Perry heckled, lobby splurges

Posted in Around The State, Health Care, Money In Politics, The Lege at 1:26 pm by wcnews

Texas Gov. Rick Perry was heckled by activists from the Texas Organizing Project (TOP) yesterday at while speaking at a luncheon for small business owners.

Speaking at a luncheon for small business owners at the Austin Hilton, Gov. Rick Perry (R-Texas) was repeatedly interrupted by organized protesters angry over his opposition to expanding Medicaid coverage for poor Texans.

“There’s six million Texans that don’t have health coverage, and we need it,” said Reynaldo Gutierrez, a small business owner from Houston who was asked to leave after interrupting the governor to read a statement. “I don’t have enough money to have health insurance.”

For his part, the governor offered an olive branch.

“If you will leave here, I will invite you to the governor’s office and we will have this debate face to face. How about that?” Perry proposed after several interruptions.


“He listened to us,” offered Connie Paredes with TOP. “But he has his mind set already.”

Baby steps perhaps, just as similar closed door discussions between the House and Senate seemed to reduce some tension as the day progressed.

You can see some of it toward the end of this KVUE video.

And the Texas Tribune reported on a $22,000 plus end of session committee dinner, An Expensive Celebration, Courtesy of the Lobby. (View the tab here).

A remarkably expensive meeting of a key legislative committee took place this week: a $22,000-plus affair at an upscale downtown Austin steakhouse for the 15-member House Calendars Committee.

That panel, which sets the daily lineup of bills for consideration in the House and thus holds life-or-death power over legislation, held its end-of-session dinner at Austin’s III Forks restaurant this past Sunday.

It cost $22,241.03 and required the use of 34 American Express cards, 11 MasterCards and 20 Visa cards. The committee chairman, state Rep. Todd Hunter, R-Corpus Christi, said there were about 140 people there, and most of them stayed for dinner.

That’s an extraordinary amount of money, as these things go, but the events themselves are common. In a tradition that stretches back as far as anyone can remember, committees in the Texas Legislature throw self-congratulatory dinners to celebrate the completion of their work.

“It’s a large gathering,” Hunter said of the Calendars dinner. “All committees do it. I don’t know how people have done it in the past. I don’t even know the amount. We invite the committee and we invite their staffs, and then we involve lobbyists and outside folks. Some of them are not lobbyists. I don’t know who paid. You can go find out.”


Not all of the 121 people at the dinner — that number is based on the number of $95 “banquets” on the check — paid for their supper. Beverages ran another $6,580, plus tax and tip. Somebody had a glass of juice for $2.75; elsewhere in the room, the restaurant was serving 24 bottles of pinot noir, 24 bottles of chardonnay, 27 bottles of cabernet and seven bottles of sauvignon blanc, each priced at between $51 and $68. Another three bottles of cabernet — a nicer one, apparently — cost $135 each. That’s on top of a long list of mixed drinks and beers. If you’re keeping count, that’s 85 bottles for 140 people.

The full tab was $18,584.55 and after a 20 percent tip was added on, the total came to $22,241.03.

That’s $183.81 per person, but only 65 guests produced their wallets. They divvied the tab evenly, most of them paying $340.07. A handful varied from that amount, with the smallest tab coming in at $338.12 and the biggest landing at $478.07. Hunter said he didn’t pay and didn’t expect the members of his committee to do so, either.

“I’ve had committee dinners since I’ve been here for seven terms,” Hunter said, speaking in characteristically clipped phrases. “Lobby pays. They follow rules. Everybody knows up front. And we even post it, so we are all in compliance.”

The calendars committee is responsible for setting the agenda on the House floor. It looks like the lobby was certainly happy with the job they did. As Lessig says, “Money buys results & erodes trust“.


