Mental health has received a lot of well-deserved attention this legislative session after the recent violent tragedies in our nation. Texas legislators deserve praise for recognizing that all Texans benefit from a stronger mental health system with increased funds for prevention and better access to services. Of the more than 250 bills related to mental health filed this session, I focused on a number of bills that move the state forward in preventing and treating mental illness, assist communities in addressing their local needs and improve the outcome of individuals of all ages with mental illness. Although numerous mental-health-related bills passed, I would like to tell you about one in particular – HB 2625 by Rep. Garnet Coleman (SB 1912 by Sen. Sylvia Garcia), which was included as an amendment to two different bills that passed. This legislation revises the clinical criteria for adults to receive public mental health services at the local mental health centers.
Currently, Texas law (as the result of HB 2292 in 2003) mandates that state dollars can only fund mental health services for individuals who are medically indigent and meet the target population criteria. To receive services, an adult must have at least one of the “Big 3 diagnoses”–schizophrenia, major depression, or bipolar disorders. The door to community-based outpatient services has been closed for adults with other mental illness diagnoses (e.g., PTSD and other Anxiety Disorders). Therefore, these individuals only get services when in crisis: in the emergency rooms and through crisis services via the local mental health center. Crisis services are only temporary, do not provide continuous care, and are very costly to our local communities.
Rep. Coleman’s bill created two tiers of criteria to receive adult outpatient services in the local mental health centers. The first tier is the current law, serving those adults with the Big 3 using funds appropriated. A new second tier permits the centers to also provide clinically appropriate treatment services, with available resources, to adults with mental illnesses when their psychological, social, and occupational functioning deteriorates. The intent is to ensure that all individuals with mental illnesses, regardless of a specific diagnosis, are able to access services. This legislation opens the door to providing continuous and comprehensive outpatient behavioral health services for adults who today are cycling through the crisis system because they do not have the “right” diagnosis.
Written by Katharine Ligon, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
The biggest news with health insurance in the 2013 legislative session is what did not pass. Before it started, I hoped the session would help prepare Texas for big changes to the health insurance market in 2014—changes that are coming whether Texas is prepared or not! For the most part, that didn’t happen.
The Legislature missed a big opportunity to better protect health insurance consumers by letting our Department of Insurance (TDI) deny rates that are excessive (no, TDI cannot do that today). HB 2782 by Rep. Smithee (Sen. Watson was the Senate sponsor) would have brought TDI oversight of rates for health insurance more in line with its oversight for most other types of insurance consumers buy—TDI can take action on rates for home, auto, title, credit, farm and ranch, mortgage guaranty, long term care, umbrella, Medigap, and more. Health insurance is one of the most expensive and most important products businesses and families buy. But Texas law treats health insurance like an exception when it comes to consumer protection, not the rule. HB 2782 had substantial support in the House, but failed to get a vote in the Senate State Affairs Committee.
At least for the next two years (but hopefully not beyond that), Texas businesses and families will lack the assurance that the premiums they pay for health insurance are fair and justified. This is a particularly bad time to tie the hands of a regulator. Not only is federal money available right now to pay for state-level rate review, but also next year, the Affordable Care Act (ACA) will change the way health insurers set premiums. For example, insurers will no longer be able to charge more to people with pre-existing conditions or charge women more than men. With sweeping market reforms coming in 2014, 2013 was the time to equip TDI with the tools to protect consumers.
Speaking of sweeping market reforms, another thing that didn’t happen this session was to prepare our insurance market and TDI for 2014. TDI lacks clear authority to enforce impending ACA consumer protections, such as no more pre-existing condition exclusions. The Legislature did not ensure that insurers could look to TDI for clarification and consumers could look to TDI for protection when all of the new ACA provisions take effect in 2014. Perhaps the Legislature followed TDI’s lead—a discussion of how to prepare the agency, insurers, and consumers for sweeping market changes was notably missing from TDI’s pre-session recommendations to the Legislature. Texas consumers are now left in the position where the refusal of TDI to be as proactive as possible when it comes to 2014 changes means that we may have to turn to federalregulators to address our concerns, questions, and complaints about insurance products licensed by TDI and sold in the state.
