Health Care: Theatrics in Washington, Angst in Texas (Updated)
(Update Below)
On the same day that the GOP stages its 33rd theatrics to repeal the health care reform law without offering an alternative, Rick Perry’s hometown newspaper, the Austin American-Statesman, paints a gloomy picture of how badly Perry’s decision to reject an expansion of Medicaid will sting health care providers and taxpayers.
The Statesman summarizes:
Hospitals and uninsured residents are likely to be hit the hardest if Gov. Rick Perry’s rejection of a massive expansion of Medicaid stands, leaders of health care organizations said.
In addition, clinics that care for the uninsured will be strained further, while taxpayers and patients with health insurance could pay more for health care, they said.
The Statesman explains, “Uninsured people will continue to seek care at hospitals, often in emergency rooms, where care is most expensive, and in clinics that serve uninsured people and those on Medicaid, a state-federal program that covers the poor, disabled and most nursing home residents.”
Patricia Young Brown, president and CEO of Central Health, the Travis County hospital district, says, “What that means is: Local communities, it’s your problem to solve. You can pay a dollar now to keep someone as healthy as possible … or you’re going to pay for it later when they’re sick,” according to the Statesman.
Other local and regional Texas health officials and organizations, according to the Statesman:
Central Health officials estimated that a Medicaid expansion under the law would save Travis County’s public clinic system $7 million to $8 million a year, according to chief spokeswoman Christie Garbe.
Regina Rogoff, CEO of People’s Community Clinic in Austin, which also serves poor and uninsured patients, said expanding Medicaid could have earned her clinic up to $1 million, enabling it to serve more people. “It’s a huge lost opportunity,” said Rogoff, whose clinic has a $9 million budget.
Austin Travis County Integral Care, which provides mental health services to local residents, had expected 50,000 more Travis County patients to join Medicaid, CEO David Evans said. “That would have lessened the reliance on emergency rooms and the reliance on high-cost hospitalizations,” he said, noting that some with the highest ER use are people with mental illness.
Jesus Garza, president and interim CEO of the Seton Healthcare Family, the largest hospital system in Central Texas, noting that Central Texas’ population is booming and that an estimated 360,000 residents in Travis and 11 surrounding counties are uninsured, says:” When you have people accessing a system and they don’t pay, that drives up the cost of care …The citizens take a big hit.”
Some differ:
Rusty Rice, a trustee and past president of the Texas Association of Health Underwriters and a regional vice president for the National Association of Health Underwriters, said he agrees that a vast expansion of Medicaid could bankrupt states: “We think there are better ways to go about decreasing the number of uninsured.”
Some are hopeful:
Mark Clayton, a senior vice president at St. David’s HealthCare: “The Medicaid program is already inadequately funded; we are paid much less than what it costs to care for patients. This is a significant financial burden. We are confident that our state’s leaders recognize the importance of the Medicaid program and are certain that they are working to find an adequate source of funding.”
Somewhat in the middle, Texas Medical Association President Michael Speer, a Houston neonatologist, says that a solution is going to take compromise.
The Statesman points out that about 1 in 4 Texans — about 6 million residents statewide — lack health insurance:
That is the highest rate of uninsured people of any state. Texas, as a result, stood to gain a large share of federal dollars to expand Medicaid: an estimated $13 billion a year, starting in 2014. The federal government would have paid all of the expansion costs until 2017, when the state would gradually start sharing costs up to 10 percent by 2020.
In addition, a new federal government report developed by the Agency for Healthcare Research and Quality (AHRQ), one of 12 agencies within the Department of Health and Human Services gave Texas the poorest score in the nation in health care quality.
UPDATE:
Fully implementing the federal health care law and adding 2 million people to Medicaid would cost Texas $11 billion less than previously estimated, the state’s health and human services commissioner said Thursday, according to the Austin American-Statesman.
The Statesman:
[Texas health and human services commissioner] Tom Suehs said it would cost $15 billion to $16 billion over 10 years if Texas fully implemented the law. That’s 42 percent less than his initial estimate of $26 billion to $27 billion to expand Medicaid to include poor single adults and more children.
A study by the federal, nonpartisan Congressional Budget Office has estimated that the additional cost for Medicaid expansion is 2.8 percent more than what an individual state would normally spend on the program.
[::]
“This will get refined as we see the complexities of what we need to do,” the soon-to-retire health commissioner told legislators.