No political gain for Texas GOP in Medicaid expansion

Posted in Around The State, Commentary, Health Care at 12:39 pm by wcnews

Yesterday I linked to this article, Texas, Congress go blue if immigration reform goes down at the bottom of a post. It makes the point that if immigrations reform dies so will the Republican Party. While that likely makes some people smile – especially in Texas – if it did happen, something just like it would emerge to take it’s place. There will always be a right wing party, not matter what it’s called.

That being said, sometimes it does look like the GOP is trying to legislate itself into oblivion when it comes to the Hispanic vote. When looking at Medicaid expansion, they have a similar issue. Their rhetoric is against it , which also pits them against those who will benefit the most, Texas Latinos have most to gain from Medicaid expansion, while GOP counties have little to gain. And it’s a political conundrum for the GOP. Being for this may get them beat in a primary, but staying against may just get the Democrat’s foot back in the door in Texas.

Republican leaders in Texas have ideological opposition to Medicaid’s expansion, but also have little political reason to expand a program that would primarily benefit a constituency leaning towards the Democrats.

“Texas will not be held hostage by the Obama administration’s attempt to force us into this fool’s errand of adding more than a million Texans to a broken system,” Gov. Rick Perry said at April 1 news conference. “That’s not just me who said that, by the way. In 2009, President Obama, himself, called Medicaid a broken system.”


Texas is one of 14 states that will not participate. Texas has the highest rate of uninsured population in the country at 24 percent, according to the Kaiser Foundation. For those with incomes 139 percent of the poverty level—those eligible for Medicaid expansion—Texas is second in the nation at 43 percent, one point below Nevada.

Kaiser data also show that a disproportionate number of Texas Latinos are uninsured. A majority of the uninsured in Texas—60 percent—are Latino, despite being 38 percent of the population. Latinos have an uninsured rate of 38 percent in Texas, compared to the statewide average of 24.

Texas appears to be an ideal candidate for Medicaid expansion: The worst health coverage rates, the promise of federal dollars, and its own estimated budget surplus of $8.8 billion.


Latinos are the fastest growing ethnic group in Texas, and are a majority of Texans without insurance. Texas Latino household incomes are about two-thirds the average, indicating Medicaid would disproportionately benefit this group. Yet with low voter turnout, most breaking for Democrats at the ballot, and with few significant competitive races hinging on Latino support, Texas Republican leaders have little reason to make the issue a political priority.

For many Texas Republicans, winning the party primary is the key election hurdle. Just ask David Dewhurst.

The worst area for health coverage are the counties along the border, many ranging from 30 percent uninsured to Texas’ leading county, Hudspeth at 43 percent, according to data from the Population Health Institute.

Jose Luna Jr. has worked as a clinical physician in El Paso for 30 years, serving many of the uninsured. Luna, currently the chief medical officer at Centro San Vincente, strongly supports the Medicaid expansion.

“There are people that I know that will die because of a lack of healthcare,” Luna said in a phone interview. “Patients that I have seen have a higher probability of dying simply because they have a lack of healthcare.”

Luna said he has lists of such patients, including one truck driver who lost his job after a stomach cancer diagnosis. Unable to work, the man lost his health insurance and relied on the clinic where Luna worked for care. The patient was unable to see an oncologist, and Luna said the only care he could provide was painkillers.

Luna said many Latinos in his community work service jobs without the full benefits many other sectors provide, explaining the dearth of insurance coverage.

“Health care should be a human right, not a privilege,” Luna said, describing the attitude towards healthcare he sees in many Latinos. Though Latinos are disproportionately affected by a lack of insurance in Texas, Luna said his support for Medicaid expansion was universal.

Republicans in Austin have little to fear in the short-term in their opposition to Medicaid expansion. However, national Republicans, who made courting the Latino vote a priority after the 2012 election loss, may take a different perspective. A Kaiser Foundation poll found that Obamacare was supported by a two-to-one margin among Latinos nationwide. [Emphasis added]

Few, if any, members of the Texas GOP see any political upside, only a downside, to Medicaid expansion, and that’s why it’s languishing. Maybe, if it inconvenienced their wealthy donors the way the flight delays did there would be some action, Hayes Slams Congress for Protecting Air Travelers Alone Among Sequester Victims.