So what did pass? SB 1795 by Sen. Watson will create standards for Navigators in Texas’ federally-facilitated Marketplace and SB 1367 will wind down the Texas Health Insurance Pool (high risk pool) in 2014 when the ACA creates a range of more affordable options in the new Marketplace. Both of these good bills prove that the Texas Legislature has the ability to react to the Affordable Care Act in a manner other than just sticking its head in the sand. But health insurance oversight is yet another area in which our elected representatives missed important opportunities to serve the public.
This piece is cross-posted from the BETTER TEXAS Blog, a blog by the Center for Public Policy Priorities.
Do you want to learn more about the new health care law and what it means for your community? Do you want to find out more about how to enroll for coverage in the new Health Insurance Marketplace?
The U.S. Department of Health and Human Services Partnership Center will be hosting a series of webinars on the Affordable Care Act for faith and community leaders between June 12 and August 7. All of these webinars will be open to the public, and will include a question and answer session for participants.
The first upcoming webinar, on June 12, will be an ACA Question and Answer session in Spanish. The following three webinars will cover Health Insurance Marketplace 101 topics including the main provisions of the health care law, how to access care in your community, the Health Insurance Marketplace, how to enroll in health insurance, and how to receive updates on implementation of the law.
Click on the links below to register for each event separately and learn more about the HHS Partnership Center here.
June 12 at 3:00 pm ET
Q and A on the ACA (in Spanish)
June 19 at 12:30 pm ET
The Health Care Law – Health Insurance Marketplace 101
July 11 at 2:00 pm ET
The Health Care Law – Health Insurance Marketplace 101
August 7 at 3:00 pm ET
The Health Care Law – Health Insurance Marketplace 101
When Texans with mental health concerns receive help, our communities, families and businesses all benefit. That’s why it has been great to see our legislature improve public investments in mental health during the 83rd Legislative Session.
Funding our public mental health system is a real step forward, but it is only part of the solution when another important opportunity exists. Our state legislature had a chance to address perhaps the biggest barrier to wellness for hundreds of thousands of Texans with mental health concerns: a lack of health insurance that keeps them from getting the treatment and services they need. Our state could have produced a plan to accept federal dollars for about 1 million uninsured Texans, so that they would have a health insurance option. Unfortunately, this never happened and politics were placed over people.
Whole communities will benefit if we develop a solution to cover more Texans with available federal dollars. Right now, unmet mental health needs cost Texas businesses an estimated $270 billion in lost revenue each year. The public spends another $13 billion addressing mental illness and substance abuse. Access to ongoing treatment and services make all the difference in whether Texans with unmet mental health needs succeed at work, in school and in the community.
Rejecting the funds altogether will only put more pressure on our state funded systems. A vast majority of uninsured Texans who use our public behavioral health system for mental health and substance abuse services would be covered if Texas were to accept these federal funds next year. It is the efficient and right choice for our state, and the governor should make sure this is addressed before the year’s end.
New research shows the key role of coverage in mental health. In Oregon, an unusual circumstance led to a lottery system where some, but not all, uninsured people could get covered through Medicaid. When researchers compared the groups with and without coverage, they found the population that had health insurance had a 30 percent lower rate of depression than the uninsured group. That real and sizable improvement followed better access to health care.
It isn’t too late for a solution, but with every month after December that we stall, lives and dollars are lost. Let’s not make Texans wait and make our public mental health system pay more. There’s a way to address the need and help more people reach their full potential from day one of the new year.