[::]
About 24 percent of Texans lack health insurance, Suehs said, the largest percentage of any state. A recent Gallup poll placed the number at 27 percent.
Suehs said expanding Medicaid would reduce the number of uninsured from nearly 5.9 million to 2.9 million. “Without Medicaid expansion, the uninsured would be back to 3.9 (million),” he said.
[::]
Texas has one of the most restrictive Medicaid programs in the country, offering coverage only to the disabled, children and some parents. Last year, state legislators underfunded Medicaid by $4.8 billion. Suehs told lawmakers he will be asking them to make up that shortfall when they meet again in January.
Nevertheless, Suehs agrees with Perry’s position that Medicaid should not be expanded. Suehs said the program needs to be improved before that happens, according to the Statesman.
Read more here.
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Wow, talk about cutting off your nose to spite your face. That is some seriously well thought out, principled, conservative thinking Gov Perry.
This from, of all places, Sidney, Australia:
THE Taliban have again rejected overtures for peace from the Afghan government, vowing to continue their violent insurgency across the country.
But at the same time, doubts appear to be emerging within the terrorist network over their capacity to win the war against the international forces currently in the country, and even over the foreign-funded Afghan Army that will be left behind after 2014
Read more: http://www.smh.com.au/world/taliban-reject-karzais-plea-for-peace-talks-20120711-21w7z.html#ixzz20LTPazyF
There are rumors/reports periodically about such talks (secrety and otherwise), sometimes even of contacts between the U.S. military and the Taliban.
Oops (I live in Texas), wrong thread. Sorry. Was supposed to be in the Defense Update one
DDW…I find the debate concerning Texas, Perry and medicaid expansion very interesting. I was controller at a North Carolina Health System and as part of our community benefit program that supported our tax exempt status, we provided 6 physicians for the sole purpose of accepting Medicaid patients. This was to provide addition health services, improve the health status of that group of patients and to reduce the number of ER visits because they could not find physicians that accepted NC Medicaid reimbursement. We knew going in we would lose money and we did. Right at $150,000 per physician practice.
Why. physician salary that was average for the specialty, office cost, insurance costs and nurse salaries per physician. And the average reimbursement per visit was less than what it takes for an average car repair.
Nice to know that a state like Texas has a Medicaid program with reimbursment rates that cover the costs including the doctor salaries. Seems like the current group of physicians should be willing to accept that Medicaid level of reimbursement and treat those patients since they would make the same as those covered by private insurance. Not all states have this level of reimbursement.
Why Perry is resisting under these conditions shows his mental lapses still exist today.
As I said the other day the hospitals would like to be paid for those emergency room visits and will take the Republican governors to the woodshed at some point. It’s all political bluster.
Suprisingly no one seems to mention any of the issues Perry had with the plan. There is supposed to be a State run exchange but the Feds would control almost every aspect of it anyway so any thought that it would be “State run” is largely an illusion and the Feds will do it anyway so ……. Then there is the adding of millions to the medicare rolls. Sure he is turning down what could be billions of dollars but he is also refusing to commit Texas to paying billions out of it’s own pocket also. He also states that he doesn’t believe the medicaid program is sustainable and that the extra burden will just make it worse. He doesn’t think that providing this coverage will have any effect but increase health care cost and is going to opt out. Now one can of course disagree but it’s not like there isn’t an arguable case here.
“Why Perry is resisting under these conditions shows his mental lapses still exist today.”
Pleasantly surprised that you see the Texas situation this way, now.
I had been under the impression that you agreed with Perry, especially since you provided a link to a CBPP report critical of the Medicaid aspects of ACA ( http://www.cbpp.org/cms/?fa=view&id=3521) which I still don’t understand. But here: (http://www.prnewswire.com/news-releases/statement-of-robert-greenstein-president-center-on-budget-and-policy-priorities-court-decision-will-allow-health-reform-to-bring-major-benefits-to-the-nation-especially-if-states-) CBPP is very supportive of ACA and the Medicaid aspects of ACA for those states that accept the Medicaid expansion.
I have some conservative friends from Texas who are visiting and for what it’s worth, they are rejoicing at Perry’s decision. The feeling is if other states offer health Insurance or medicaid to poor people and Texas does not, then those people will migrate to those other states and Texas will alleviate a big portion of the burden of providing health care, food stamps, welfare, education costs for poor schools etc etc.
