Author: DW Admin

Express-News Editorial Board

Anywhere from 100,000 to 300,000 people here who would have received health care will, instead, remain uninsured. READ MORE

Published by the San Antonio Express News: Texas’ refusal to participate in the mostly federally funded expansion of Medicaid was the biggest health story of the recently concluded legislative session, but in other, less heralded actions, lawmakers sought to get more medical care to more people. READ MORE

by Becca Aaronson

Despite Gov. Rick Perry remaining strongly opposed to expanding Medicaid, a House panel on Tuesday considered legislation that would expand coverage to poor adults under the Affordable Care Act.

“This is not Medicaid expansion; this is Texas Plus or Medicaid Plus One,” said state Rep. Sylvester Turner, D-Houston, who laid out his House Bill 3376 at the House Appropriations Subcommittee on budget transparency and reform.

HB 3376 would expand Medicaid coverage to individuals below 133 percent of the federal poverty line. The bill includes a severance clause that requires the state to stop financing the program if the federal government reduces its share of financing below 90 percent and — “in the spirit of conservatism,” as Turner put it — also includes cost-sharing requirements such as co-payments.

“I don’t think anyone can dispute the numbers. We may dispute whether or not we want to do it,” said Turner, emphasizing that the state comptroller estimates expanding Medicaid coverage as proposed in HB 3376 would save the state $50.4 million in the 2014-15 biennium. “From a fiscal, financial, budgetary point of view, the numbers are overwhelming.”

Health care providers, advocates and religious leaders overflowed the committee room to testify in favor of the state expanding Medicaid coverage. Anne Dunkelberg, associate director and health policy analyst with the left-leaning Center for Public Policy Priorities, testified that health care premiums can consume 40 percent of a low wage earner’s income, prohibiting the working poor from purchasing coverage.

But not all lawmakers seemed swayed by the testimony.

“We always paint a picture of people crying in bed at night because they don’t have health insurance, and I really don’t think that’s true,” said Rep. Myra Crownover, R-Denton, the chairwoman of the subcommittee. She gave the example of healthy, uninsured adults she knows who do not think they need health insurance. “Everybody really wants car insurance when they have a car wreck, [but] they’d like to drive around uninsured if they could get away with it,” she said.

A report by Billy Hamilton, the state’s former budget estimator and former deputy comptroller, estimates the state could achieve even greater savings by expanding Medicaid — $1.2 billion in the 2014-15 biennium, as Texas would spend less on other health programs to cover poor populations. Hamilton also estimates the Medicaid expansion would cost Texas $15 billion over 10 years, while allowing Texas to draw down $100 billion in federal financing. Another report by the Hobby Center estimates as many as 4.4 million of the 5.8 million Texans without insurance in 2010 could have insurance by 2014, depending on how federal health care reforms are implemented.

But Perry and other opponents of expansion say that Medicaid is broken and that expanding Medicaid under the Affordable Care Act would compound the exponentially rising costs of Medicaid.

These Texas Tribune interactives show the economic impact of the Medicaid expansion by legislative district, and the effects on uncompensated care and the rate of uninsured by county. Texas Impact and the Methodist Healthcare Ministries of South Texas commissioned the reports.

Kevin Moriarty, president and chief executive of Methodist Healthcare, told the committee that Hamilton’s reports provide compelling arguments to expand Medicaid coverage from a humanitarian, financial and budgetary perspective.

“Taxpayers get our dollars back. It seems to me fairly ludicrous to allow these funds to go to other states,” Moriarty said. “Taxpayers locally pay more because we don’t do this.”

Moriarty also emphasized multiple studies that show 5,000 to 9,000 people die each year because they lack access to health insurance.

John Davidson, health care policy analyst for the conservative Texas Public Policy Foundation, testified that the state should not expand Medicaid, but rather, seek a private market solution to expanding health coverage.

“We believe its reckless and unconscionable to expand a program that’s so obviously flawed,” said Davidson, emphasizing that low reimbursement rates and bureaucratic red tape have created a fragile network of Medicaid providers, and that multiple studies show Medicaid recipients have had worse health outcomes than those with private health plans.

If Texas does not expand Medicaid, Davidson said, a third to half of the potentially eligible population could qualify for a subsidy to purchase a private plan through the health insurance exchange.

