Medicaid expansion showing fault lines in Texas GOP

Posted in Around The State, Commissioners Court, Health Care at 10:20 am by wcnews

This is a very interesting article on the division inside the Texas GOP over expanding Medicaid.  Mostly between the “bidness” community and the wing nuts, Perry Pressured by Texas Businesses Over Medicaid Refusal.

Businesses are often allied with Perry, a failed contender for last year’s Republican presidential nomination. The chambers, however, argue Texas shouldn’t pass up $100 billion over the next decade to cover 1.5 million adults. Obama’s plan would pay all costs until 2016, then the state’s share would gradually increase to 10 percent in 2020. Perry says that’s too expensive.

“This may be the only time that we have taken an actual formal position that is opposite that of the governor,” said Richard Dayoub, chief executive officer of the El Paso Chamber of Commerce. “I don’t know of any issue that has created so much concern across the state and has amassed so much support across party lines and throughout the business sector.”

Chambers supporting expansion in Dallas, San Antonio, Fort Worth and Arlington include members ranging from publicly traded companies to small shoe stores and family restaurants, many of them strained by health costs.

With so many uninsured in Texas this seems to many business and corporate Republicans as a no brainer.

About 29 percent of Texas citizens lack insurance, according to a March 8 poll by Gallup Inc. The state ranked 40th in health last year because 30 percent of residents are obese and one of every four children lives in poverty, according to United Health Foundation, affiliated with UnitedHealth Group Inc. (UNH).

Hospitals have urged expansion because it will reduce expensive and ineffective emergency-room visits, said Stephen Mansfield, chief executive of Methodist Health System in Dallas and next year’s chairman of the 2,100-member Dallas Regional Chamber.
“The eight other Republican governors were just as opposed to this initially as Rick Perry,” said Mansfield, who met with him in February. “They came to understand the economics.”

Chamber lobbyists from Dallas, Fort Worth and San Antonio have discussed Medicaid with legislators during the current session in Austin, officials said. Dayoub of the El Paso chamber spoke with Lieutenant Governor David Dewhurst and House Speaker Joe Straus, both Republicans, and about 35 legislators of both parties.

Business groups “are looking short term,” said Republican Senator David Duell, a Greenville physician who met with chamber representatives. He said he doubted the Obama administration’s commitment “with the long-term viability of the federal government in question.”

Such opposition is “idiocy,” said Margaret Jordan, a former Federal Reserve Bank of Dallas director who is president of Dallas Medical Resources, a consortium of hospital executives and businesspeople headed by billionaire oilman Ray Hunt. “Medicaid expansion is a win-win for everybody.”

Refusing to expand Medicaid could cost Texas employers as much as $448 million in fines because the 2010 law penalizes some companies when workers can’t obtain affordable coverage, Jackson Hewitt Tax Service Inc. said in a March 13 report.

Perry and other opponents will compromise because of pressure from hospitals and businesses, Trevor Fetter, chief executive officer of Dallas-based Tenet Healthcare Inc. (THC), said in an interview Feb. 27. Tenet is the third-largest U.S. hospital firm.

“There isn’t a scenario I can envision that is worse than the status quo in Texas,” Fetter said.

The problem for the “bidness” community in Texas is that Perry is no longer accountable to them. He’s now controlled by his ego and adherence to extreme ideology.  But they only have themselves to blame.  They created this monster and have allowed it to grow beyond their control. And now that something they want and need is not ideological pure to the politicians they’ve been bankrolling, they’re unable to turn the screws.

The influence of business on Texas Republicans is modest compared with that of evangelicals and Tea Party-affiliated groups, said Mark Jones, who teaches politics at Houston’s Rice University.

“The Republican base views Obamacare as a matter of principle, while the monied interests view it as a dollars and cents issue,” Jones said.

And it doesn’t look like anything anyone says, not matter how logical and sound it may be, can change their mind. That kind of argument doesn’t work on ideology.

Duncan, however, says Texas can’t afford the deal because Medicaid crowds out spending for education, parks and other priorities.

“It’s not a free lunch,” Duncan said. He said he was unconvinced by studies by former deputy State Comptroller Billy Hamilton and Waco economist Ray Perryman suggesting expansion would boost the state’s economy by increasing business activity and productivity.

It was inevitable. The GOP in Texas has gotten so extreme over the last several years that they can no longer be worked with. They have their agenda and that’s it. It’s sad and funny all at the same time. The business community is now reaping what it sowed.

What this article shows is that there are many who support the Texas GOP financially that are for expanding Medicaid. The only one in a position of power that’s likely for Medicaid expansion is Speaker Joe Straus, but he won’t really say it out loud. As stated before, if the far right in Texas won’t go for the greed argument it’s hard to see anything that can trump their ideology.

Here’s the latest list from Progress Texas that shows Who Supports Medicaid Expansion in Texas.