Written by Clayton Travis, Texans Care for Children
Back in January, I noted that the most sweeping Medicaid issue of the 2013 session—with over a million uninsured Texans, billions of federal dollars for our economy, and hundreds of thousands of new jobs at stake—would be Texas’ opportunity to cover all citizen adults up to just above the poverty line in Medicaid, with a better than $9 federal match for every $1 Texas spends. I also predicted then that regardless of the outcome, every legislator would learn about this issue and what it means for the communities they represent.I am not sure if we can really claim to have reached all legislators, but we certainly had a robust discussion that surely touched most of them, including marches, rallies, and public hearings. Still, the most conservative elected officials prevailed over the moderates and prevented the Legislature from moving forward even with a conservative, market-based alternative offered by Rep. John Zerwas.As a result, unless the Governor takes action soon, in January 2014 Texas adults above the poverty line will get taxpayer-funded sliding-scale help with health insurance, but Texans below poverty will qualify for nothing. Next door in New Mexico and Arkansas, though, working poor adults will gain the coverage that Texans are helping to pay for.
So the learning curve continues! The Texas Association of Business and 22 chambers of commerce have allendorsed finding a “Texas Solution” to cover the poor and draw the estimated average $6 billion in annual new federal funds. And, as more folks hear that national tax experts estimate Texas employers will be paying at least $300 million every year in tax penalties for uninsured workers, as a direct result of Texas rejecting coverage for the working poor, we hope more local and state officials will see the light.
As we move forward after session and continue working to get more Texans health coverage, you can send a letter to the Governor, and email a copy to the Texas Well and Healthy campaign, calling for him to do the smart thing for Texas and the fair thing for the working poor. It would be a great way to start the next phase of our campaign to make sure health reform is not denied to the very Texans who need it most.
Written by Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
There are risks to starting your own business, but the ability to find affordable health coverage shouldn’t be one of them. However, the decision to stay at a job because an individual doesn’t want to lose his or her employer-sponsored health insurance is so common it has a name: “job lock.” It’s easy to understand why would-be entrepreneurs wouldn’t want to risk striking out on their own when private health insurance is often exorbitantly expensive.
Health care reform to the rescue!
Beginning next year, the Affordable Care Act will provide access to high-quality, affordable health insurance through an online marketplace. Better health coverage options outside of employment will help give people the security and encouragement they need to start their own businesses. A recent study from the Urban Institute and Georgetown University found that the ACA will help enable 1.5 million Americans set off on their own business ventures. That includes 124,000 Texans. (This article explains the foundation for the 1.5 million people finding.)
Health care reform provisions that will lead to more robust and reasonable health coverage plans for entrepreneurs include:
- No more discrimination against people who have preexisting conditions
- No more premium hikes because of an individual’s health status
- Tax credits to help reduce premium costs for low and moderate-income individuals and families
- Expanded Medicaid in some states (so far, not Texas)
- Insurance plans that must include essential health benefits
- Help with the costs of deductibles and co-pays in many cases.
The infographic below provides a breakdown of the how many people in each state will be self-employed due to the ACA. Check it out and share the great news!
Editor’s note: Two members of our team, who have made outstanding contributions to this movement to improve access to health care for Texans, had their last days on the job. They move on to new horizons, while continuing the work of educating and organizing others to make health care system betters. Their farewell messages can be found below.
Dear Texas Well and Healthy members,
Today is my last day working on this campaign, and I wanted to take a moment to thank each and every one of you for your commitment to ensuring that all Texans have access to affordable health insurance and quality health care. Over the past two years it has been an honor and a privilege to travel around this great state to give presentations about the Affordable Care Act. I have personally spoken (at presentations, trainings, conference calls, and webinars) to more than half the membership in this campaign, and meeting you has been an unforgettable experience. Getting to meet you, the committed and enthusiastic people who fight for equality and justice, has filled me with hope for a bright future for health care in Texas.
I am sad to be leaving this job behind, but I also look forward to completing my doctorate at the University of Texas at Austin in the next year (the topic is Health Care Systems in Sandinista Nicaragua, for those who want to know). I’ll be back in the health care working world when that is done, and I sincerely hope to cross paths with some of you in the future.
Until then, I wish you all the very best. Keep fighting the good fight.
To a well and healthy Texas!
Cheasty Anderson
*******************************************************************************************************************
This week, many Texans came together to celebrate all the amazing work we’ve done together over the session and take a deep breath before we start it all again. Something else happened this week, too. I wrapped up my time with Texas Well and Healthy and Engage Texas as Organizing Director. I have transitioned to a new role as Texas State Director with Enroll America.
