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.
Hello, Texans! And for that matter, hello Americans! I’ve got some news to tell you about, but you’ve got to bear with me for a second here. First I’m going to use a bunch of jargony health care language that will make your eyes weep with boredom. But then I will explain what it means in such clear and precise terms you will be glad you stuck with me, because when I’m done, you will have information that gives you, the consumer, a first taste of what buying-power might feel like in the health care marketplace. (You know, eventually. Let’s not get crazy here.)
So here’s the boring part. The Centers for Medicaid and Medicare Studies (CMS) just released a huge – and I do mean HUGE – database of billing data for hospitals that accept Medicare patients around the country. Basically, it’s a giant spreadsheet that itemizes the top 100 most frequently billed items for Medicare. Then, (drum roll) in two pretty side-by-side columns, the database tells us: 1) how much the hospital bills private patients (that means non-Medicaid and non-Medicare patients, either with or without insurance); and 2) what they accept in payment from Medicare.
The differences (and there are many) are staggering on a number of levels. If you take the time to make sense of the data, you will see that you can compare procedures from hospital to hospital anywhere in the country. So let’s pick a city and a random illness from the list. If you live in Austin, TX, (which I do, so let’s go with that), you can compare the average cost of hospitalization at competing Austin hospitals for simple pneumonia. Or if you want to see how much the same hospital treatment would cost you if you lived in New York City or Louisville, KY, you could also look up the prices at hospitals in those cities. So this is good. An Austinite might call Seton Hospital and ask why they charge $61,099 for pneumonia when Brackenridge, a half mile away, charges $42,252. A $19,000 difference. My brand new car didn’t cost that much.
So this is good. You as a consumer (in theory at least), could look at this hospital billing database when pondering your upcoming need to, have a limb amputated, for example, and decide to go with the hospital in your area that charges less. Or more, I guess, it’s your choice. But either way, you have access to INFORMED decision-making, which you currently do not have. This is an important first step, and one we should have taken long ago.
Hospital representatives will protest that these prices are a non-issue because, as they say, “nobody actually pays that price.” Unless, of course, you’re one of the almost 50 million Americans without health insurance. In that case, that’s exactly what you get billed. You may not end up paying that much (honestly, who among us actually could?), but that is what your bill will say. If you have cash in the bank or assets to claim, you may lose everything you have before the hospital bill is settled. Sixty percent of bankruptcies in this country are the direct result of medical bills, and these price lists are where those medical bills come from. It is outrageous.
But back to what the hospitals say. These prices, they protest, are just a place for starting negotiations with insurance companies, Medicaid, and Medicare, all of which get a heavily “discounted” rate. I fail to see how such an obviously random and ludicrously inflated price list could be an effective tool in negotiation, and now that we are all getting to take a good look at these price lists, I’m hoping the exposure to daylight will help remedy some of the worst excesses.
But that’s not all! Don’t forget that second column of data that tells us how much Medicare pays for those same procedures. Hang on a second while I look it up in the database… Aha. Brackenridge might charge an average patient $42,252 for simple pneumonia, but from Medicare, they accept an average payment of only $11,859. That is more than THIRTY THOUSAND DOLLARS LESS. The down payment on my house wasn’t even close to that much.
And at Seton, where patients are billed $61,000, they accept a payment of $9,730 from Medicare. Which is less than Brackenridge gets, even though they charge private patients more (why? That makes no sense!), but it is $51,369 less than what they charge non-Medicare patients. FIFTY-ONE THOUSAND DOLLARS. I don’t even have any “real world corollary” comparisons for that kind of money, but it’s more than most Americans earn in a year.
The take-away message here is in two parts. As I mentioned earlier, we consumers are now armed with information we never had access to before, and that can only accrue to our benefit, especially for the uninsured among us. Even in emergency situations, having done this research you could know which hospital in your area typically charges less and go there. So that’s the small win. The bigger, longer-term triumph for consumers is that the secret’s out. There is no rhyme or reason to these hospital charges, and the fact that Medicare payments are so much lower, much more consistent from one hospital to another, and (get ready for the big finish) that hospitals still profit at Medicare rates will empower consumer advocacy groups to fight for greater transparency, upfront billing estimates, and lower costs for private patients. It won’t be quick, and it will be a tough fight, but it will happen.
Now if somebody could just turn all that data into a smart phone app.
For more information about out-of-control health care costs, please read Stephen Brill’s fantastic article, “Bitter Pill,” published this year in Time. You can also see his interview with Jon Stewart here.
Written by Cheasty Anderson, Center for Public Policy Priorities
You, the community of supporters of health care for every Texan, have done amazing work for 1.5 million uninsured Texans. You called and emailed, rallied and wrote letters. Your efforts led to a solid majority of House lawmakers registering support for the health care solution bill this week.
