Health Care: Theatrics in Washington, Angst in Texas (Updated)
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.”
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.
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.
[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.