“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 surveys by the Data Resource Center for Child & Adolescent Health from 2003, 2007 and 2011 show progress for Texas kids “on several health-status measures . . . and a significant uptick in mental-health screening and diagnosis for children in recent years.”
What can cause improvements like that? No doubt, a lot is 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.
What’s more, as more kids got covered, more families reported good news about their children’s health. Check out the trends.
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
We’ve developed a new resource that explains why it is so important for Texas to come up with a health care solution before the 2013 legislative session ends later this month. For 1.5 million Texans, health coverage is within reach. Now, it’s up to all of us to help to make sure it happens.
HB 3791 by Rep. John Zerwas is not Medicaid expansion, but it would use newly available state and federal funds to provide private health insurance to low-income adults. Our infographic illustrates a health care solution could provide needed coverage to hard-working Texans AND economically benefit the state as a whole.
This session our campaign has been so excited by the amount of people who have visited their elected officials, marched at rallies, shared their personal stories, and showed in various ways that they care about finding a health care solution for Texas.
- Myra Crownover – Denton, district 64
- Sarah Davis – Houston, district 134
- Todd Hunter – Corpus Christi, district 32
- Dan Branch – Dallas, district 108
- Angie Chen Button – Garland/Dallas, district 112
- Byron Cook – Corsicana, district 8
- John Frullo – Lubbock, district 84
- Charlie Geren – Fort Worth, district 99
- John Keumpel – Seguin, district 44
- Doug Miller – New Braunfels, district 7
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.
Written by Anne Dunkelburg, Center for Public Policy Priorities. Cross-posted from the Better Texas Blog
It has been an exciting week for Medicaid expansion at the Texas Capitol! On Tuesday, signatures from 37,000 Texans who have added their names to petitions in favor of Medicaid and Medicaid expansion were shared with members of the Texas House of Representatives. It’s the latest evidence—including support from chambers of commerce, local governments, health provider groups and majorities of Texans polled—that there’s a groundswell of support for accepting federal dollars to extend coverage to nearly 1.5 million low-income Texans next year. Legislation that would extend Medicaid or advance a “Texas solution” received hearings on the same day in a House Appropriations subcommittee. Below are some photos from a press conference highlighting the petitions:
The very next day, NETWORK’s Nuns on the Bus held a rally and press conference at the Capitol in support of expanding health coverage to over a million Texans. Afterward, they visited their legislators’ offices to make sure their message was heard loud and clear: Medicaid expansion is the right thing to do. Below are some photos from the rally and press conference:
After seeing all these photos of activists, it’s hard not to be interested in getting involved! Visit our Take Action webpage, and learn how you too can advocate for a well and healthy Texas.
Written by: Liz Moskowitz, Texans Care for Children
Right now, Texas is being offered an incredible opportunity to cover 1.5 million residents who are currently uninsured. In the state with the highest uninsured rate in America, accepting federal funds to expand Medicaid to those who live up to 133% of the federal poverty level makes sense fiscally and morally. Not only would a substantial amount of Texans have access to preventive and affordable health care, but it would create an economic windfall for Texas, including creating jobs. It would also reduce the burden on hospitals and county taxes to cover uncompensated care costs, which in turn could relieve increasing medical costs and insurance premiums.
With the all of these incredible and important benefits, supporters are coming out all over the state to stand up for the Medicaid solution. These include not just health care organizations, but local governments, chambers of commerce, and many others. In order to visualize this widespread and ever-growing support, Texas Well and Healthy has created an interactive Google map, available here.
It is important to let know our state legislators that we as individuals, our organizations, and local leaders are onboard with Medicaid expansion. Please sign our petition, urging lawmakers to accept these federal funds to extend Medicaid and bring health care and jobs to Texas. We have also developed a toolkit, “Getting Leaders to Call Upon Leaders,” to guide you through the process of reaching out to your local government to sign resolutions and letters of support for the Medicaid solution.
Patricia Gonzales’ story is not an uncommon one in Texas. She is a mother of three from Pasadena, Texas. Two of her children have mental health needs that require proper ongoing treatment. Her 22 year old daughter has ADHD and has been on medication since she was diagnosed at the age of 6. With proper medication she performed well in school and was able to participate in sports. Once she turned 19, she lost access to Medicaid benefits that kept her functional in her school and community. Due to the lack of medically necessary treatment she was not able to continue into higher education. The family tried working with safety net clinics in her area to continue her medication, but they only offered limited access to generic brands that weren’t as effective.
One in 5 children in the United States experiences a mental health concern and many develop a serious mental illness during their late adolescence. A disruption of medically necessary services occurs for thousands of Texas’ transition age youth (ages 14-24) each year as they age out of Medicaid. Currently, Texas’ Medicaid program serves only a small proportion of parents and aged and disabled adults. In order to qualify a transition age youth would have to have a disabling serious mental illness.