The committee temporarily recessed so that House members could meet in the chamber. When they return later Tuesday afternoon, they are expected to consider House Bill 3791, authored by Rep. John Zerwas, R-Simonton, which would require the state’s health commissioner to craft a “Texas solution” to Medicaid by pursuing a Medicaid waiver or authorization from the federal government to reform Medicaid while expanding coverage to poor adults.

During budget negotiations, the Senate approved a rider by Sen. Tommy Williams, R-The Woodlands, which would also encourage the state to prioritize premium assistance for private market plans and contain state spending on the program. The House approved a similar measure during its budget negotiations, then backpedaled on that decision and removed the amendment on a party-line vote. 
 

This article originally appeared in The Texas Tribune at http://www.texastribune.org/2013/04/16/house-panel-considers-medicaid-expansion-proposal/.

Kevin C. Moriarty, For the Express-News

Gov. Rick Perry has made it clear where he stands on expanding the state’s Medicaid program to include low-income adults. READ MORE

Published by the San Antonio Express News: While Gov. Rick Perry on Monday surrounded himself with the state’s premier Republican leadership to excoriate Medicaid expansion, Democrats responded with their own political stars: the Castro brothers of San Antonio, who urged the governor to find a compromise to provide health care for more than a million low-income Texans. READ MORE

Published by Health Affairs GrantWatch Blog: On March 8, while a Texas House committee held our state’s first Medicaid expansion hearing, the Center for Public Policy Priorities hosted a legislative briefing with invited presentations by researchers from Rice University and George Washington University. They have studied the impact that the Affordable Care Act would have on the uninsured population in Texas, as well as the effects the new health care law will have on primary care access across our state. READ MORE

Published by The Houston Chronicle at Chron.com: Expanding Medicaid could make available $900 million in state general revenue funds that otherwise would be slated for health care as lawmakers work to pay for state priorities, according to a report released Tuesday. READ MORE

by Becca Aaronson

As state legislators consider what “a Texas solution” to Medicaid expansion would look like, others have begun addressing the question of how Medicaid expansion would affect the state budget and local taxes.

With extra federal money coming in, Medicaid expansion could offset $1.2 billion in the 2014-15 biennium budget that Texas would spend on other health programs to cover poor populations, according to a report released Tuesday by Billy Hamilton, the state’s former budget estimator and former deputy comptroller. The report was commissioned by Texas Impact and the Methodist Healthcare Ministries of South Texas.

“The issue needs to be examined closely by the affected agencies,” Hamilton said in a written statement. “The estimates are conservative but preliminary until we receive feedback from the agencies that that have access to much more detailed internal data and information concerning their programs and strategies.” 

This chart looks at how Medicaid expansion could impact spending on certain state programs, based on Hamilton’s report. The third column shows requested general revenue funds for the 2014-15 biennium, and the last column shows the amount that would be freed up by Medicaid expansion. 

AgencyProgramRequested GR Funds Only (FY 2014-15)GR Available Due to Medicaid Expansion (FY 2014-15)

 
Total
$3,446,483,003
$1,203,841,678

HHSC
Medicaid Pregnant Women
$871,792,147
$259,428,748

HHSC
Medicaid Health Services-Other Adults-TANF Level
$497,527,508
$303,625,617

HHSC
Women’s Health Services
$60,145,250
$28,679,175

HHSC
Undocumented Aliens & Legal Permanent Residents
$312,893,444
$28,121,533

HHSC
Breast and Cervical Cancer Program
$39,495,524
$13,646,568

HHSC
Non-Full Benefit Payments-Other
$68,657,493
$30,344,291

HHSC
Medical Transportation-Full Risk Broker Model
$60,966,753
$1,794,602

HHSC
Medical Transportation-Fee for Service
$122,165,357
$3,596,641

DSHS
Immunize Children & Adults in Texas
$58,603,692
$11,695,545

DSHS
HIV/STD Medications
$64,792,088
$28,638,761

DSHS
HIV/STD Services
$32,417,582
$12,896,011

DSHS
Kidney Health Care
$50,877,031
$13,232,277

DSHS
Community Primary Care Services
$26,897,446
$13,585,177

DSHS
Mental Health Services for Adults-Outpatient Services
$388,838,766
$95,807,889