I have had an amazing time working with this campaign. I can honestly say I’ve never had such a great time fighting such a tough fight! Of course I will still be very much involved with many of you in my new role, too, as the focus turns to how we get people enrolled in health insurance they need.
Allow me also to introduce you to the new Health Care Coordinator for the campaign. Laura Brubaker, who worked previously with Progress Texas, has been very involved with the Medicaid expansion fight. She will be taking over for me, officially starting in her new role June 3rd. You are in good hands with Laura, and you can reach out to her at: laura@engagetexas.org.
Best,
Mimi Garcia
“Health of Texas Children Improving, Surveys Show,” read a headline this week in the Dallas/Fort Worth publication D HealthCare Daily. The report goes on to say the National Survey of Children’s Health–from 2003, 2007 and 2011-2012–indicates progress for Texas kids “on several health-status measures, (including) a significant uptick in mental-health screening and diagnosis for children in recent years.”
What else is noteworthy from the study:
- Children reported to be in excellent or very good health in Texas climbed 5 percentage points to 82% in the last decade.
- Children who received a check-up in the past year climbed 8 percentage points to 83% over the same time period.
- Parents reporting their children were breastfed at any time climbed 6 percentage points.
- The rate of children receiving developmental screenings tripled from 2007 to 2011.
What can cause improvements like that? No doubt, a lot is a lot at play. But, with swings so large, public policy is often a part of the story.
Here in Texas, between 2003 and 2011, our state shored up Children’s Medicaid and CHIP, cutting red tape in two systems that help kids throughout Texas see a doctor when they need to. The result? The number of uninsured children fell by hundreds of thousands in recent years, even as our overall child population grew. We still lag behind most of the nation in insuring kids, but Texas has made progress.
(For how Texas compares to the nation as a whole on the survey findings, see this snapshot from the Data Resource Center for Child and Adolescent Health.)
It is nice to see as more kids got covered, more families reported good news about their children’s health.
Because the governor is hesitant to expand Medicaid, the legislature will probably adjourn without taking full advantage of the dollars available to Texas to cover the uninsured through the Affordable Care Act. Fortunately there is more than one way to skin a cat, which in this case means a way to pull down all the dollars in the affordable care act through a market solution rather than by expanding traditional Medicaid, and it can be done before the legislature meets again in 2015.
Here’s how it would work. The Affordable Care Act divides the uninsured into three groups: 1) those who can afford health insurance; 2) those who can afford private health insurance with sliding-scale premium assistance; and 3) those who can’t afford health insurance. The act assumes that a state will enroll those who can’t afford health insurance in traditional Medicaid (drawing the line on affordability at those with incomes below 138 percent of the poverty level), but it doesn’t have to work that way.
The federal government negotiated an alternative plan with Arkansas that allows that state to take the federal dollars it would have gotten from enrolling its eligible citizens in traditional Medicaid and instead use those dollars to buy them private health insurance coverage. state Rep. John Zerwas, a medical doctor from Houston, proposed legislation to create a similar “Texas Solution.” While his proposal was approved in committee, it was not scheduled for a vote by the House, even though a majority apparently favored the idea.
Going forward, though, nothing stands in the way of our state leaders from striking their own deal with the federal government. Texas law provides all the authority our leaders need. Making a deal would be good for Texas.
More than a million Texas citizens could gain coverage, including more than 800,000 working Texans. This number includes young adults, but it also includes older adults who will not qualify for Medicare for years. And it includes more than 66,000 uninsured Texas veterans and their spouses.
This brings me to a problem you may not have heard about. Last summer, when the United States Supreme Court held the Affordable Care Act constitutional, it threw a wrench into the way the act works by also ruling that the federal government could not impose a penalty on states that chose not to expand Medicaid.