Unfortunately, though, one of our best opportunities to get this done was taken away. HB 3791, the bill by Rep. John Zerwas that would expand health care coverage to low-income Texans, will not make it to the House floor for a vote.
There are a lot of ways for a bill to die, but this one met a particularly unsatisfying end without an up-or-down vote when a group of powerful leaders stepped in to make sure the bill never appeared before the House chamber.
We will continue to work on a way to get these Texans covered and will report back to you soon. In the meantime, to voice your discontent to those few who killed this bill, contact the governor and the Speaker of the House, and members of the Texas Calendars Committee.
Say: Texas still needs a health care solution so over 1 million fellow Texans can have coverage!
Governor Perry: (888) 503-1874
Speaker Straus: (512) 463-1000
Calendars Committee Contact information:
Chair: Rep. Todd Hunter
Capitol Phone: (512) 463-0672
District Phone: (361) 949-4603
Email Address: todd.hunter@house.state.tx.us
Vice Chair: Rep. Eddie Lucio III
Capitol Phone: (512) 463-0606
District Phone: (956) 365-4458
Email Address: eddie.lucio_iii@house.state.tx.us
Rep. Roberto R. Alonzo
Capitol Phone: (512) 463-0408
District Phone: (214) 942-7104
Email Address: roberto.alonzo@house.state.tx.us
Rep. Carol Alvarado
Capitol Phone: (512) 463-0732
District Phone:(713) 649-6563
Email Address: carol.alvarado@house.state.tx.us
Rep. Dan Branch
Capitol Phone: (512) 463-0367
District Phone: (214) 745-5768
Email Address: dan.branch@house.state.tx.us
Rep. Angie Chen Button
Capitol Phone: (512) 463-0486
District Phone: (972) 234-8980
Email Address: angie.button@house.state.tx.us
Rep. Byron Cook
Capitol Phone: (512) 463-0730
District Phone: (512) 463-0730
Email Address: byron.cook@house.state.tx.us
Rep. Myra Crownover
Capitol Phone: (512) 463-0582
District Phone: (940) 321-0013
Email Address: myra.crownover@house.state.tx.us
Rep. Sarah Davis
Capitol Phone: (512) 463-0389
District Phone: (713) 521-4474
Email Address: sarah.davis@house.state.tx.us
Rep. Craig Eiland
Capitol Phone: (512) 463-0502
District Phone: (800) 345-2630
Email Address: craig.eiland@house.state.tx.us
Rep. John Frullo
Capitol Phone: (512) 463- 0676
District Phone: (806) 763-2366
Email Address:john.frullo@house.state.tx.us
Rep. Charlie Geren
Capitol Phone: (512) 463-0610
District Phone: (817) 738-8333
Email Address: charlie.geren@house.state.tx.us
Rep. Helen Giddings
Capitol Phone: (512) 463-0953
District Phone: (972) 224-6795
Email Address: helen.giddings@house.state.tx.us
Rep. John Kuempel
Capitol Phone: (512) 463-0602
District Phone: (830) 379-8732
Email Address:john.kuempel@house.state.tx.us
Rep. Doug Miller
Capitol Phone: (512) 463-0325
District Phone: (830) 625-1313
Email Address: doug.miller@house.state.tx.us
Written by: Mimi Garcia, Engage Texas
Unless our state takes action soon, come Jan. 1, 2014, Texas adults just below the poverty line, such as parents in a family of 4 living on $23,000 a year, will have no access to affordable health care under the Affordable Care Act. But their neighbors with a family of 4 living on $29,000 a year—just above poverty—would qualify for sliding-scale premium assistance and reduced out-of-pocket costs in the new health insurance marketplace.
While our leadership has been steadfast in their refusal to accept the opportunity to cover this group of Texans, our legislators had been relatively silent on the issue, minus a few press conferences. But for the first time during the 2013 legislative session, a committee of lawmakers met last week to discuss Medicaid Expansion, which is estimated to cover an estimated 1.1 million uninsured low-income parents and other adults in 2014.
Two very different bills were heard in last week’s hearing–HB 3376 by House Appropriations Committee vice chairman Rep. Sylvester Turner, and HB 3791 by Rep. John Zerwas, who serves as the chairman of the HAC subcommittee on health and human services. CPPP joined dozens of organizations and individual Texas family consumers in testifying on both bills.
CPPP supported Rep. Turner’s bill, which is a straightforward directive to implement the coverage for our poorest uninsured adults. We shared with legislators Census data showing Texas is home to more than 800,000 uninsured U.S. citizen workers with incomes below the ACA Medicaid threshold (138 percent of the federal poverty income limit). Those uninsured Texas workers are highly concentrated in the retail, food service/hotel, health care, and construction sectors. Our testimony also showed the wide range of jobs in Texas that have typical wages that would qualify a worker for the ACA’s Medicaid coverage, either as a childless adult or as a parent.