DSHS
Mental Health Services for Adults-Inpatient Services
$9,584,492
$2,623,967

DSHS
NorthSTAR Behavioral Health Waiver Medicaid PMPM
$11,206,918
$2,249,380

DSHS
NorthSTAR Behavioral Health Waiver Indigent PMPM
$53,330,198
$33,395,719

DSHS
Substance Abuse Treatment
$25,086,000
$9,429,500

DSHS
Indigent Health Care Reimbursement (UTMB)
$11,500,000
$5,507,001

DSHS
County Indigent Health Care Services
$1,162,602
$1,162,602

DSHS
Texas Center for Infectious Diseases (TCID)
$20,247,936
$16,029,616

DSHS
South Texas Health Care System
$6,321,329
$3,660,544

DSHS
Mental Health State Hospital Off-Campus Medical Care
$19,513,552
$5,557,403

DSHS
Mental Health Community Hospitals Inpatient Services
$139,006,192
$48,312,993

TDCJ
Treatment Alternatives to Incarceration
$20,871,696
$16,084,078

TDCJ
Special Needs Programs and Services
$37,859,890
$28,046,469

TDCJ
Inpatient and Clinical Care for Incarcerated Adults
$314,622,083
$154,689,191

TDCJ
Substance Abuse Felony Punishment Facilities
$114,766,718
$28,974,943

UTMB
UTMB Indigent Care
$5,333,316
$3,025,439

The dominant fiscal argument for proponents of Medicaid expansion is that the program would reduce billions in uncompensated care costs shouldered by local government entities and public hospital districts. Spending on uncompensated care, the proponents say, raises private insurance premiums and local tax rates.

In response to those assertions, Sen. Charles Schwertner, R-Georgetown, has filed legislation, Senate Joint Resolution 61 and Senate Bill 1808, calling for a constitutional amendment to reduce local tax rates if Texas reaches an agreement to expand Medicaid and the program realizes cost savings.

“Ultimately, we’re talking about our own federal tax dollars, taxes we already pay, that would be used to alleviate these expenses,” Schwertner said in a statement. “If this is really about reducing costs and saving people money, then it makes absolutely no sense for Texans to be taxed twice for the same services. This legislation would protect Texans from double taxation.”

Hamilton estimates the Medicaid expansion would cost Texas $15 billion over 10 years, while allowing Texas to draw down $100 billion in federal financing. These Texas Tribune interactives show the economic impact of the Medicaid expansion by legislative district, and the effects on uncompensated care and the rate of uninsured by county, according to Hamilton’s estimates.

John Davidson, a health policy analyst at the conservative Texas Public Policy Foundation, said Friday at a legislative hearing that other states that extended Medicaid to adult populations did not see a reduction in uncompensated care costs.

“Property owners should not expect taxes from county hospital districts to go away if the state expands Medicaid,” Davidson said in an email, adding that the Affordable Care Act cuts billions in Medicaid and Medicare financing to hospitals to pay for provisions in the law and therefore, hospitals may continue to seek additional public financing for uncompensated care.

Although state Republican legislators have overwhelmingly rejected Medicaid expansion “in its current form” under the Affordable Care Act, they’ve begun negotiations on what Medicaid expansion would look like in Texas.

Rep. John Zerwas, R-Simonton, filed House Bill 3791 to grant the Health and Human Services Commission the authority to reach an agreement with the federal government to expand Medicaid, if certain parameters determined by the Legislature are met. Currently, the bill requires the agreement with the federal government to include cost-sharing measures, such as copayments, and allow Texas flexibility to tailor benefits offered by the Medicaid program. It also includes a severability clause to end the expansion program if the federal government reduces it share of financing.

The federal government would pay 100 percent of Medicaid expansion enrollees’ health care costs from 2014-16, and then, would pay a smaller percentage each year until the federal share reached 90 percent in 2020. Texas can opt in or out of Medicaid expansion at any point, but the 100 percent federal financing match is only available in 2014-16. Texas would also be required to pay half of the administrative costs, which the Legislative Budget Board estimates would cost the state $50 million in 2014. 

This article originally appeared in The Texas Tribune at http://www.texastribune.org/2013/03/12/medicaid-expansion-offset-state-spending-and-local/.