It’s a really good deal

Posted in Around The State, Health Care, The Lege at 12:17 pm by wcnews

Yesterday Gov. Rick Perry signed the bill that allowed the GOP to finally pay for Medicaid through 2013, aka the Medicaid IOU. Back in 2011 the one thing they were willing to put in limbo was health care for the neediest among us.  While the neediest among us have been taken care of in the current biennium, the issues with the uninsured in Texas continues.

While the GOP continues to argue over how to insure the uninsured, those without health insurance in Texas continue to suffer. Via Brains and Eggs, The prospects for Medicaid expansion in Texas.

Slicing more skin off the necks of poor people to throw into the game is, frankly, a non-starter. They have already given enough of their lives — children, seniors, and those below the poverty threshold. We are already at the blood-out-of-a-turnip stage in Texas.

— Many working, low-income Texans aren’t offered healthcare coverage through their jobs, and many more simply don’t get paid enough to purchase it. (Forget for a moment the unemployed, the underemployed, and the under-self-employed.) These are the crisis situations: people who put off doctor visits because they cannot afford them, and then go to the emergency room when their health takes a turn for the worse.

— Large majorities of Texans polled say they want Texas to accept the federal dollars for Medicaid.

— Then there are the personal stories. For example: my father, 86 84, who had a good job all his working life and then a comfortable retirement, is at medium-to-end-stage dementia and has essentially outlived his assets. So it’s humiliating enough for seniors like him who find themselves at the prospect of spending the very end of their lives on the government dole (when they are even capable of understanding that). But because health care providers are refusing new Medicaid patients — in large part because the state pays its Medicaid bills very slowly — people like him are falling straight from middle class all the way through the shredded safety net.

And people like him have no advocates. My dad can’t write a letter or an e-mail; can’t make a phone call, can’t go to a townhall meeting to speak to his state rep, can’t march at a rally. You know what’s even worse about his situation, though? If he lived in Arizona, or New Jersey, or Florida, he would be getting covered. Because their conservative governors can see the benefits of expanding Medicaid. Not our governor, though.

I find empathy, however, to be somewhat fungible among Texas Republicans. So a straight appeal to the financials is what we are left with, and it’s a good thing those arguments are pretty solid.

That’s right, don’t appeal to their compassion, appeal to their greed. And yesterday we found out even more about how expanding Medicaid is a really good deal, Nine hundred million reasons why expanding Medicaid is a good idea.

The point is that every way you look at it, this is the right thing to do, and the only rationale for opposition is ideology and a deep indifference to the suffering of others.

Burka’s latest post on expanding Medicaid in Texas makes several points that are worth noting. Joe Straus appears to be for a deal, and if he was in charger there would probably be one already. He’s not, the “wacko birds“, aka wing nuts, are. Unfortunately the only way to get the wing nuts to change their mind is to get Perry to change his mind. And Burka doesn’t see that happening.

Of all the big issues to be resolved by the 83rd Legislature, none is bigger than Medicaid expansion. This has mainly been a House show up to this point, with Joe Straus acting as the leading proponent of moving forward and allowing himself to become the target of criticism on the right. This is an awkward situation for the speaker, as the GOP caucus is already on record as opposing expansion, while Straus is on record as wanting to move forward. When the Republican caucus voted overwhelmingly to oppose expansion, Straus wisely let the moment pass. He allowed the opposition to run wild and make their statement.


Every time a situation like this arises, I think it is appropriate to ask of the opponents and the naysayers—I am referring mainly to Michael Quinn Sullivan and Empower Texans, but also of the anti-government faction generally—”What is your solution?” (Sullivan’s group has been hypercritical of Straus but has remained mute about senators who support expansion.) Is it better to turn down federal funds and to dump the cost of health care for the uninsured on hospital emergency rooms and ultimately on local-property taxpayers? Make no mistake about it: The health care costs of the uninsured in Texas are a hidden tax on property. Property taxpayers have to make up the difference in the health care costs of the uninsured, or see local taxes go up. I grant you that there is a cost to accepting federal funds. The cost is in the loss of control over health care policy in this state. But, let’s face it, health care policy in this state stinks. We have great hospitals, great research, and lousy government. I’d rather put the money in the hands of the people who deliver the services than in the hands of the politicians. I suspect this is what Straus thinks too. Forget the ideology. Show me the money.

I fear that Texas is going to let a great opportunity slip through its fingers. State officials, including Straus, appear to insist on a “Texas-centric solution” before they will touch filthy lucre. Unless Straus’s powers of persuasion are superhuman, it isn’t going to work. Medicaid is an entitlement program. If state officials insist upon co-pays, deductibles, and other devices that are incompatible with the concept of an entitlement program, the state is going to pick up its marbles and say no, as it has done in the past. Unless things change, the best we can hope for is to squeeze out some dollars that can be used to obtain insurance for the uninsured. Very few things would be more helpful for business—and taxpayers—in this state.

If they won’t respond to greed then it’s unlikely they’ll respond to anything else. Public pressure is likely the only thing left that can change their minds. So call your representative, especially if you live in a District with a wing nut representative.  (Find out who your representatives is here).  And click here to see how this will impact your local community.

