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Home | Tag Archives: medicaid

Tag Archives: medicaid

Voters in four states have approved Medicaid expansion by ballot. Will Texas do the same?

Olga Kauffman is tired of the politics surrounding Medicaid.

Kauffman, a San Antonio resident who works as a health specialist with Urban Strategies, a group that builds public housing and provides services to residents, says she sees families struggle every day because of lack of access to health care and insurance.

She recalled helping a 31-year-old mother with ovarian cancer get on Medicaid, the joint federal-state health insurance program for people who are poor or disabled. The mother of three, who evacuated the U.S. Virgin Islands after Hurricane Irma, had Medicaid there but didn’t realize she needed to apply for it again in Texas. Kauffman said it took months for her client to hear an answer, and in that time she missed several chemotherapy appointments and couldn’t afford her prescription drugs. Two weeks after she died, her Medicaid application was approved. It’s those moments that Kauffman thinks about when telling people how Medicaid can leave people behind.

”I’ve had stories of families I’ve seen being torn apart because they lost a loved one because they didn’t have access to health care,” Kauffman said.

Stories like that of Kauffman’s client are why some Texas legislators are hoping to gain traction on bills that would put a constitutional amendment on the ballot for voters to decide whether the state should expand Medicaid coverage.

Texas is one of 14 states that have not expanded Medicaid under the Affordable Care Act. An estimated 1.1 million low-income Texans would be eligible for coverage under a Medicaid expansion, according to the Kaiser Family Foundation. Low-income families often make too much money to qualify for Medicaid coverage and too little to buy private insurance.

Idaho, Nebraska and Utah voters approved Medicaid expansion through ballot initiatives during the 2018 elections. Maine voters did the same in 2017.

“If it’s on the ballot, of course I would vote for it, and I would tell everybody I know to vote for it,” Kauffman said.

Seeing other states take Medicaid expansion to voters is what Rep. Celia Israel, D-Austin, says gave her the idea to file House Joint Resolution 40. She said she’s frustrated that Texas “has not shown the political fortitude” to expand the program and that giving the decision to voters may take political pressure off of Republicans.

Expanding Medicaid through the Affordable Care Act — also known as Obamacare — has been a nonstarter in the GOP-dominated Texas Legislature. Republicans including Gov. Greg Abbott, Lt. Gov. Dan Patrick and former Gov. Rick Perry have argued that expanding Medicaid would increase health care costs for the state — especially if the federal government ever breaks its promise to help pay for the surge of newly eligible people.

Israel’s strategy so far has included courting Republicans in districts that have lost rural hospitals. Nineteen rural hospitals have closed permanently or temporarilysince 2013, according to the Texas Organization of Rural & Community Hospitals.

“I’m getting mixed responses,” Israel said of her progress. “I’m making the case that we have lost so many rural hospitals in Texas, and one of the reasons we wouldn’t have lost those rural hospitals is if we had said yes to expanding Medicaid.”

Anne Dunkelberg, associate director of the Center for Public Policy Priorities, a left-leaning policy organization, said the 2018 election cycle and polls showed that health care is a top issue for voters.

“The bottom line is even though individual members have seen desirability moving in this direction, it’s not something they’re going to fall on their sword and buck their leadership over,” Dunkelberg said.

Texans making decisions about health care in their state “is a fundamentally good idea,” and Medicaid expansion should be on the ballot for voters, said Dr. Deane Waldman, director of the conservative Texas Public Policy Foundation’s Center for Health Care. But he said Medicaid expansion would not necessarily mean more people would have access to care. He added that the billions of federal dollars Texas receives for expansion would not last long because of the program’s expensive mandates.

“You expand Medicaid, and what’ll end up happening is even more people will expect to get care and will be unable to find it,” Waldman said. “That really is the essence of why I think that the evidence shows that expanding Medicaid is bad both for the health of Texas and their access to care and the state of Texas because we’re going to end up with a shortfall.”

State Rep. John Zerwas, chairman of the House Appropriations Committee, attempted an alternative to Medicaid expansion during the 2013 session. The Richmond Republican’s House Bill 3791 would have allowed Texas to receive federal money in the form of block grants to enroll individuals in a private health plan using a sliding-scale subsidy, rather than expanding Medicaid to cover them. The bill also had a “pull the plug” provision if the federal government failed to continue funding. It had some bipartisan support but never reached the House floor for a vote.

