Texas Slow on Health Care Reforms

February 16, 2012
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Texas is almost alone among the nation’s largest states in failing to start work on a key piece of the Affordable Care Act, as legislators and state agencies follow Gov. Rick Perry’s dictum to delay action until after a Supreme Court ruling and the November election.

“Politics superseded good policy,” state Rep. Garnet Coleman, D-Houston, said of the inaction on creating an exchange to help small businesses and individuals buy health insurance.

Texas is one of nine states – other than Florida, the others are mostly small, with relatively few uninsured residents – identified by the Kaiser Family Foundation as having made “no significant progress” toward establishing an exchange. A Perry spokeswoman said there are no plans to change that.

“(Perry) feels the health care bill is unconstitutional and misguided,” spokeswoman Lucy Nashed said. “There are no plans to implement an exchange.”

But analysts say the delay makes it more likely the state will miss a Jan. 1, 2013, deadline for proving a state exchange is on track. If it’s not, the federal government will impose its own exchange.

People shopping for insurance through the exchanges may not notice the distinction – those with incomes up to about $88,000 for a family of four would qualify for subsidies in a federal exchange, just as they would in a state-run pool.

But it’s likely to add fuel to recent anti-federal regulation fervor. A 2011 survey by Texas A&M University’s Public Policy Research Institute found 63 percent of Texans preferred a state exchange to a federal operation. Almost 40 percent felt the state should not set up an exchange.

“The risk is that the federal exchange may not look exactly like the state exchange would,” said Jennifer Tolbert, director of state health reform for the Kaiser Family Foundation. “If you wait for some of these critical milestones (such as the Supreme Court ruling), states may not have enough time to get an exchange up and running.”

Most provisions of the law begin in 2014, and the exchanges are central to finding affordable health insurance and qualifying for subsidies.

High national rate

People with incomes up to 133 percent of the federal poverty level – about $14,400 for a single person – will be covered by an expansion of Medicaid, the federal-state program for low-income residents. It now covers mainly children, the disabled and low-income elderly people.

The exchanges are aimed at most other uninsured residents. At 24.6 percent of the population, Texas has the highest rate in the nation.

Opponents see two ways to overturn the law.

The Supreme Court will hear arguments next month and is expected to rule this summer on whether the mandate requiring health insurance is constitutional. It also must decide whether the rest of the law can be implemented without a mandate. The presidential election presents another chance; the Republicans vow to repeal it.

State Rep. John Zerwas, an anesthesiologist and Richmond Republican, unsuccessfully pushed a bill to create an exchange last year. “It was the desire of the governor to take a wait-and-see position, in light of the fact that it was being challenged (in court), and in consideration to what might happen in November,” Zerwas said.

He and other officials said Perry could create an exchange by executive order;Nashed said Perry has no plans to do so.

Zerwas said he believes an exchange could help the uninsured, especially those who own or work for a small business.

Tainted by Obamacare

“The problem with an exchange is, it got synonymous with Obamacare and it was tainted,” he said.

According to the Kaiser Family Foundation, 13 states and the District of Columbia have established exchanges. Arkansas and Louisiana will use a federal exchange or work with the federal government. Work is ongoing in most other states.

Texas is farther along in preparing for the Medicaid expansion, thanks to a waiver granted by the federal government late last year that could provide as much as $29 billion over five years to expand and improve care.

Coleman said that money also could be used to train more health care providers, including primary care physicians and nurse practitioners.

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16 Responses to Texas Slow on Health Care Reforms

  1. Ryan on March 7, 2012 at 3:02 pm

    After a week-long delay, the House is expected to vote today on a bill that lays the foundation for the state’s health reform plans.

    Senate Bill 1580 contains the guidelines for creating Oregon’s coordinated care organizations. The groups are a critical piece of the overall heath care transformation that Gov. John Kitzhaber is pushing hard for.

    Under the plan, the organizations will bring together hospitals, clinics and other providers to better coordinate the care of the 600,000 people on the on the Oregon Health Plan.

    In theory, more tightly coordinated care will mean earlier and less expensive treatments, lowering the overall cost of health care.

    The bill was held up — along with other reforms — as House Republicans tried to advance their jobs agenda. Ultimately, they had to allow the bill to proceed in order to balance the budget.

    The Senate passed the health care legislation on a bipartisan vote of 18 to 12. The legislation will need support from both Democrats and Republicans in the House as well, where the parties are split evenly.

    As for the other reforms, which include changes to the state’s K-12 education system, they’re still being held up. The deadline for bills to move is this week; lawmakers are expected to end their short, one-month session on Wednesday.

