Published by the KZTV10.COM: Texas Republicans have made it clear they hate the idea of expanding health care for the poor under the Affordable Care Act, but a key leader pledged Friday to work on a state alternative to accomplish the same goal and bring in the same federal matching funds. READ MORE

San Antonio, Texas — Billy Hamilton, the former deputy comptroller for Texas and the author of the Methodist Healthcare Ministries’ (MHM) commissioned report, “Expanding Medicaid in Texas: Smart, Affordable and Fair,” is expected to testify before the Texas House Appropriations Committee in Austin on Friday, March 8, 2013 regarding the potential expansion to the state’s Medicaid program.

Hamilton’s testimony comes on the heels of House Speaker Joe Straus’ (R-San Antonio) plea to fellow Republican lawmakers to come together in order to propose a solution that would be supported by our state leadership.

According to Hamilton, under a moderate enrollment scenario, Texas could experience a $1.8 billion increase in taxes from new federal Medicaid funds from fiscal years 2014 to 2017. Proponents of expanding the state Medicaid program have hailed the economic analysis within the report as the singular and most compelling argument for why Texas should follow suit with the expansion.

Dr. Michael Cline and Dr. Steve Murdock, authors of the MHM-commissioned report, “Estimates of the Impact of the Affordable Care Act on Counties in Texas” will also be present at the hearing to offer lawmakers their perspective on how Texas counties will be impacted by implementation of the Affordable Care Act, which gives states the option of expanding their state Medicaid program.

The hearing will take place just as advocates plan to gather at the Capitol for a legislative briefing hosted by the Center for Public Policy Priorities. Attendees at the briefing will have an opportunity to hear from Dr. Cline and Dr. Murdock as they present findings from their report, as well as Dr. Leighton Ku of George Washington University as he presents findings from the MHM-commissioned report, “The Potential Primary Care Crisis in Texas: A County Based Analysis.”

Each study highlights the impact of implementing the Affordable Care Act at different enrollment scenarios on a county-by-county level, and even addresses the workforce issues that will no doubt become part and parcel of the debate as lawmakers grapple with expanding the state Medicaid program.

For more information about the legislative briefing hosted by the Center for Public Policy Priorities, contact Brian Stephens at stephens@cppp.org. To download the reports by Dr. Cline and Dr. Murdock, Mr. Hamilton, and Dr. Ku visit www.mhm.org.

by Bee Moorhead & Kevin C. Moriarty

A rebuttal from the groups that commissioned the Hamilton report on Medicaid expansion; they say the concerns about expansion, elucidated in a recent critique of the report by Sen. Bob Deuell, are unfounded

As representatives of the faith community, we believe that health care is a core value – but we also believe in weighing the facts and making smart policy decisions, so we commissioned a report by universally respected state budget expert Billy Hamilton to find out what the fiscal and economic impacts of Medicaid expansion would be in Texas. Since our report was released, legislators and others have raised important concerns about expanding Medicaid. We believe lawmakers deserve to have their questions and concerns addressed thoroughly as they debate one of the most important legislative decisions Texas has made in decades.

Many of the most common concerns about Medicaid expansion are unfounded.

Fears about the possibility of people shifting from private insurance to Medicaid causing negative effects to the insurance industry, creating a new class of uninsured and causing premiums to increase are unfounded. Dr. Michael Cline and Dr. Steve Murdock with the Hobby Center for the Study of Texas at Rice University have estimated that approximately 1.5 million uninsured individuals will sign up for the ACA subsidized insurance under a moderate enrollment scenario. The Health and Human Services Commission estimates about 10 percent of privately enrolled individuals will shift to Medicaid, although some states have experienced less. In Texas, that would be about 87,000, which the 1.5 million would totally overwhelm. The net effect of the ACA, then, will be a huge boost to the insurance industry. This issue was debated and put to rest during the original debates on passing the ACA. Our report provides a range of enrollment scenarios as well as the data for people to develop their own assumptions about shifting.