He said Medicaid expansion in general still “comes with political radioactivity” that Republicans are hesitant to deal with. Just pursuing a waiver is still “a pretty steep hill to climb.” Zerwas said he doesn’t plan on bringing his bill back and also doesn’t believe Medicaid expansion needs to be taken to voters. He acknowledged that Texas has the highest number of uninsured people in the country but says there’s not a cost-effective way to provide care for the Medicaid population.

“It’s just politics, you know, and I’ve lived through this by virtue of carrying the bill in 2013 and was portrayed as someone who just loved Obamacare and was looking to grow it in the state of Texas,” Zerwas said. “Politically and in my party especially at that time and still so … it continues to be one of those things that Republicans rail against because they see it as a very heavy cost to the state.”

But Sen. Nathan Johnson, D-Dallas, who filed Senate Joint Resolution 34, which also would create a constitutional amendment to expand Medicaid, said that “it should not take a leap of courage to put this on the ballot.” Amid Texas’ problems with the opioid epidemicmaternal mortality and access to mental health services, he said, it would be difficult for lawmakers to go back to their constituents and tell them why they refused to put Medicaid expansion on the ballot.

“It starts to become a bit of an embarrassment,” Johnson said. “I think we have the potential to be a leader in health care. … We have vast resources and tremendous amount of power and will when we decide to employ it.”

For Kauffman, she said she understands the politics around Medicaid, but when it starts affecting the lives of families, then it “needs to become apolitical.”

“It needs to become a quality-of-life and health care issue,” Kauffman said. “It needs to be taken into consideration that we need the best health care for families in Texas, and if the only way is to expand Medicaid in Texas, then we should do it.”

Disclosure: The Texas Public Policy Foundation and the Center for Public Policy Priorities have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.

Author: MARISSA EVANS – The Texas Tribune

Congress is Eyeing big Medicaid Cuts: Here’s Why it Matters to Texas Families

Despite years of sleepless nights, emergency room trips and long stares into the financial abyss, Kate Robinson-Howell and Bob Howell of Austin are adamant that they are a Medicaid success story.

Their second child, Apollo, was born with a malformed esophagus and trachea. He had emergency surgery to reconstruct his airway when he was just four months old. Now two years old, Apollo eats through a gastronomy tube that protrudes from his stomach, suffers from chronic lung disease and has endured dozens of emergency room visits and countless hours of speech, physical and feeding therapy.

“We’re just on edge constantly,” Robinson-Howell said. “If people don’t see it, it’s hard to appreciate how incredibly intensive and relentlessly demanding it is to raise a child with a chronic illness.”

To the average visitor, Apollo might look like any other toddler. He likes trains because his four-year-old brother Oliver likes trains. His voice is raspy, but he thanks visitors and calls them “sir.”

Robinson-Howell, who has worked in the health care policy field in the past, said the only reason the family finances have not been “ridiculously torpedoed” is that they qualify for Medicaid through a Texas program that covers kids with chronic conditions.

Medicaid helps families like the Howells afford their children’s health care. But the program, which was expanded under the Affordable Care Act, better known as Obamacare, could see major cuts if the U.S. Senate adopts the cost-saving provisions of the House-passed American Health Care Act. According to an analysis by the Congressional Budget Office, the House proposal would reduce future Medicaid spending by $834 billion over 10 years.

Supporters of the Medicaid reforms in the legislation say they will control runaway spending. Detractors say the plan uses Medicaid cuts — the bulk of which would go into effect in 2020 — to finance the repeal of Obamacare taxes that mostly fall on the wealthy.

“The budget being balanced on the back of disabled children is asinine and atrocious, and we should all be mortified that it’s even being talked about,” Robinson-Howell said.

Chris Jacobs, the founder and CEO of Juniper Research Group and a conservative health care policy expert, said Texas children with disabilities like Apollo would likely see little to no reduction in Medicaid help under the House proposal.

Jacobs pointed to a June report from the nonpartisan Centers for Medicare and Medicaid services that said more than 70 percent of Medicaid cuts will come in the form of a repeal of the Obamacare Medicaid expansion. Because Texas has not voted to expand the program, Medicaid cuts may not be as dramatic as in other states, he said.

U.S. Rep. Roger Williams, Robinson-Howell’s congressman, voted for the American Health Care Act, writing in a May 4 statement that it will “begin to undo the damage caused by Obamacare.” His office did not respond to requests for comment for this story.