What this means is that Speaker Straus is for the expansion, and so are most normal Republicans, aka business oriented Republicans.  They know this is a good deal and they want it.  They just have not yet been able to allay the fears of enough elected GOP members of The Lege that it won’t cost them their seat if they come out in favor of the expansion.  They’re more worried of MQS and the GOP base, then they are of the business lobby.

Further Reading:
Impact of Medicaid Expansion on State Budget Examined.
Expansion of Medicaid will free up $900 million, study finds.


Politically palatable?

Posted in Around The State, Health Care at 3:40 pm by wcnews

The news just keeps getting worse for the uninsured in Texas, Texas Uninsured Rate Drifts Further From Other States.

For the fifth straight year, Texas has the highest uninsured rate in the country — the 28.8% of adult Texans lacking healthcare coverage in 2012 is the highest for any state since Gallup and Healthways started tracking insurance coverage in January 2008. This widens the gap between Texas and the state with the second-highest uninsured rate in the country, Louisiana (24.0%), to 4.8 percentage points — the largest number separating these two spots on record. Massachusetts continues to have the lowest uninsured rate in the U.S., at 4.5%.

Yes, the Massachusetts of “Romneycare” fame. That’s almost three in ten Texans without health insurance. Here’s the list of the worst 10, starting with Texas.

But we have “a good reglatory climate” here in Texas. Here’s what the Texas Hospital Association had to say about this:

The following statement is a response from the Texas Hospital Association, which may be attributed to Dan Stultz, M.D., FACHE, FACP, THA president/ chief executive officer:

“Uninsured patients still require health care, and a growing uninsured population strains hospitals, taxpayers, and the insured. An uninsured workforce draws additional concern for what it says about the state’s ability to compete. By expanding Medicaid, however, Texas employers can ensure increased access to primary care, which promotes increased workplace efficiency and decreased morbidity and mortality.”

Apparently it’s not quite “politically palatable” yet to insure the uninsured for Texas GOP lawmakers.

Medicaid expansion got its first Capitol hearing Friday, with new numbers revealed and deep divides further exposed between Republicans and Democrats in the Texas House.

But most of the action on Medicaid expansion continues to take place in private meetings among leading Republicans, including members of Gov. Rick Perry’s office, as they search for a politically palatable way to negotiate concessions from the federal government. The primary goal is to insure more low-income Texans without significantly expanding a Medicaid program they consider to be bloated and unsustainable.

Against that backdrop, the House Appropriations Committee hearing had an anticlimactic feel, leaving one key Democrat to question its purpose.

“I just need to know where we’re going,” said Rep. Sylvester Turner, D-Houston.

“If this hearing is to put information before us so we can design something in a positive way … then I am more than willing to take the time,” Turner said. “But if this meeting is only for informational purposes so we can say you all came, you spoke, we heard, thank you very much — and nothing is going to move forward — then I got that, and I’m through with it.”

Kyle Janek, head of the Health and Human Services Commission, which administers Medicaid, assured Turner that his agency is not crafting a Medicaid expansion plan, nor would it do so without direction from the Legislature.

What yesterday’s hearing was about was some House GOP lawmakers were trying to make it look like they were doing something on Medicaid expansion, without actually getting anything done. But while they continue to do nothing the situation for the many Texans stays bad or gets worse. How bad does it have to get before expanding Medicaid in Texas becomes politically palatable.


A House hearing on Medicaid expansion in Texas, still trying to find a way in

Posted in 83rd Legislature, Around The State, Health Care, The Lege at 3:16 pm by wcnews

The Medicad expansion is a really good deal.  Let’s not kid ourselves, if it wasn’t we wouldn’t be hearing comments like this from House Speaker Joe Straus.

House Speaker Joe Straus, R-San Antonio, said Thursday that he is trying to steer the conversation toward reforms that make sense for Texas.

“After you say no, the next question is: OK, then what? We need to move forward now with something that is more specific, put it on the table and negotiate it,” Straus said.

A central question is whether an agreement can be crafted that wins the approval of Gov. Rick Perry, who adamantly opposes Medicaid expansion and vigorously attacked Affordable Care Act, dubbed Obamacare, in his unsuccessful presidential campaign.

Straus said he didn’t anticipate a conflict with Perry.

“I don’t think there’s separation here,” he said. “Gov. Perry is a good negotiator, and I don’t think he’ll make a bad deal for Texas. I just want the Legislature to be a good, supportive partner in trying to work out something that does make sense for Texas and for Texas taxpayers.”

Perry spokesman Josh Havens said the governor is looking for solutions that reinforce individual responsibility, control costs and address the state’s unique needs.

“Naturally, it all depends on what the proposal is,” Havens said. “The governor is always open to discussing Texas-based solutions because Texas knows best how to take care of Texans.”

It’s a good deal for the state, and an even better deal for city and county governments.

This seems to be the crux of the issue.