Worries that accepting the federal funds will somehow increase the federal deficit or debt are also unfounded. The federal government is not borrowing money to pay for the Medicaid extension to low-income adults or the ACA’s subsidized insurance. The ACA has built-in revenue streams and offsets that will more than pay for expanded Medicaid and subsidized insurance. In fact, it will generate more revenue than it spends; the Congressional Budget Office, the nonpartisan arm of Congress that estimates the fiscal impact of legislation similar to our Texas Legislative Budget Board, estimates that the ACA, including the Medicaid expansion, will shave more than $200 billion off the federal deficits over the next ten years.

To manage anxiety that the federal government will renege on its promise to fund 90 percent of the cost for low-income adults beyond 2020, Texas could include an automatic trigger, such as Arizona is doing. Texas could discontinue the program if Congress reneges on its promise.
Another concern is that the Medicaid system in Texas cannot handle an influx of new patients since only about 59 percent of physicians accept Medicaid patients, according to Community Health Choice (CHC), a managed care organization, that compared Medicaid payments from the Health and Human Services Master File to active physicians licensed by the Texas Medical Board. The ACA, however, recognized this national problem and fully funded a rate increase for primary care services up to the Medicare rate for 2013 and 2014. Extending the rate increase is optional for states, which would continue to receive federal matching funds to help pay for it.

In Texas, the Medicaid reimbursement rate was only 61 percent of the Medicare rate in 2012, according to the Kaiser Family Foundation, close to the national average of 59 percent. Nationally, the average cost of a 30-minute office visit for a new primary care patient was $63.46. In Texas, an increase to the Medicare rate would bring that fee up to $104.03—a substantial improvement.

A recent study conducted by Sandra Decker, an economist with the Centers for Disease Control, and published in Health Affairs, found that 83 percent of physicians nationally accepted Medicare compared to only about 69 percent that accepted Medicaid. She also found that the percent of physicians accepting new Medicaid patients correlated with the amount the state paid Medicaid doctors as a percent of the Medicare rate. Consequently, the rate increase that began in January in Texas should create a substantial increase in the number of physicians accepting new Medicaid patients.

Finally, Texas and other states have been looking for “flexibility” in the Medicaid program, including co-payments and a strong focus on managed care. Recently, the administration released its Final Rule for copayments and increased rates that states may charge for provider visits, including giving states’ the flexibility to charge higher rates to those above the poverty level who use hospitals for non-emergency care. Texas has long been a leader in implementation of Medicaid managed care, which is now available statewide. With the streamlining of eligibility systems that the ACA enacted and the new flexibility in co-payments now afforded the states, Texas no longer has a pressing need for a Medicaid block grant.
On the other hand, there are some very real dangers regarding Medicaid expansion that legislators should attend to promptly.

First, over the next ten years, Texans will be paying into a $100 billion kitty collected by the ACA’s new revenue streams and offsets to extend Medicaid to low-income Texans. If Texas opts out of the extension, then Texans will be effectively donating that $100 billion to the federal government!

If Texas delays the extension a biennium, presumably for time to “fix” Medicaid, then Texans will permanently lose $7.7 billion in federal funds. Texas has a long history of continuing to serve more than 3 million children and adults in its Medicaid program while implementing major reforms and structural changes. There is no reason why the state cannot implement improvements while serving this new population.
At the same time that Texans are paying in to the $100 billion kitty, Texans will continue to pay out the same high state and local costs for this group, who currently seek help in local hospital emergency rooms and community health clinics. The total annual amount of unreimbursed health care costs for local government alone in Texas amounted to about $2.5 billion in 2011 and hospitals shouldered another conservative estimate of $1.8 billion. This estimate includes only uninsured individuals and excludes any unreimbursed costs of Medicaid or other government-sponsored programs.

Although the ACA will relieve some of this burden, since people from 100 percent to 400 percent of the poverty level will be able to obtain subsidized insurance through the insurance exchange, much of it will remain unless the state extends Medicaid to adults below 138 percent of the poverty level.