    • Mariela on April 23, 2012 at 4:08 am

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  2. Allen on March 22, 2012 at 11:48 am

    The Affordable Care Act: What happens without individual mandate? “When the U.S. Supreme Court hears oral arguments next week about the constitutionality of the 2010 health care reform law, the most controversial element the justices will consider is the imposition of a financial penalty on people who decline to buy insurance,” write Carter Price and Christine Eibner. (USA Today)

    “This week marks two years since of the passage of the Patient Protection and Affordable Care Act, and if the Obama administration has chosen to all but ignore the second anniversary of Obamacare, the rest of us should pause and reflect on just what a monumental failure of policy the health-care-reform law has been…After all, when health-care reform was passed, we were promised that it would do three things: 1) provide health-insurance coverage for all Americans; 2) reduce insurance costs for individuals, businesses, and government; and 3) increase the quality of health care and the value received for each dollar of health-care spending…Two years in, we can see that none of these things is true,” writes Cato’s Michael Tanner. (National Review)

    Room for Debate asks: If redeployments were reduced, would the United States be forced to reconsider staying in Afghanistan? Could a draft spread the burden of combat and its reality to more Americans?

  3. THANH on March 23, 2012 at 12:50 pm

    A program created to help insurance-seekers in Texas cut through the complexities of federal health care reforms is shutting down in April, just 15 months after it opened its call center and years before the law goes into full effect. Officials with the Texas Department of Insurance say they plan to help fill the gap, but it is unclear whether they can handle what some health experts call a beast of a policy change: millions of new patients will be required to acquire health insurance, and those first-time policy holders will need help understanding their rights and benefits.

    When President Obama signed the Patient Protection and Affordable Care Act in 2010, a consumer education program was also created. That September, the federal government awarded the Texas Department of Insurance a $2.8 million grant to start the Consumer Health Assistance Program.

    As of January, the department reported, the program had answered 8,900 calls and resolved nearly 5,600 cases statewide. A staff of nine employees had dispersed multilingual public service announcements, given field presentations, begun a Web site and staffed a hot line.

    State officials say they were allowed to use unspent money to keep those employees on through April 14. But federal financing was not renewed, and unlike some other states, Texas is not seeking alternative means to maintain its program.

    Medical officials who are aware of the unit’s work lament the timing of its closure, as the Affordable Care Act’s rules will not be completely in place until 2018.

    In the meantime, health providers are anticipating a nightmare situation. Nearly a quarter of Texas’ population is estimated to be uninsured. Unless the United States Supreme Court dismantles parts or all of the law, those people will be required to sign up for benefits beginning in 2014.

    “There will be lots of people who’ve had no experience with insurance before who will need to have a lot of guidance,” said Regina Rogoff, the chief executive of People’s Community Clinic in Austin, a safety net provider. “They’re driving blind.”

    Louis J. Goodman, the chief executive of the Texas Medical Association, said doctors were as perplexed as consumers. The federal law is wide in scope, and the association has poured resources into helping practitioners understand the rules and deadlines.

    “We’ve worked on the doctors’ side as much as we can,” Mr. Goodman said, but more consumer education is “absolutely necessary.”

    In the field, he said, overhead costs at clinics could rise because patients increasingly rely on nonmedical staff in their doctor’s office to explain benefits.

    Processing claims can be tedious. The medical association’s Hassle Factor Log, a last resort for doctors trying to resolve claims issues, recovered a record $1.6 million last year for 300 doctors who would have otherwise gone unpaid for their services.

    Genevieve Davis, the medical association’s payment advocacy director, said she regularly spoke with doctors who complain of spending less time with patients and more time mired in paperwork. And when insurers or employers refuse to cover a service, patients blame their doctors.

    “Trying to get patients to understand that takes away from being able to focus on practicing medicine,” Ms. Davis said.

    Health providers say that what separates the assistance program from other insurance resources is that it arms consumers with information on the new health care laws before they walk into a doctor’s office.

    But John Greeley, a Texas Department of Insurance spokesman, said the tools developed by the program would carry over to a different section in the agency that covers general consumer concerns. He said the department would maintain resources to help people gain access to insurance.

    • Vlad on April 23, 2012 at 10:03 pm

      I have had Medicare since about 1999/2000. Medicare pays 80% of what they consider is rebalnsaoe cost. Believe me that isn’t much. For example: Suppose I have a bill of $1000. Medicare determines that rebalnsaoe cost is $400; they pay 80% of that. And even though I have a private insurance which supplements Medicare, Medicare still sets the rebalnsaoe cost which means in my example that my private insurance will pay 20% of $400. Whoever performed the service (doctor, hospital, whoever) is out $600. When my doctor retired about five years ago I called four places which wouldn’t take me on as a patient because I have Medicare.Even though private insurance companies are in it for profit, because they charge much higher premiums than the government does for Medicare, they can afford to pay more out because of those higher premiums. It’s truly a case of you getting what you pay for.Because I don’t work, Medicare is primary and my Blue Cross/Blue Shield is secondary so Medicare sets the reimbursement rate. Secondary insurers REQUIRE that a person be entitled to Medicare if they are eligible to cut down on the costs of the secondary insurance.If I didn’t have Medicare and I wasn’t eligible for it, my Blue Cross/Blue Shield would be reimbursing my doctors and hospitals at a much higher rate than what Medicare does.Now why doesn’t everyone in the United States have Medicare? The insurance companies wouldn’t stand for it and the medical community would be backing them up. Our representatives and senators wouldn’t dare extend Medicare to all Americans!Frankly I think Medicare should be extended to everyone with increased premium rates and higher payments to providers of services and it could be administered through the private companies. But who am I?