With Congress undoing the one and only thing you could say was good about the sequester, which is that it bound together the poor, middle class and the wealthy with the across the board cuts, sadly, this should not be that surprising, given their voting records.

Hayes pointed to a study from Larry M. Bartels of Princeton which noted that:

In almost every instance, senators appear to be considerably more responsive to the opinions of affluent constituents than to the opinions of middle-class constituents, while the opinions of constituents in the bottom third of the income distribution have no apparent statistical effect on their senators’ roll call votes.

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It would be preferable that the Texas GOP wake up and do what is right now, and keep people from having to suffer unnecessarily. But if this is what it takes for Texans to finally wake up and vote in people that will actually make this a reality, then so be it.

Further Reading:
Teen’s struggles move legislator, only so much though.
Legislature doesn’t go with Perry’s proposed $1.6 billion business tax cut.
Some on the right Texas are taking notice of the work Battleground Texas is doing, Battleground Texas Training Supporters to Register Voters..
Payments to doctors, other providers at center of debate over Medicaid expansion.


Perry oozing on Medicaid expansion

Posted in 83rd Legislature, Around The State, Health Care at 11:57 am by wcnews

That’s what always hopeful Sister Simone Campbell says about Texas Gov. Rick Perry’s possible evolution on expanding Medicaid in Texas, Nuns on the Bus: Perry ‘oozing’ toward Medicaid expansion.

Religious leaders and a San Antonio lawmaker are putting their faith behind Rick Perry to be the next Republican governor to work with the Obama administration to expand healthcare coverage in the state.

“We understand that Gov. Perry is moderating his position (on Medicaid) as he sees the needs of real Texans,” said Sister Simone Campbell, executive director of NETWORK, a national Catholic social justice group. “We just have to give him enough room so he can save face and he’ll do the right thing.”

Perry remains firmly opposed to expanding Medicaid, spokesman Rich Parsons said Wednesday afternoon.

Campbell, who has traveled to different state legislatures and Congress with the group Nuns on the Bus since its inception last year, said nine other Republican governors who initially rejected “ObamaCare” have agreed to expand their healthcare programs to meet the coverage requirements of the Affordable Care Act.

“He’s oozing in our direction,” said Campbell before speaking at a rally Wednesday of more than a hundred activists on the south steps of the Capitol.

Catholic nuns and advocacy groups from San Antonio, Houston, Dallas/Fort Worth and Corpus Christi traveled by bus to Austin to urge lawmakers and Perry to expand Medicaid, which they say will extend coverage to more than 1.5 million Texans who are currently uninsured.


“Some say we should be at home in our convent chapels, praying for the world, not meddling in politics,” said Sister Elizabeth Riebshlaeger, a Sister of Charity of the Incarnate Word in San Antonio. “But we know the doors leading out of our chapels lead here… ”

Kuff has a round up of what happened earlier in the week on Medicaid expansion in House committees, House discusses Medicaid expansion.  It’s clear from this that many in the Texas GOP are still trying to find a way in to expanding medicaid.

Further Reading:
Texans approve of expanding Medicaid.
Medicaid: Texas.


Still trying to find a way in…Janek and Coleman

Posted in Around The State, Health Care at 3:27 pm by wcnews

A Democrat and a Republican are trying to find a way to get Texas to expand Medicaid.  But it’s hit a snag, Janek happy to be secret envoy on Medicaid-related talks, as long as it’s not public?

Text messages to a legislator show that Kyle Janek, Gov. Rick Perry’s point man on health care, was content last week to start planning a trip to Washington to meet with Cindy Mann, director of Medicaid and CHIP services and deputy administrator of the U.S. Centers for Medicare & Medicaid Services.