We estimate that Texans will also need to find an additional $889 million for this next biennium alone to fund the additional children who are currently eligible for Medicaid but not enrolled and who will sign up through the streamlined enrollment process provided through the new federal health insurance exchange. For the 2016-2017 biennium, the total will increase to $1.6 billion.

And, if Texas wants to solve its Medicaid physician shortage, it will need to find yet an additional $161 million for the 2014-2015 biennium to extend the basic primary care services rate increase that the ACA funded for 2013 and 2014, according to HHSC’s July 2012 estimates, and an additional $92 million to extend it to all physicians providing primary care services. Although the extension of the primary care rate increase beyond 2014 is technically optional, the state will need to find the money anyway to ensure enough available physicians to treat the new children materializing in 2014.

Without the new state and local revenue that extending Medicaid would bring, however, Texas will be hard-pressed to find these additional revenues. If Texas opts in, however, then an estimated $500 million in state revenue will flow in for the next biennium and about $1 billion in the following biennium due to the influx of federal funds for the adults. In addition, it will add an estimated $700 million in the next biennium to state revenue and $1.4 billion to local coffers. Since the federal funds will pay 100 percent of the services to adults for the next three years and no less than 90 percent in 2020 and beyond, general revenue that Texas now spends on this population at the state and level would become available. And, local hospitals will no longer have to shoulder the burden of uncompensated costs for this population. In effect, we would be shifting this population from the “Locally Funded Emergency Room Treatment” program to managed care through Medicaid, a far more efficient option.

But most importantly, if Texas opts out, people below the poverty level will have no insurance. Since the ACA assumed that Medicaid would cover them, it does not provide an option for insurance subsidies for this group. If Texas opts in, however, people that do not currently have adequate health care and rely on expensive emergency rooms for sporadic care will have a primary care physician, preventive care and referrals to specialists when necessary—just like people with private insurance enjoy.

As other states, such as Arizona, New Mexico, Ohio and Florida have come to realize, this decision is a no-brainer. Politics need to be set aside, and Texans need to come together to do what is best for Texas: extend Medicaid to low-income adults.

Bee Moorhead is Executive Director of Texas Impact and Kevin C. Moriarty, President & CEO, Methodist Healthcare Ministries of South Texas, Inc.

Copyright March 05, 2013, Harvey Kronberg, www.quorumreport.com, All rights are reserved

Published by the Mason County News: What a joyful and spirit filled day we experienced at the San Angelo District Leadership Training and Celebration January 12. We made a change to make the sessions convenient to laity by offering each session twice, back to back, and the change worked well. READ MORE

Published by the San Antonio Express News: A proposed Medicaid expansion plan would increase the number of Texans receiving health care, but Perry and others say the system is too broken to fix with more money. READ MORE

Published by the Dallas/Fort Worth Healthcare Daily: Another report has calculated the potential financial cost of Texas foregoing Medicaid expansion. According to the study, prepared by former Texas deputy comptroller Billy Hamilton, the expansion would create about 231,000 jobs by 2016 and ease the financial burden borne by counties, cities and local hospital districts. The study said Medicaid expansion would cut the state’s uninsured rate by 25 percent and provide insurance for up to 2 million people. READ MORE

Published by Kaiser Health News: News outlets report on analyses in California, Georgia, Florida, Texas and Wyoming. READ MORE

Published by the Dallas News: A new study says accepting big federal money to expand the Medicaid program for the poor would do much for what ails Texas’ health care system, such as providing relief for local taxpayers who support hospital districts such as the one in Dallas County. 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

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92 women competitively selected to explore “The Future of Texas is Now: From Local to Global”

Mrs. Dianne R. Dorsett of Methodist Healthcare Ministries of South Texas, Inc. has been selected to join an elite network of more than 5,000 women as a member of the Leadership Texas Class of 2013.