I’d have to think about the validity of this premise but it did stop me short when they told me.
@jdledell
But those would be the minimum wage workers the Texas economy depends on.
Good point, Ron. Just like the so-called illegal aliens the Texas housing/construction industry , the landscaping industry, etc. depend on, but, yet, are demonized by the Texas GOP
RP, “Nice to know that a state like Texas has a Medicaid program with reimbursment rates that cover the costs including the doctor salaries. Seems like the current group of physicians should be willing to accept that Medicaid level of reimbursement and treat those patients since they would make the same as those covered by private insurance. Not all states have this level of reimbursement.”
I might be wrong here but I thought the article said that Medicare was underfunded. So sure, there might be published reimbursement rates, but if it’s underfunded and no one receives all their money, then no group of physicians would accept any of these patients.
So what it comes down to (again) is the perfect case for a tax increase…. Americans need and expect a certain level of service. That costs money. America can’t just keep cutting taxes and expect the same level of services. If conservatives don’t support taxes, then there needs to be a discussion about what will be cut. Which, for Republicans, means cutting social programs aimed at keeping a stable society and protecting vulnerable people.
DDW..My point in a previous post was not meant to support or criticize Perry, texas or any acion he was taking.
My point was looking at Texas and comparing to other states in the general area indicated that many had problems when the use of the quality indicators was used as a measure of healthcare in a state. Mnay had nothing to write home about.
My position on states accepting Medicaid money is based on the knowledge that almost every state in the union is reducing Medicaid reimbursement to physicians and doctors. If the physicians can not cover their costs, most will not accept those patients. Nor would any businessman provide services to a customer if they receive less money for the service than the cost of time and supplies they supplied.
Somehow in America we have come to the conclusion that everyone in business has a right to make money except doctors and hospitals. They are expected to provide services at or below cost and that is an unsustainable position to hold.
We also look at the bills and comment about how much that doctor charged. No one gives much thought that it also covers the receptionist salary, the nurses salary, office cost and malpractice cost that can be close to 6 figures.
The federal government will continue to reduce reimbursement, forcing more cost onto the states. There is no way the feds can continue for years to fund Medicaid and Medicare at its current level. When that happens, all the congress has to do is write legislation that funds medicaid at 75% and not 90% for the added covered lives and the states are then holding the bag.
Not until we have one payor system with all healthcare workers paid by the federal government so they do not worry about reimbursement will we have a system where everyone can receive equal care. No one will have Cadillac plan, no benefits through retirement programs, no federal programs, just everyone on a Medicare type system. And the same Medicare law that makes it a crime for a doctor or hospital to receive any payment over the deducible from a Medicare patient will also apply to this system. Whats good for the goose is good for the gander.
“Somehow in America we have come to the conclusion that everyone in business has a right to make money except doctors and hospitals.”
Pretty steep irony here considering the incredibly high costs of their services. The medical industry is the single biggest industry in the country. It dwarfs Oil. I’m not saying there aren’t doctors getting the shaft, but hospitals make money. The problem lies in the way “free market” forces have twisted the entire medical field. From the AMA, to HMO’s, to pharma companies, you name it. Its a mess, and its not because they aren’t charging enough.
If Medicaid is unsustainable, a dubious proposition at best, the reason is that we have way too many poor people. The way to solve that should be to stop manufacturing them. It is important to increase the level and quality of education. Stop basing the economy on increasing the level of income inequality and actually try to decrease income inequality. Stop using high levels of unemployment as a means to suppress wages and restore full employment as a primary goal of the economy.
Establish the principle that as long as unemployment and poverty are tools of our economic policies that the unemployed and poor aren’t responsible for their plight. That it is up to the winners of those policies to provide for the people who those policies disadvantage. Only then will there be the political will to change.
The cost of increasing payouts to the federal government is inflation. We can pay that cost, and did so for quite a number of years (1945-1982). Ask yourselves, is the situation now worse or better than then.
Thanks for explaining, RP
Its worse. Much much worse.
Perry’s decision represents the worst in what passes for republican thinking. The people who will be negatively effected the most by this are those with the least power to influence politicians. People like Perry seem to have nothing to lose by indugling their appetities for sociopathy, especially in a state like Texas where it has become so much the norm. Disgusting and irresponsible.