In total, unreimbursed charity care creates a $4.3 billion annual tax burden on local government entities and public hospitals, Billy Hamilton, the state’s former chief budget estimator, told the committee. Overall, he said, there is enough local and state spending in the current system to cover the state’s share of Medicaid expansion costs.

“I know this is a controversial issue… but I don’t really think you’re going to see a more overwhelming fiscal opportunity during your service here,” said Hamilton. “I served this Legislature for 30 years and I’ve never seen anything like it.” [Emphasis added]

The committee also heard testimony from judges from Harris and Dallas counties who spoke in favor of expanding Medicaid, and from John Davidson, a policy analyst from the conservative Texas Public Policy Foundation, who spoke against Medicaid expansion.

It’s a really good deal. Here’s Billy Hamilton’s testimony today at the House Appropriations Committee.

And Texas Impact has more video here.  It’s obvious enough Republicans in The Lege want a deal.  They just have to find a way in.  Keep looking.


Trying to find a way in

Posted in Around The State, Health Care at 11:09 pm by wcnews

When it comes to accepting the Medicaid expansion in Texas the GOP’s stance has definitely changed.  While they continue to say they’re against it, their rhetoric has changed.  It seems as if they’re trying to find a way in, instead of trying to justify not getting in.  Like this report from today’s GOP House caucus.

House Republicans on Monday agreed not to expand Medicaid as called for under the federal Affordable Care Act — but left the door open to doing so if the Obama administration grants Texas enough flexibility.

They’re getting leaned on by business, especially the hospitals, and it’s a really good deal for Texas. And the more it’s in the news, and the more people hear about it, the more they like it. Survey: Majority of Texans Support Medicaid Expansion.

A voter survey conducted by the Texas Hospital Association adds to the growing chorus of statewide support for Texas to expand its Medicaid program. According to the poll, 54 percent of voters said the State of Texas should participate in the expansion of Medicaid. After learning more about Medicaid expansion, 59 percent responded favorably.

What a deal might look like is put forth in this article, Somewhere in Texas is Medicaid middle ground.

Sen. Tommy Williams, chairman of the Finance committee, is inching his way in that same direction (see his related commentary).

It becomes a crucially important question for Texans whether there might be common ground between what these senators are thinking, what Perry is vocally insisting and what federal Medicaid officials will allow.

Go beyond the sound bites, and there is more to what Perry has said.

In July, the governor sent a letter to U.S. Health and Human Services Secretary Kathleen Sebelius saying Texas has “no intention” of joining in Medicaid expansion under Obamacare. But a news release about his letter also stated what he wants to do to expand healthcare in Texas.

Topping the list is “the allocation of [federal] Medicaid funding in block grants so each state can tailor the program to specifically serve the needs of its unique challenges.”

In other words, give us billions of federal dollars and back away. It’s too much to expect the Obama administration to go along with a “no strings attached” approach. But there might be another way.

“As a common-sense alternative, Gov. Perry has conveyed a vision to transform Medicaid into a system that reinforces individual responsibility, eliminates fragmentation and duplication, controls costs and focuses on quality health outcomes.”

What does that mean? Almost anything Perry wants it to mean. But it is important that he thinks about alternatives.

“This would include establishing reasonable benefits, personal accountability and limits on services in Medicaid,” the news release said. “It would also allow co-pays or cost sharing that apply to all Medicaid eligible groups — not just optional Medicaid populations — and tailor benefits to needs of the individual rather than a blanket entitlement.”

That means he would go for a plan that might not have all the benefits or services as today’s Medicaid and includes “personal accountability.” That gets further explanation in the next sentence: It means “co-pays or cost sharing.”

“Tailored benefits” means some people might qualify for some Medicaid benefits but not all.

Some elements of Perry’s alternative might even be acceptable to strong Obamacare proponents as a way to get expansion going (see related commentary from Scott McCown of the Center for Public Policy Priorities).

The case for getting Medicaid coverage for more Texans is not hopeless. Much could happen during the current legislative session. But if it does, it’s not likely to be Obamacare all-or-nothing.

Texas has received important Medicaid waivers in the past. The focus now, as in all contentious public policy-making, must be on middle ground.

As stated before, however the GOP wants to rationalize it is fine with me, as long as they get around to accepting the Medicaid expansion.


Medicaid expansion – the local impact

Posted in Commissioners Court, Health Care, Williamson County at 6:06 pm by wcnews

The benefits of expanding Medicaid in Texas are many.  But that expansion will have the most impact at the local level.  Texas Impact, via their report “Smart, Affordable and Fair: Why Texas Should Extend Medicaid Coverage to Low-Income Adults”, makes this clear.

Here’s what they have to say when they break down the local impact.

Texas has an extraordinary opportunity to expand health care coverage that would benefit up to 2 million of its citizens. The federal government would pay about $100 billion toward this expansion over 10 years, with the state responsible for only about $15 billion under a moderate enrollment scenario.

Extending Medicaid to low-income adults certainly would benefit the newly eligible. It also would benefit the wider economy and reduce demands on local indigent health programs and hospital charity care.