In the world of health care acronyms, that agency is CMS. And CHIP is the Children’s Health Insurance Program.

“Kyle, can you check your schedule for you and I go to Washington?” Rep. Garnet Coleman, D-Houston, texted Janek on April 1.

“You bet,” Janek swiftly replied. “Let me look at some dates. Given the House calendar, should I look at Mondays/Fridays or is it all getting to be the same now?”

Coleman responded, “Either. I will see when I can get in.” Early Wednesday, Coleman continued the exchange of messages, mentioning Mann specifically.

But when Coleman spoke to reporters around midday Wednesday about the planned trip, and the reporters spread the news, Janek’s office got a little uptight. One can only presume that Perry’s did, too.

But this is the money quote:

“No meeting has been scheduled yet. As you know, legislators are still considering several options. Once they’ve reached a consensus we’ll have the detailed guidance needed to begin negotiations with CMS on Medicaid reform. We have ongoing talks with CMS on a variety of topics so we’re always open to trying to get more information from CMS on any of the options being discussed.”

As long as they’re still trying..


Medicaid Expansion in Texas, hoping for a miracle

Posted in Around The State, Bad Government Republicans, Health Care at 10:01 am by wcnews

These two videos do a pretty good job of laying out the idiocy of Perry and the wing nuts stance against expanding Medicaid in Texas.  The first video sets up the issue and also replay’s Perry’s “Oops” moment – it’s worth watching just for that.

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The second video includes Congressman Joaquin Castro (D-Texas) and has a great explanation of how bad it will be for Texas if Medicaid isn’t expanded.  Castro does think Texas will eventually find a way to expand Medicaid, whether under this governor or the next governor.  Ezra Klein does a great job of explaining how “disproportionate share” payments will negatively effect Texas.  And Ryan Grim does a good job of explaining the ideological box that Perry and the wing nuts have put themselves in.

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To add to this the Kaiser Family Foundation (KFF) came out with a new study that shows Hispanics would benefit the most from expanding Medicaid in Texas.

Today the Texas Tribune has an article on a budget rider that will be debated today regarding disproportionate share payments, Public, Private Hospitals at Odds Over Budget Rider.

Kuff has this post on a purported Medicaid reform plan by Sen. Tommy Williams. The sad part is that like his wing nut leader Perry, Williams is incapable of saying he’ll have anything to do with Medicaid.

Of course, the federal government is paying for it, assuming that Williams’ Republican colleagues in Washington don’t succeed in figuring out some way to cripple it. One must admit there is some risk to that, however perverse the whole thing is. Be that as it may, I’d like to know how much revenue Williams thinks he can “scrape” this way, and how many people it would help. I’m going to step out on a limb and guess that the number is smaller than the number of people who would be eligible for expanded Medicaid. More importantly, why this for a revenue source and not the billions of dollars of federal money available? Back to the Trib for that:

State Rep. John Zerwas, R-Simonton, confirmed Wednesday that he will incorporate into his own Medicaid reform bill a proposal by Sen. Tommy Williams, R-The Woodlands, to use premium tax revenue to subsidize private health policies for the uninsured.

“It fits very well with Texas’ attempt to find a unique solution that would be sustainable,” Zerwas said. He said the measure would allow Texas to embrace some parts of federal health reform “earlier versus later,” and would “hopefully bring insurance policies to these people that otherwise wouldn’t have them.”

But the two lawmakers diverge on a key point — whether or not to draw down billions of federal dollars to expand the state’s Medicaid-eligible population under the Affordable Care Act.


Medicaid expansion is “completely off the table — what I’m interested in is a reform program,” Williams said Wednesday morning.

Zerwas said he authored House Bill 3791 to craft a “Texas solution” to Medicaid reform that would allow the state to draw down federal Medicaid expansion financing while implementing cost containment reforms. So far, Zerwas has suggested those reforms include co-payments and wellness incentives, but the details of his plan remain thin.