“Mrs. Dorsett is one of 92 outstanding women leaders competitively selected from across the state to participate in the longest-running women’s leadership development program in the US. Throughout the year-long program, she will have the opportunity to broaden her perspective on our state by exploring four Texas cities and receiving cutting-edge information from renowned experts, government officials and other leaders to positively inform her work and community for years to come,” said Candace O’Keefe-Mathis, CEO of Women’s Resources. Leadership Texas, now in its 31st consecutive year, is the flagship program of the Texas-based foundation headquartered in Dallas.

Launched in 1983 as the first statewide program for women’s leadership development, Leadership Texas is patterned after, though not affiliated with, the co-educational civic programs that have found success in a number of cities throughout the state and nation. “Our founders decided to create Leadership Texas to help women become better, more informed leaders in our state’s communities, organizations and corporations,” O’Keefe-Mathis added.

The theme for the 2013 program year is ‘The Future of Texas is Now: From Local to Global’ “Participants will visit Dallas, Bryan/College Station, Galveston and Austin where each city’s opportunities and challenges will help to illuminate the participants’ knowledge of our rapidly evolving state across three common themes– the economy, education and the environment,” O’Keefe-Mathis said.

“We consider it a privilege to offer these influential women leaders from a broad diversity of professional and personal backgrounds some new perspectives, opinions and validation on some of the issues, people and places they might not otherwise encounter outside of the program. We recognize that it is necessary for today’s successful leaders to understand the cultural, social and economic shift before us and the programming of Leadership Texas provides opportunities and access to help the women impact the future of our evolving state.”

Through the generous contributions of the Leadership Texas Program Partners, the program continues to provide the most up-to-date information on leadership and issues affecting Texas. Corporate Program Partners providing major support for Leadership Texas 2013 include Southwest Airlines, Blue Cross Blue Shield and Texas Instruments.

“Program Partners provide more than financial support for the program; their women leaders also participate in Leadership Texas to build connections for the benefit of the entire state,” O’Keefe-Mathis said.

Women’s Resources

Leadership Texas is a program of Women’s Resources (WR). Established in Austin, Texas, in 1974, Women’s Resources seeks to advance the power of leadership and legacy through programs that connect, inspire, empower and honor women. To extend Women’s Resources’ message of strength and build bridges to and opportunities for women, WR founded Leadership America in 1988 and helped in the creation of complementary women’s programs in California, Illinois, Missouri and North Carolina, among others. WR also established the nation’s first comprehensive women’s history museum, The Women’s Museum: An Institute for the Future, which opened in Dallas, Texas, in association with the Smithsonian Institution in 2000. Since 1996, WR has been offering a series of national retreats for emerging women leaders called Power Pipeline. In 2009, WR launched new globally focused programming under its newly acquired banner, Leadership International, the Sandy Tyler Regional Series and Leadership Short Courses for the 21st Century.

Published by The Texas Tribune: Gov. Rick Perry says Texas won’t expand Medicaid, but that hasn’t stopped health care advocates and some lawmakers from continuing to argue that expanding coverage to low-income adults would save the state money. READ MORE

Report commissioned by Methodist Healthcare Ministries shows why expansion is smart, affordable and fair.
 
San Antonio, Texas – The debate brewing in Austin whether the state of Texas will expand its Medicaid program, a key component of the Affordable Care Act, has reached a fever-pitch as a new report commissioned by Methodist Healthcare Ministries (MHM) of South Texas, Inc. and authored by the former Texas Deputy Comptroller, Billy Hamilton laid out in no uncertain terms why expanding the program to low-income adults is smart, affordable and fair.
 
In the report titled, “Expanding Medicaid in Texas: Smart, Affordable and Fair” Hamilton provides the most comprehensive analysis to date of the costs and benefits to local tax authorities (including counties, cities and hospital districts) and state government if the legislature chooses to extend Medicaid benefits to low-income adults under the Affordable Care Act. The report includes county-level data and tables detailing regional breakouts of caseloads, spending and fiscal impacts for each of the state’s 20 Regional Health Partnerships—multi-county regions coordinating healthcare spending and delivery under Texas’ new federal Medicaid Transformation Waiver.
 