Read about how we got our numbers

The amount of state match necessary to extend Medicaid to low-income adults would equal a small fraction of current local government and hospital spending on low-income health care. What’s more, covering low-income adults will result in new local revenue because it will generate good-paying jobs and commerce. So local governments will SAVE on health costs at the same time they are GAINING new sales and property taxes without raising tax rates.

At the same time, more people in every area of Texas would have health insurance, doctors and other health workers would be more fairly compensated for treating low-income folks, and the state could stop spending so much on piecemeal programs that only treat some health problems. People with health insurance will live longer and be healthier–and the many low-income adults in Texas who are parents will be able to take better care of their kids, too.

It’s not hard to see from that how insuring so many who are currently uninsured will have an extremely positive impact at the local level. A healthier population, less emergency room visits, and less expenditure on the uninsured. Just another reason why this makes sense and will lower costs that are paid by local property tax payers.

Here are the numbers:
By County – Williamson.
By House Districts in Williamson County – HD-20, HD-52, and HD-136.
By Senate District – SD-5.

Also Progress Texas is keeping track of local governments that are coming out in favor of Medicaid expansion, many large county governments are on board.

It would likely be a great help to Williamson County, but I doubt our elected officials could see past ideology and do what’s best for the county. I would be very happy if they proved me wrong.

[UPDATE]: Some video from Jason Stanford, Not even Rick Perry is this stupid:

The wing nuts and Medicaid Expansion

Posted in Around The State, Bad Government Republicans, Health Care, Right Wing Lies at 1:13 pm by wcnews

From the Texas Tribune, GOP Lawmakers to Stick With Perry on Medicaid Expansion.

Two key Republicans legislators — both of them doctors — say they’re sticking with Gov. Rick Perry’s position that Texas will reject the Medicaid expansion provision of federal health reform, despite a rising tide of Republican governors who are embracing it.

During a Texas Tribune Triblive conversation on Wednesday, Rep. John Zerwas, R-Simonton, and Sen. Charles Schwertner, R-Georgetown, both spoke against expanding Medicaid, which they called a “broken system.” But they left the door open to working with the Obama administration if it provides more flexibility to let Texas operate the program as it sees fit.

There are many falsehoods that the wing nuts spout about Medicaid. They believe their oft spouted mythology government is reality, but it’s not. The fact is Medicaid is not broken, and is much, much more efficient then private insurance. Here’s one of the Ten Myths About Medicaid.

* Myth 9—The Medicaid program is inefficient.
* FACT: Medicaid compares favorably to other parts of the American health system when measuring administrative efficiency and per enrollee costs.

Compared to private health programs, Medicaid has lower administrative costs per claims paid when compared to private sector plans. Medicaid per capita growth has been consistently about half the rate of growth in private insurance premiums. Both of these factors show that despite program growth, Medicaid is an efficient program.

And, of course, there’s much more about the problems with Medicaid are more the fault of Congress then anything else, Steve Brill: The Health Care Moochers Are Providers, Not Consumers.

Steven Brill has written a must-read article for this week’s Time magazine about health care costs and why we really do have to be concerned about them. Following on that, he made an appearance on the round table segment of This Week to discuss those costs and why he’s sounding the alarm.

Anyone who has spent even a day in the hospital knows what the problem is. When one over-the-counter pain reliever administered in the hospital costs as much as an entire bottle at the pharmacy, there’s a very, very big problem.

Brill correctly points out that Medicare is an efficient program that Congress has managed to hog-tie into some ridiculous costly measures:

And it actually that bears on the conversation we’re having, because a chunk of that money is paid by Medicare. Medicare is I point out in the article is very efficient at most things. It buys health care really efficiently, which is a great irony, because it’s supposed to be the big government of bureaucracy.

Where Medicare is not efficient is where Congress, because of lobbyists have handcuffed Medicare. Medicare can’t negotiate what it pays for any kind of drugs. It can’t negotiate what it pays for wheelchairs, diabetes testing equipment. And if Congress took those handcuffs off of Medicare, you could get about half of the spending cuts that we’re sitting around here talking about.

Yes, this. Of course, that assumes anyone in Congress is brave enough to stand up to the mighty PhRMA lobby, which seems to have as deep a lock on Washington as the gun lobby. Brill also makes the compelling argument for lowering the Medicare eligibility age, which I have argued over and over again here at C&L. The single biggest cost-saver for Medicare would be to drop the eligibility age, let people buy in until they actually reach retirement age, and then they would drop to the levels under the Social Security law.

The problem with Medicaid for Perry and the wing nuts,like Schwertner and Zerwas, is that it’s a government run, not for profit system, that works well. And that’s an affront to everything they believe. They would much rather the federal government give them a chunk of money they could then give the the for profit system, which funds their campaigns. But we all know how that would turn out.


However they want to rationalize it is fine with me

Posted in Around The State, Bad Government Republicans, Health Care at 11:26 am by wcnews

Personally I find the whole government and business comparisons to be a bunch of crap. Because there should be no profit motive involved in government, the motive should be to provide great service for the taxpayers. Government should not be run like a business and business should not be run like a government.  They’re different for a reason.