    • Vinicius on April 25, 2012 at 2:28 am

      The privately inuserd pay less, get faster service and have a broader range of choices. Why do you hate your grandparents so much that you demand they be deprived of that?Most old people ALSO buy private insurance because Medicare sucks so badly. Those who were NEVER ENROLLED in Medicare (a vanishing group, but there are still plenty left) are gleeful they are not among the unfortunate souls who ARE on Medicare. Why do you hate your family so much you demand they be locked into the more expensive, delay-intensive, choice-limiting system you’re pushing?

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    • Brancaleone on April 23, 2012 at 5:13 pm

      The simple aewnsr is Freedom of Choice. First of all you must understand that there is a great deal of fraud involved with Government run Medicare. Scam artists regularly milk Medicare out of BILLIONS of dollars. Private insurance companies are out to make a profit and therefore investigate the claims much better.It should also be noted that Medicare has approx $1100 deductible each year for hospital coverage and $162 per year for Outpatient deductible. After that the member is responsible for 20% co-insurance. Add to that the fact that there is no routine dental coverage, no routine vision coverage and no prescription drug coverage.Private plans are requires by law to follow federal guidelines that either meet or exceed original Medicare coverage. Most of them far exceed these guidelines. Many plans offer dental, vision part d coverage and even health and wellness, transportation and/or fitness classes (health club memberships)The private insurance companies receive a set monthly per member fee as determined by our federal government and not a percentage. If this amount is less than the cost of care for a certain individual the insurance company is liable to pay with no additional reimbursement.Insurance is actually defined as pure-risk but closely monitored by underwriters. They have an idea of what health care costs but there are so many variables that there is no clear cut number that can actually be obtained. It is all based upon estimates.Private insurance competes for more business and thus offers additional benefits and lower co-payments in order to entice more people to join their plan. We can all keep blaming the big bad insurance companies or give the reigns over to the government who will dictate what we deserve and what they feel we need. What a novel idea. Our government thinks they are more intelligent than we are and has decided that we are too stupid to decide what is best for ourselves.With all of that being said. Everyone still has a choice to have original Medicare or choose a private plan. Medicare advantage is growing at an incredible pace and there are over 11 million seniors and growing who have made this choice. I will side with Seniors on this one. They know what works because they use these programs every day. Not everyone will ever have the same opinion but the overwhelming majority of seniors will tell you quit screwing with my Medicare They like what they have

    • Cemre on April 25, 2012 at 12:51 am

      That was debated in Congress in 2009 and rjteceed Medicare for those from 55 to 65. It would have cost too much for the U.S.A. to subsidize more people when they are not getting enough revenue to pay for current recipients. Medicare does subsidize private health care providers and insurance companies that accept Medicare patients. It is not socialism if the Medicare enrollees pay for it. By monthly Part B premiums that range from $96.50 to $600 some of whom did not work and reside in the U.S. long enough or had over $85K annual income, or are also covered by employer health plans. Medicare patients also pay 20%+ of all their medical bills, unliked Medicaid where the government foots the entire bill or they purchase another policy called Medigap or supplemental insurance for $125 to $150 a month additional. Even though Medicaid is supposed to be shared funding with the states, the states have been using stimulus money since 2009 to pay their share. That money ends in July.Dont forget that millions of children and adults who are disabled and handicapped also have Medicare.

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    • Mayra on April 23, 2012 at 11:14 am

      I used admiral’s young pesorn policy when I insured my 1st car-it has a higher excess for under 25 s and you aren’t insured to drive any other cars 3rd party as most policies allow and this made it much cheaper for me. They also do a 10 month bonus accelerator which allows you to get 1 yrs no claims bonus in 10months making your insurance cheaper after that time.Having another driver on your policy can help. I am now 25 and even having my 22 yr old BF added to my policy made it cheaper!I have seen companies like Norwich Union advertising that named drivers can get their own no claims bonus which I think is really good for younger drivers, it should make your insurance cheaper as you could put your mum as the main driver and you as a named driver but you can still get a no claims bonus which will really help as you get older.There are other factors which make insurance cheaper that may be out of your control: engine size, postcode, where the car is parked, immobiliser etc, miles travelled, if you have a pass plus certificate, value of the car etcGood luck!

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