Still not clear what, other than straight up antipathy to Medicaid and the ACA, is driving Williams’ refusal to draw down federal funds. The sad thing is that even this baby step, two years out, would be a big improvement over anything the Republicans have done to health care in Texas. It’s ridiculously limited and needlessly complicated, which gives you some idea of just how bad the status quo is, but it’s still a tiny nudge forward. I just hope Rep. Zerwas’ perspective wins out in the end.

The only silver lining we can hope for is that the Texas GOP’s immoral stance on health care will make them vulnerable in Texas much sooner.  Now that would be the miracle we need.


Unwilling to compromise on the moral choice

Posted in Around The State, Bad Government Republicans, Health Care at 11:51 am by wcnews

Via One Texas.

From yesterday’s dueling press conferences, A Deafening Roar for Medicaid Expansion.

This morning, volunteers with Progress Texas and the Texas Organizing Project rallied outside Governor Perry’s office demanding he expand Medicaid in Texas to cover hard working Texans. Perry hosted a 10 minute long “roundtable” discussion – where no members of the public were invited – and a joint press conference on Medicaid expansion with Senators John Cornyn & Ted Cruz, along with other Texas Tea Party members. Texans came from across the state to make it known that we need health care, and we need it now – check out our Facebook photos from the rally.


The protest only finished a couple hours ago and we’ve already been mentioned by Politico, the Fort Worth Star-Telegram, the Dallas Morning News, and the Houston Chronicle. We were so loud, members of the press inside could barely hear what the Governor and Senators Cruz & Cornyn were saying!

Here’s video from the press conferences yesterday via the Texas Tribune.

“This is no longer a Democratic issue or a Republican issue,” Julián Castro said. “This is about providing health care insurance so that more of our Texas families can be healthy.”

“Governor,” Joaquin Castro said, “I hope you will give up the swagger and get serious about expanding Medicaid in Texas.”

More, State Leaders Make Case For, Against Expanding Medicaid.

Republicans including U.S. Sens. Ted Cruz and John Cornyn, Gov. Rick Perry, Lt. Gov. David Dewhurst and members of a conservative think tank gathered first, reaffirming their opposition to expanding Medicaid, a key tenet of “Obamacare” that is widely supported by Democrats. The expansion — and, in particular, the flexibility the federal government has shown some Republican-led states in implementing it — has in recent months drawn the support of some fiscal conservatives reluctant to pass up billions of federal dollars and the opportunity to curb Texas’ ranks of the uninsured.


The Republican event was followed by a Democratic one led by U.S. Rep. Joaquin Castro, D-San Antonio; his brother, San Antonio Mayor Julián Castro; U.S. Rep. Lloyd Doggett, D-Austin; and legislative Democrats. They demanded that state leaders find a way to draw down the federal money and lift Texas’ stigma as having the highest uninsured population of any state.

“Even though many states with staunch Republican governors have said expanding Medicaid is the smart thing to do, the governor has stubbornly refused to do so,” Joaquin Castro said.

Julián Castro said: “As elected officials, the public hires us not to do the ideological thing but to do the smart thing. People from across the political spectrum … have suggested that Texas should do the right thing and accept the expansion of Medicaid.”

The other part is that this is Texas taxpayer money that will go to other states if we don’t opt in…and we’ll still be paying for these people when they show up at the emergency room.

“This is federal money that is going to be spent whether we opt into the program or not,” he said. “In other words, if we don’t reclaim our federal dollars that Texas taxpayers are paying, they’re going to go to other states.”

There is nothing that can be said to fight against the ideological bias of Perry and the wing nuts. They  will not compromise on anything Obama related. The Democrats in Texas, the Obama administration, and many traditional GOP supporters are willing to work on a deal. But Perry and the wing nuts, who have locked themselves into an ideological box, are unwilling to compromise on this, the moral choice of our day.


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.

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