Using data from the 2012, MHM-commissioned research by Dr. Michael E. Cline and Dr. Steve Murdock, “Estimates of the Impact of the Affordable Care Act on Counties in Texas,” and the same policy implementation scenarios, Hamilton concludes that by bringing low-income adults into the Medicaid program, the state can infuse new, much-needed funding into Texas’ healthcare delivery system. For example, under a moderate enrollment scenario, Texas could experience a $1.8 billion increase in taxes from new federal Medicaid funds from fiscal years 2014 to 2017.
 
According to MHM President & CEO, Kevin C. Moriarty, while the estimated financial impact from the expansion would provide a boon to local communities, the central issue is the access to care that families, who would otherwise go without, would become a reality. “Our primary concern in these matters is always creating access to care for the least served and most vulnerable in our communities,” explains Moriarty. “As a nonpartisan, faith-based organization, the tenets of our faith require us to look at this from a non-political perspective. When you strip away the rhetoric, and view this as a moral decision, the choice should become crystal clear,” continues Moriarty. “But, one has only to read the data in this report to also see that expanding Medicaid to low-income adults is also smart from a job-creation and revenue standpoint; affordable, given the resources local governments and healthcare systems are already spending on unfunded patients and what would be needed for the annual state match that is necessary for the expansion; and fair, given the tax relief this would provide to citizens whose dollars are already paying for hospital district taxes,” says Moriarty.
 
MHM owns and operates clinics in San Antonio, as well as offers behavioral health and counseling, health education, and family wellness programs. It also provides grants to agencies that offer healthcare services and program. This year the organization plans to spend $78.3 million to sustain the programs and services it offers, and to continue providing funding to nearly 75 agencies across South Texas that also offer services to the uninsured and underserved in their local communities. The organization anticipates nearly 800,000 individuals will be served from their efforts. “MHM is the largest private funding source for healthcare services in South Texas, and even with our resources and dedication to our mission, we are unable to meet the need that exists for healthcare services, particularly in rural areas where access is limited to none. We want to be a part of a solution, to do what our faith asks us to do, but we can’t do it alone,” states Moriarty. “There is a tremendous opportunity before our legislature to come up with a solution to a problem that has real, life-and-death consequences for people—a problem for which the solution has so many additional benefits beyond the relief it will give to so many uninsured individuals. I believe it would be immoral for our state not to take action on something that we can, and should do for our citizens.”
 
At present, there are 17 states and the District of Columbia that plan to expand their Medicaid program to low-income adults—including Arizona, Nevada and New Mexico.
 
“I would like to think that the leadership in our great state can put aside political ideology to do what is right by the people they are elected to serve. It boggles the mind, that our Governor and others who are in the unique position to positively influence so many lives—potentially up to 4 million people —
would reject an opportunity to do what I am sure their own faiths—no matter the denomination—would call upon them to do,” laments Moriarty.
 
The full report prepared by Billy Hamilton Consulting for Methodist Healthcare Ministries and Texas Impact can be downloaded  by visiting www.mhm.org. The “Estimates of the Impact of the Affordable Care Act on Counties in Texas” report prepared by Dr. Michael E. Cline and Dr. Steve Murdock are also available on the MHM website.
 
About Methodist Healthcare Ministries (MHM) of South Texas, Inc.

Methodist Healthcare Ministries (MHM) is a private, faith-based, not-for-profit organization dedicated to providing medical and health-related human services to low-income families and the uninsured in South Texas. The mission of the organization is “Serving Humanity to Honor God,” by improving the physical, mental and spiritual health of those least served in the Southwest Texas Conference area of The United Methodist Church. To learn more about MHM, please visit www.mhm.org.
 

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