Texas, which has one of the nation’s highest rates of uninsured children — 11 percent, according to a June study by the nonpartisan Georgetown University Center for Children and Families — is especially vulnerable to Medicaid cuts of any type. Almost half of all Texas children with insurance get it through Medicaid.

The study also noted that rural children in Texas have disproportionately benefited from health care reforms brought about by Obamacare. In 2009, the year before the landmark reform bill was signed into law, 18 percent of rural Texas children were uninsured. By 2015, that number had fallen to 11 percent.

Ronnequa Tennon of Elgin said Medicaid is keeping her daughter alive. Now 3 years old, her daughter was born prematurely. She weighed just one pound, one ounce at birth, and immediately required a ventilator to breathe. She still requires round-the-clock medical care and will likely be on life support for the rest of her life. Tennon, who is between jobs, said she could not afford her daughter’s expensive medications without Medicaid.

“I would be out of her life, and probably working up to 10 jobs just to keep her living,” Tennon said.

U.S. Reps. Michael McCaul and Bill Flores, Republicans who each represent parts of Elgin, both voted for the House health care plan.

After the May vote, McCaul said in a statement, “My vote for the AHCA is the first step towards building a stronger foundation for our nation’s healthcare system.”

Flores’s post-AHCA statement said: “The bill … enacts the largest entitlement reform in decades by modernizing and strengthening Medicaid.”

It’s unclear precisely how potential cuts would affect Texas children and families on Medicaid. But Stacy Wilson, president of the Children’s Hospital Association of Texas, says AHCA specifications ensure that there will be less Medicaid money to go around — particularly in the Lone Star State.

If the House proposal becomes law, Medicaid cuts would come in the form of a fundamental change in the payment structure of the program. Today, the federal government matches state Medicaid spending dollars. The House plan would mandate that a state’s allotment of federal Medicaid funds would be calculated on a per capita basis based on 2016 spending, capped and then adjusted for inflation yearly.

A May study published by the nonpartisan Brookings Institution looked at how a per capita cap would have affected Medicaid funding in the 2000s. It concluded that “no state would have received more funding under a per capita cap than under current law in any year.”

Jacobs said Texans would be fine under the House plan’s per capita cap.

“I think the impact would be limited to minimal if the per capita caps went into effect,” he said, adding the reform would “control costs by giving states more flexibility.”

According to a June University of Texas/Texas Tribune poll, just 20 percent of Texans who have been following the health care debate have either a “very favorable” or “somewhat favorable” view of the American Health Care Act, compared with 51 percent who say they have a “somewhat unfavorable” or “very unfavorable” view.

It is unknown how the Senate version of the legislation will handle Medicaid. The legislation, which U.S. Sen. John Cornyn, R-Texas, said he wants to see voted on before the August recess, will be unveiled Thursday, according to the Washington Post. There have been no hearings on the legislation, which Republicans have drafted out of the view of the public.

But in a Tuesday speech on the floor of the Senate, Cornyn said he wanted to make Medicaid “sustainable into the future.” He cited the Medicaid changes in the House plan as a way to keep program spending increasing “at a sustainable rate.”

Robinson-Howell said she has begged her representatives not to cut health insurance programs. In a Feb. 7 letter to Cornyn, she wrote, “Any cuts to ACA will put my two-year old son’s life at risk.”

She said Cornyn responded with a letter in June reassuring her that he would work to end wasteful foreign assistance spending.

A spokeswoman for Cornyn said Robinson-Howell “should have received a healthcare-related reply from Sen. Cornyn in March.”

Disclosure: The Childrens Hospital Association of Texas and the University of Texas have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.

Read related Tribune coverage:

  • U.S. Sen. John Cornyn predicted a new GOP health care overhaul would pass Congress by the end of July. [link]

Author:  KIRBY WILSON – The Texas Tribune

Study: Medicaid Increasingly Important to Rural Texas

AUSTIN, Texas – A new report shows Medicaid is important to ensure that rural families, in Texas and across the country, have access to the care they need to stay healthy.

The Georgetown University Center for Children and Families finds 46 percent of children in rural Texas are on Medicaid, compared with 41 percent in metro areas.

Stacy Wilson, president of Children’s Hospital Association of Texas, says these children and their families risk losing access to health care as Congress and the White House consider cuts to the program.

“Children who have access to Medicaid have a higher educational attainment level,” she points out. “They also are more productive in the workforce, they contribute to our economy.

“Getting children the best start that they can get through important programs like Medicaid and CHIP help our economy.”