Be that as it may, Ross Ramsey makes some solid points on how Perry and the wing nuts use the business analogy only when it suits them, and throws it aside for ideological reasons when it doesn’t. Medicaid Expansion Confounds Conservatives.

Both Perry and Dewhurst can claim to know how the business world works, whether their recent records support it or not. But look at the capper: They and others are talking seriously about walking away from a gargantuan federal freebie.

The federal government is offering to pay all of the costs of expanding the Medicaid program to some of the state’s uninsured population for three years, then to pay 90 percent of the costs for several years after that. Texas could, according to a report commissioned by Texas Impact, an interfaith public policy group, spend $15 billion over the next 10 years and pull down $100 billion in federal funds as a result.

Here’s the business question: Why leave that kind of money on the table, especially if it’s going to be spent elsewhere if Texas opts out?

The argument for expansion is that it would take care of a lot of people for some period of time — even if it doesn’t take care of them forever. The choice is between insuring a crowd of people for a few or many years, or not insuring them at all. Between providing their health care in expensive and inefficient emergency rooms, or taking care of them by expanding Medicaid.

It’s not just a good-government take-care-of-those-less-fortunate thing, either. Medicaid has enough flaws to feed a dozen think tanks. But by expanding Medicaid, the state would also bring in billions of dollars to pay for health care for people who aren’t insured now, providing relief to local taxpayers who wouldn’t be on the hook for nearly as much uncompensated care, turbocharging the state’s medical economy, and bringing federal tax dollars paid by Texans back into the state.

If you don’t do that last bit, by the way, the money would otherwise go to places like California, Massachusetts and New York. Where’s the business sense in that? And where, because that’s a transfer of wealth in some measure from red to blue states, is the political sense?

It might be true that a Medicaid expansion will work only for a few years in Texas and other states; they can quit if that time comes. For many officeholders, it makes political sense to opt out. But if they were running state government like a business, without the political undertow, the conversation would already be over.

There are a few things Ramsey says that I don’t agree with. Like “..politicians understand how businesses operate”, and “Medicaid has enough flaws to feed a dozen think tanks”. But his general overall point that for the good of the state, Perry and the wing nuts should be able to set aside ideology and do what’s right, and hide behind an “it’s good for business” excuse, to do what’s right.  That I can agree with. If that’s what it takes for the GOP in Texas to do the right and moral thing the so be it.

[UPDATE]:  Perry is digging in, Gov. Rick Perry heckled in DC as he rules out Medicaid expansion.

Gov. Rick Perry faced hecklers this morning in Washington as he made clear today that despite mounting pressure, he won’t expand Medicaid, even though that could cut the number of uninsured Texans by as much as 1 million.

“We are not going to be expanding Medicaid in Texas,” he told the Texas State Society over the shouts of protesters filtering through the window of the Republican-run Capitol Hill Club, arguing that doing so would be too costly.

On the sidewalk, roughly 30 people shouted “Rick, Rick, You make me sick!” and “You will never be president.”

Inside, four people who paid $30 for a breakfast of scrambled eggs and chicken fried steak blended in with more than 100 members and guests of the Texas group, popping up to interrupt Perry at regular intervals.

“Do you bequeath our next generation of leaders death and illness? Healthcare is a human right. Healthcare is a human right, Gov. Perry. Do what is right for Texans,” one woman shouted at the governor before a Perry aide escorted her out.

“Two million people in your state do not have healthcare because you are refusing to have Medicaid expanded,” another heckler shouted later.

[UPDATE II]: Michael Lind at Salon has a great article on why Perry and the wing nuts don’t want to expand Medicaid, because they’re cheap labor conservatives.   Southern poverty pimps:

Finally, there is the welfare state. Universal, portable social insurance programs like Social Security and Medicare increase the bargaining power of workers, by reducing the penalty for quitting a job because of poor wages or poor treatment. If they quit, they don’t endanger their healthcare access or their retirement security. Workers with adequate social insurance are more likely — to use a time-honored Southern phrase — to be “uppity.”

Apart from a high federal minimum wage, nothing could be a greater threat to the Southern cheap-labor economic strategy than universal, standardized federal social insurance. In order to maximize the dependence of Southern workers on Southern employers in the great low-wage labor pool of the former Confederacy, it would be best to have no welfare at all, only local charity (funded and controlled, naturally, by the local wealthy families).

But if there must be a modern welfare system, then the Southern oligarchy prefers a system that allows state governments, rather than Washington, D.C., to control eligibility and benefit levels. By controlling eligibility, Southern state governments can minimize the amount of the local workforce that has access to good social insurance, reducing the power of Southern workers to be “uppity.” At the same time, giving Southern states the option to have lower benefit levels provides the neo-Confederates with yet another bargaining chip, along with low wages and low taxes, that can be used by Southern state governments to lure business from more generous states or nations.