This could all change if the state decides to accept new federal dollars set aside to expand Medicaid eligibility for all low income individuals. This way, children who currently benefit from mental health services are able to continue receiving therapies and medication as a young adult until they obtain the financial stability to purchase health insurance on their own.
Patricia’s youngest son is one of these children. He is able to thrive in school and band with ADHD and an anxiety disorder. He constantly sets challenging goals for himself and hopes to attend college three years from now. But, Patricia is concerned he will not have access to affordable and comprehensive health insurance at a point in his life in which he will be going through many complex transitions such as continuing onto college, finding employment and living on his own. Expanding Medicaid will provide Patricia’s son with an assurance that his aspirations will not be disrupted by his mental health needs.
Written by Clayton Travis, Texans Care for Children
Over 66,000 uninsured Texas veterans and their spouses could gain health care coverage if the state moves forward with Medicaid expansion under the Affordable Care Act.
In Texas, over 200,000 veterans and their spouses are uninsured – the highest of any state in the nation.
Under the ACA, states have the opportunity to extend Medicaid coverage to U.S. citizen adults with incomes up to 138% of the federal poverty income level (FPL), roughly $32,000 annually for a family of four. In Texas, this expansion would extend Medicaid coverage to many low-income parents, caretakers, and childless adults who do not currently qualify—including a substantial number of veterans and their spouses.
According to a new report published by the Urban Institute, an estimated 48,900 uninsured Texas veterans (38% of all uninsured Texas vets) will be eligible for Medicaid coverage if Texas chooses to participate in the expansion.
Moreover, three-quarters of these veterans—over 36,000—have incomes below 100% of FPL and would not be eligible for subsidies in the exchange. The same is true for the 11,500 uninsured spouses of veterans whose incomes also fall below 100% of FPL.
Implementation of Medicaid expansion in Texas will be critical to ensuring that our lowest-income veterans and their spouses have access to affordable health care.
In total, Medicaid expansion would extend eligibility to approximately one third of all uninsured Texas veterans and spouses, over 66,000 people.
Nineteen bills supporting Medicaid expansion for low-income adults have been filed during the 2013 legislative session, and budget directions for expansion are included in both the House and Senate appropriations bills.
Texas needs to move forward with Medicaid expansion this session in order to improve the health and well-being of those men and women – and their family members – who have put their own health and lives at risk serving in the armed forces.
All calculations are derived from data provided by the Urban Institute.
For more information, please see:
- The most recent Urban Institute report, Uninsured Veterans and Family Members: State and National Estimates of Expanded Medicaid Eligibility Under the ACA
- CPPP’s policy fact sheet, Medicaid Expansion Would Benefit Thousands of Texas Veterans
Written by: Megan Randall, Center for Public Policy Priorities
Three of four people who will be eligible for coverage through the new online health insurance marketplace opening in October say they want in-person assistance to help them learn about and enroll in coverage. Navigators—in-person assistance providers who will help consumers and small employers enrolling in the marketplace—are one of the ways the Affordable Care Act addresses this demand. Navigators will also be able to tailor outreach efforts to marketplace enrollees who, compared to people who are insured today, are more likely to be lower income, less educated, more racially and ethnically diverse, and more likely to speak a language other than English.
Today, the U.S. Department of Health and Human Services released its Funding Opportunity Announcement (FOA) for ACA Navigators in federally facilitated or state partnership exchanges. U.S. HHS encourages all applicants to submit a letter of intent (optional) by May 1, 2013 to firstname.lastname@example.org. Final applications are due by 1 p.m. (EDT) on June 7, 2013 through grants.gov. Awards will cover a 12-month period of performance following the anticipated August 15, 2013 award date.
The total $54 million award will be distributed among the 34 eligible states according to a formula that directs more funding to states with larger uninsured populations, with $8,151,185 earmarked for Texas. At least two types of eligible entities will receive awards in each state, including at least one community and consumer-focused nonprofit.
You can find the full grant announcement on www.grants.gov by searching for CFDA 93.750.
Applicants must have an Employer Identification Number/Taxpayer Identification Number (EIN/TIN) as well as a Dun and Bradstreet Data Universal Numbering System (DUNS) number, and must register for the System for Award Management (SAM) database in order to apply. Completing these steps can take up to four weeks. More information can be found at the grants.gov page, “Get Registered.”
U.S. HHS will host two technical assistance calls in upcoming weeks for organizations interested in applying:
First call: Thursday, April 11, 2013 from 3:30 to 5:00 p.m. EDT
Toll-free teleconference phone number: 877-267-1577; ID: 5119
Second call: Friday, April 19, 2013 from 3:30 to 5:00 p.m. EDT
Toll-free teleconference phone number: 877-267-1577; ID: 2917
U.S. HHS also released a rule last week that proposes the training, conflict of interest, and privacy/security standards that will apply to Navigators. Comments on the rule are due by 5 p.m. on May 6, 2013.
Written by: Stacey Pogue, Center for Public Policy Priorities