Officials in Texas have declined to expand Medicaid under the Affordable Care Act. Despite that, Texas had the largest decrease in its number of uninsured children, with 52,000 children in small towns and rural areas gaining coverage between 2009 and 2015.

But current proposals would slash $1.4 trillion from Medicaid over the next decade.

Joan Alker, executive director of the Georgetown University Center for Children and Families, says the research shows states that expanded Medicaid saw a significant increase in levels of coverage, and improved health outcomes for rural families.

“There is such clear link between the role of the Medicaid program and the growing importance of the Medicaid program, and declines in the rate of uninsured kids and adults in small towns and rural areas,” she points out. “It’s very, very striking.”

Besides providing access to necessary medical care, Alker says Medicaid also improves economic security and helps protect families from medical debt and bankruptcy.

And she notes the program is a crucial support for entire communities, as it provides funding for rural health centers and hospitals.

Texas Officially kicking Planned Parenthood out of Medicaid

Texas health officials on Tuesday delivered a final legal notice to nix the funding Planned Parenthood receives through the Medicaid program.

After more than a year of delays, Texas is officially kicking Planned Parenthood out of the state’s Medicaid program.

In a move that could affect thousands of low-income women, state health officials on Tuesday delivered a final legal notice to defund the organization from the Medicaid program through which it provides family planning and women’s health services to the poor. Planned Parenthood had previously received $3.1 million in Medicaid funding, but those dollars will be nixed in 30 days, according to the notice which was obtained by The Texas Tribune.

That cut-off day will only be delayed if the organization appeals the state’s decision in the next 15 days by requesting an administrative hearing with the Texas Health and Human Services Commission.

The battle over the funding Planned Parenthood received for those health services — which are separate from its abortion services that receive no public funds — began in October 2015 when Gov. Greg Abbott and state health officials first moved to cut off Medicaid dollars, about 90 percent of which comes from the federal government, to the organization’s Texas affiliates.

Feeding on outrage sparked by the release of controversial undercover videos of Planned Parenthood officials, Republicans cited the videos — and unspecified allegations of billing fraud — as proof of “acts of misconducts” by the organization and said they would cut off Medicaid funding. But the state’s threat initially appeared to be a feint.

In October 2015, Texas officials delivered a notice of intent to boot Planned Parenthood from the public insurance program and gave the organization 30 days to respond to its notice and request an “informal resolution meeting” with health commission attorneys. If the organization did not act, the state said, it would issue a “final notice of termination,” formally ending Planned Parenthood’s participation in Medicaid. That order would have gone into effect 15 days after the organization received it.

But more than a year went by without a final notice. Meanwhile, Planned Parenthood continued to provide well-woman services to roughly 12,000 low-income women.

Texas health officials did not immediately respond to a request for comment regarding the final notice and why it was delayed more than a year.

In October, a spokeswoman for the governor said Abbott was “disappointed and troubled by the lack of progress” in defunding the women’s health organization but that he still expected the issue to “move forward.”

Abbott and other Planned Parenthood opponents have repeatedly pointed to undercover videos filmed by an anti-abortion group that showed Planned Parenthood officials in Texas discussing the use of fetal tissue for research. They’ve claimed the videos serve as proof that the organization is “harvesting” fetal tissue.

But there has been no evidence so far that Planned Parenthood “harvests” fetal tissue in Texas or that it engaged in wrongdoing, as claimed by anti-abortion activists. And state officials investigating the organization over purported practices have repeatedly declined to provide details about their investigation.

The fight over Medicaid funding is likely to play out in federal court where Planned Parenthood preemptively filed a lawsuit a year ago seeking to block Texas’ efforts. At the time, it was thought that Planned Parenthood affiliates would be cut from the Medicaid program as early as Dec. 8, 2015.

But the lawsuit sat virtually idle for a year because Texas had not delivered its final legal notice to defund the organization.

Federal officials have already warned Texas that pushing Planned Parenthood out of the state’s Medicaid program could put Texas at odds with federal law. And federal courts in other states have ruled that Planned Parenthood cannot be legally kicked out of Medicaid.

Read more:

  • More than a year after lawmakers originally ordered it, Texas announced in November it would enact significant cuts to the money that it pays therapists who treat vulnerable children with disabilities in two weeks.
  • In June, the U.S. Supreme Court handed Texas abortion providers a major victory by overturning Texas’ 2013 abortion restrictions.

Disclosure: Planned Parenthood has been a financial sponsor of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.

Author:  ALEXA URA – The Texas Tribune

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