It is all a system, you see. Southern conservative policies toward immigration, labor unions, the minimum wage and social insurance don’t reflect supposed conservative or libertarian ideologies or values, even if conservative or libertarian intellectuals are paid to dream up after-the-fact rationalizations. These policies are reinforcing components of a well-thought-out economic grand strategy to permit the South, as a nation-within-a-nation in the U.S., to pimp its cheap, dependent labor for the benefit of local and foreign (non-Southern) corporations and investors.


Texas House to debate Medicaid Supplemental today

Posted in 83rd Legislature, Education, Health Care, The Lege at 11:01 am by wcnews

Here’s the floor report for HB 10 from the House Research Organization for today. There are eight prefiled amendments. This is the unpaid Medicaid expenses that The Lege decided in 2011 to leave for the 2013 legislature to deal with, so they could pass a so-called balanced budget without raising taxes while still gutting public education.

The Democrats will try to get returning money to public education into the discussion today as well. Via Peggy Fikac, Will school finance work its way into the Medicaid IOU debate after all?

Some lawmakers may be angling to open up a debate on education funding and other issues when the Texas House takes up a must-pass bill Thursday to pay a giant looming Medicaid IOU this fiscal year.
A handful of amendments have been pre-filed to House Bill 10, including one by Rep. Trey Martinez Fischer, D-San Antonio, that would give lawmakers the opportunity to put findings into the bill regarding “inadequate funding” of public schools.

This isn’t what GOP leaders were looking for when they offered, and the House approved, a rule that says if lawmakers want to add money to any program through HB10, they must deduct it from other programs that would be funded in the legislation.

That would be tough, because the bill fills a Medicaid hole and provides money that public schools need to make it through the rest of the fiscal year. There isn’t any extra money floating around in the measure.

Leaders have said they are looking at whether they can put any additional funds into public schools this fiscal year through a separate supplemental spending bill.

The House rule didn’t stop several lawmakers from pre-filing amendments to add money to items including programs for strugglings students, school security and technology, college financial aid and transportation – the latter to take care of roads damaged by increased use or oversize and overweight vehicles related to the energy boom.

Martinez Fischer’s amendment wouldn’t add money, but it has the potential to be a springboard to a lengthy discussion and potentially, some votes on how schools are funded. He and other Democrats have been vehement about the need to quickly address restoration of funding cut from public schools two years ago when Comptroller Susan Combs projected a revenue shortfall. Revenues have come in much higher than her estimate.

House Appropriations Committee Chairman Jim Pitts, R-Waxahachie, has said HB 10 must pass quickly to ensure health-care providers are paid and patients get treated in the Medicaid program.

The more the Democrats can highlight the GOP’s neglect of things that matter most to working and middle class Texans and show that there is an alternative the more the overall debate will start moving in the right direction.

On another note regarding Medicaid, the wing nut Florida Gov. Rick Scott has changed his mind on Medicaid, In Reversal, Florida Gov. Scott Agrees To Medicaid Expansion.

But Wednesday, Scott, a Republican, pulled a complete turnabout. He said Florida would accept the federal government’s offer of funding, at least for the three years it has promised to pay the entire bill.

The decision “is not a white flag of surrender to government-run health care,” he said. Instead, he called the Medicaid expansion a common-sense solution for real health care problems.

“Quality health care services must be accessible and affordable for all — not just those in certain ZIP codes or tax brackets,” he said at the briefing. “No mother, or father, should despair over whether or not they can afford — or access — the health care their child needs. While the federal government is committed to paying 100 percent of the cost of new people in Medicaid, I cannot, in good conscience, deny the uninsured access to care.”

It’s time for Perry and the wing nuts to wake up. It’s the moral and fiscally responsible thing to do. And it’s a really good deal for Texas.

Further Reading:
Better Texas Blog, How Texas Gets Its Money. How Texas Spends Its Money. Why It Doesn’t Add Up.
Texas Impact, Extending Medicaid to Low-Income Adults…What’s in it for Your Community?
Via the FWST, Rally at Capitol urges Texas to spend more on Medicaid.

“We know Gov. Perry is completely out of touch with the reality that’s facing Texans in the area of healthcare,” Sen. Wendy Davis, D-Fort Worth, told the crowd. “He is out of touch with Texans who have to wait until they are so sick they have to go to the emergency room so they can get healthcare.”


Big news on public education and health care

Posted in Around The State, Bad Government Republicans, Education, Health Care at 5:56 pm by wcnews

Today the biggest non-surprise in Texas history became reality, Judge: School finance system unconstitutional.

Texas’ system of funding public schools is unconstitutional, state District Judge John Dietz ruled Monday.

Dietz ruled that the state had not provided adequate resources to lift students to the state’s new high standards.

“We either want increased standards and are willing to pay the price or we don’t,” Dietz said.

He also found that wide disparities had emerged between school districts that are considered property poor and their wealthier peers. And he said the Legislature had effectively imposed a statewide property tax in violation of the Texas Constitution.

After 12 weeks of trial testimony, Dietz announced his decision from the bench to a packed courtroom and upheld all the major claims by the school districts. A direct appeal to the Texas Supreme Court is expected soon.