We testified in a neutral position on Rep. Zerwas’ bill because it mixes in one bill proposals we strongly support with ideas we fundamentally oppose. On the plus side, Rep. Zerwas’ bill could provide the framework for an Arkansas-style conservative compromise, which CPPP supports. However, the bill also calls for Texas to ask Congress for a Medicaid block grant, which we oppose, and includes a “Plan C” fall-back proposal to cover only about 30,000 of the estimated 1.1 million Texans. Because Arkansas lawmakers and federal Medicaid officials have now succeeded in reaching a deal to ensure the poorest adults are not left out of coverage in 2014, there is just no excuse for Texas not to reach the same goal and have care choices available for all in January 2014.
To get involved and stay informed about advocacy on the ACA Medicaid coverage opportunity—and general work to move Texas forward to cover the uninsured—sign our CPPP pledge here and share it with your family and friends. You can also sign up for emails from the Texas Well and Healthy campaign. If your organization wants to take a stand, check out the Cover Texas Now Coalition, a partner in that campaign.
Watch testimony from more members of the Texas Well and Healthy campaign at last week’s hearing.
Written by Anne Dunkelburg, Center for Public Policy Priorities. Cross-posted from the Better Texas Blog
Dear Cheasty,
I’m confused about the contraception regulation controversy that exploded in the news last week. I was under the impression that women already have access to birth control through their insurers. Is anything going to change with the compromise they reached on Friday?
Thanks,
Confused about Contraception
Dear Confused,
Creative Commons License photo credit: brains the head
Well, the air is still clearing, and even health policy experts still have some unanswered questions, but I can at least clarify the basic facts and circumstances for you. Let’s start by addressing your first point.
You are mostly correct in your belief that women already are guaranteed access to contraception coverage through their insurer. Just like the Obamacare mandate, for a number of years now the state of Texas has had a law in place that requires any insurance plan that offers prescription drug coverage to also cover contraception. That includes all FDA-approved methods, from the birth control pill to diaphragms, to IUDs. (Not condoms, which are sold over the counter, but you get my drift.) Texas is one of 28 states that have such regulations, but even in states without the laws, this was fairly standard practice. The innovation here is that Obamacare promises women access to contraception with no additional co-pay – in other words, free.
But what was the big deal? Hasn’t this “no co-pay contraception” part of Obamacare been in the news for a while? Why, all of the sudden, were Catholic bishops on tv and radio complaining about government interference in their right to religious freedom?
In short, that’s a great question. First of all, the Obama administration did not, as it might appear from the dust-up, just release a regulation solely about contraception coverage. What we’re talking about here are the ACA’s regulations about preventive care. Preventive care includes everything from annual exams to mammograms, blood work, colonoscopies, and yes, contraception.
Anybody who is paying attention has known about these regulations for months. But early last week, The Department of Health and Human Services released their final version of the regulations, and the Catholic bishops were ready for battle.
The original (pre-kerfuffle) regulations contained an exception for religious organizations. So if an organization’s primary purpose is the practice of religion (i.e., a church or diocese), then it doesn’t have to cover contraception through its insurance plan. However, if an organization is affiliated with a religion, but its primary purpose is not the practice of religion, (i.e., Seton Hospital or charities), then those institutions were not exempt.
The Catholic bishops were furious because, in essence, they felt the regulation was forcing Catholics to condone and pay for something that violated their religious beliefs. In an election year where conservatives seem to be grasping at straws, this generated a lot of political momentum.
Friday’s compromise quelled the hubbub by retaining the original exemption for churches, and by setting up a system that will work as follows. If Jane Doe works for XYZ Catholic University and XYZ doesn’t cover contraception, Jane Doe will call XYZ’s insurance company and say, “Hey insurance company, I need coverage for contraception.” The insurance company will then adjust Jane Doe’s policy to cover contraception. XYZ’s insurance plan will pay for it, but the cost will not come out of the plan’s premiums. This way, the employer need not know, nor must they pay.
Wait a second, you say. The insurance company will just eat the cost of contraception?
Essentially, yes. Obama wagered that insurance companies would be okay with this deal because it’s cost effective for them (birth control is way cheaper than an unintended pregnancy), and pretty much, he was right. They’ve issued a statement belly-aching about “setting a bad precedent,” but so far, so good. Churches and diocese and the like will still have the exemption they started with, but all the rest of us will have access to contraception at no additional co-pay, as originally promised in the law.
Disaster averted, it seems, for the time being. While the U.S. Bishops are still not satisfied, it appears most catholic voters support the policy.
Well, Confused about Contraception, I hope this helped clarify things for you about contraception. In short, you can rest easy. No matter where you work, or what your employer’s position on birth control is (unless you work for a Catholic church), your guaranteed access to contraception coverage is secure. It took some fancy footwork, but by Friday evening all seemed to have calmed down. What a roller coaster!
To a well and healthy Texas,
Cheasty Anderson
Center for Public Policy Priorities
