, but my personal experience has been, the policy was inexpensive and increases were few and far between, until O’Care passed. Of course, now that policy covers me getting addiction treatment (doubt I’ll need that) and me getting pregnant (doubt I’ll need that either), so there’s that.