Two-thirds of Texas school districts sued the state claiming that the Legislature has failed to live up to its constitutional obligation to provide an “efficient system of public free schools.” Their multitude of claims amount to a culmination of nearly 30 years of school finance litigation.

For the first time, charter schools joined in the school finance litigation and argued that the lack of state funding for classrooms and other school facilities is unconstitutional, as is the current cap limiting the number of new charter operators. Dietz said the the Legislature has discretion over both of those issues and thus did not violate the constitution.

A sixth plaintiff group, called Texans for Real Efficiency and Equity in Education, argued that state requirements, such as minimum salary requirements for teachers and the lack of competition render the system inefficient and thus unconstitutional. The Texas Association of Business has joined this lawsuit.

Dietz said the claims by TREE warranted scrutiny by the Legislature but were not in the purview of the court.

The scheme current GOP leadership put into place in 2006 did absolutely nothing to fix the school finance problems. And, in all likelihood, only made them worse.  The Texas Tribune has more on the ruling.

Harvey Kronberg has the ruling and Judge Dietz’s comments here.

Also today another Republican governor caved and will be accepting the Obamacare Medicaid expansion, John Kasich Accepts Obamacare’s Medicaid Expansion.

The governor unveiled the decision as part of his budget proposal.

“We are going to extend Medicaid for the working poor and for those who are jobless trying to find work,” Kasich said at a press conference in Columbus. “It makes great sense for the state of Ohio because it will allow us to provide greater care with our own dollars.”

The four other Republican governors to back the Medicaid expansion are Brian Sandoval of Nevada, Susana Martinez of New Mexico, Jack Dalrymple of North Dakota and Jan Brewer of Arizona. About a dozen GOP governors from red states have rejected the expansion; others from mostly blue and purple states have yet to decide. Democratic governors have broadly embraced it.

And in Texas the support just keeps growing for expanding Medicaid in Texas.  Here’s a
Statement from Representative Garnet F. Coleman on the Texas Medica Association’s recent call for a bipartisan solution to expand Medicaid in Texas.

“As someone who has advocated for Medicaid expansion from the very beginning, I applaud TMA’s statement that we need to find a way to implement the expansion here in Texas. It’s a great start, and I agree with their position that denying care to over 1 million disabled and low-income Texans is ‘unconscionable.’

However, the devil is in the details. TMA’s proposal that Texas should have more ‘flexibility’ in the Medicaid program is worrisome because of its vagueness. ‘Flexibility’ has long been a code word used by those who only want the ‘flexibility’ to reduce Medicaid services, beneficiaries, or both. Further, it’s unclear whether TMA wants more flexibility in the entire Medicaid program or just the expanded portion. Finally, the federal government already allows for Medicaid flexibility through the 1115 Waiver process, most recently seen in the 1115 Transformation Waiver that allows Texas health providers to continue to receive federal UPL funds after the switch from fee-for-service to managed care.

TMA correctly points out that the low reimbursement rate of Medicaid in Texas has resulted in only 30% of Texas physicians accepting new Medicaid patients, but I want to remind everyone that Medicaid reimbursement rates are set by the Texas State Legislature and the Governor through the appropriations process, not by Washington. We could simply pass a budget that raises them. I’d vote for it. Also, physicians are not the only providers who see Medicaid patients. Advanced practice nurses, physician assistants, and entities such as Federally Qualified Health Centers, county hospital districts, and Accountable Care Organizations will all help fill the gap. Our primary goal should be to ensure that all Texas have access to care, and this is something we can do.

Finally, Texas, not Washington, will decide whether or not we expand Medicaid in this state. Governors across the country of each party are realizing that expanding Medicaid is important and the best policy for their populations; we need to do the same. The bipartisan solution that TMA calls for is already on the table. We just need to take it.”

And today Texas Impact and the Texas Catholic Conference release a letter to Gov. Perry, Lt. Dewhurst, and Speaker Straus urgin them to Extend Health Care Coverage to 1.3M Uninsured Texans.

In a letter today to the legislative leadership, two of the state’s largest religious organizations urged policymakers to extend Medicaid coverage to 1.3 million low-income, uninsured Texans as part of the federal Affordable Care Act; failing that, the organizations called for any proposed alternative to Medicaid be equal in coverage or breadth of eligibility that would have been achieved under that expansion.

The letter, signed by the executive directors of the Texas Catholic Conference and Texas Impact, reminded Governor Rick Perry, Lieutenant Governor David Dewhurst, and Texas House Speaker Joe Straus that “[a]s people of faith, we are called to provide affordable and accessible health care coverage for our sick and dispossessed brothers and sisters.”

“Failing to care for the poor and vulnerable unnecessarily increases sickness, premature death, and needless suffering. It would result in the unnecessary, untimely deaths of an estimated 8,400 low-income Texans every year,” the letter stated.

Read the letter here. Looks like all the bad GOP policy decisions of the last decade are starting to come home to roost.

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