But act’s sliding-scale premium assistance is only available above the poverty line. If a state like Texas doesn’t already cover adults up to the poverty line and doesn’t expand Medicaid, then the state creates a terribly unfair coverage gap. Starting in 2014, those living from 100 to 138 percent of poverty can get sliding-scale premium assistance, while those living below 100 percent of poverty who don’t already qualify for Medicaid get nothing.
In Texas, if you are an adult, chances are you don’t already qualify for Medicaid. Texas Medicaid basically covers only low-income children, seniors, people with disabilities, and pregnant women. Only adults raising children and making less than $4,000 a year (for a family of three) qualify for Medicaid. Working age adults without children do not qualify at all.
This coverage gap creates a big problem for employers. If Texas chooses not to cover everyone up to 138 percent of poverty, Texas employers will pay higher taxes in 2014 because the Affordable Care Act taxes employers who don’t provide health benefits if their employees make between 100 and 138 percent of poverty and sign up for premium subsidies. The Jackson-Hewitt Tax Services estimates Texas businesses will pay $299 to $448 million each year in extra tax penalties for these workers if our leaders don’t provide a Texas Solution.
Finding a Texas Solution to fully implementing the Affordable Care Act would not only help employers, it would bring a projected $6 billion a year in federal funds to Texas communities, build the health care work force and reduce the need for local property taxes to fund indigent care.
Experts project it would also create up to 300,000 jobs, which is why 20 Texas chambers of commerce, the Texas Conference of Urban Counties, and the Texas Association of Business all supported a Texas Solution.
Fortunately, we can afford to develop a Texas Solution at little to no additional cost by shifting current costs to the federal tab and bringing in new revenues from increased business activity.
For the sake of Texas, our leaders need to make a deal with the federal government to fully implement the ACA through a Texas Solution that provides Texas citizens the health insurance they need.
Written by Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from Better Texas blog.
The Associated Press reported today that Texas hospitals could lose $56 million in 2014 in special Medicaid payments to hospitals that serve lots of people on Medicaid and the uninsured (so-called DSH or “disproportionate share hospital” payments). A newly proposed federal rule lays out a formula for how the federal budget will reduce those payments over time, as the number of uninsured starts to drop in 2014 with new coverage under the Affordable Care Act. According to the federal guidance, the numbers published today are just for illustration, but they are said to be in the ballpark of what states can expect.
The most staggering thing about the cuts to our state’s safety net hospitals is that Texas can choose right now to eliminate those cuts with simple leadership. By moving ahead with an alternative to Medicaid expansion that relies on private health insurance, or a “Texas Solution” as it has been dubbed, instead of being $56 million down in 2014, our state could be gaining an estimated $2.4 billion in new federal Medicaid spending (according to Texas Medicaid officials). Based on historical Texas Medicaid spending, about 40%–or $990 million of that new 2014 Medicaid spending–would go to hospitals.
If you have your calculator handy, yes, that is more than 17 times the projected cut in DSH payments. This is not an accident! The Affordable Care Act was designed to reduce the DSH payments for care for the poor, because Medicaid would ensure that hospitals could now get paid for care to working poor adults, most of whom are currently excluded from Texas Medicaid under state law.
Of course, if Texas fails to accept the funding already designated in the federal budget to cover working poor parents and other adults, 1.1 million Texans will also remain uninsured. Many will seek care in the very same hospitals that now rely on DSH payments to help pay for that care. The cost of continuing to provide care for the uninsured, combined with cuts in DSH payments, will threaten the economic security of local hospitals throughout the state.
This is why 20 Texas Chambers of Commerce, the Texas Conference of Urban Counties, and the Texas Association of Business all supported a Texas solution to cover the poorest uninsured Texans and bring home billions in federal income tax dollars. The Texas Solution has been called “Smart, Affordable and Fair” by former Deputy Comptroller Billy Hamilton and the “Only One Rational Choice” by economist Ray Perryman.
This is a hit Texas hospitals simply don’t have to take. Yet another reason to call on Texas leaders to finish the job and bring home coverage for the poorest of Texas’ uninsured in 2014.
Written by: Anne Dunkelberg, Center for Public Policy Priorities
