How Did Texas Get Into This Mess? The Medicaid Cuts edition

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In a case of no news being good news, there are no developments today in the ongoing story about the extreme cuts to Medicaid reimbursement rates for acute therapy. That’s because, as of Friday afternoon, State District Judge Sulak’s temporary injunction against the rate cuts went into effect.

Well, there was some news. Rep. Matt Krause became the first NE Tarrant County Tea Party-endorsed House member to write new HHSC executive commissioner Chris Traylor requesting that HHCS:

redouble its efforts to learn precisely how these cuts will affect the quality of care and access to care of the patients that utilize and need these services. This information is vital to guiding the HHSC as it proceeds on its path to follow through with the Legislature’s intent and maintaining the best interests of the Texans affected by these proposed cuts.

Could Rep. Jonathan Stickland’s plea to remember the kids be far behind?

Now that we’ve reached a moment of relative calm, it’s time to take a look at how Texas got into this mess in the first place.

Back on May 29th, the Texas House of Representatives voted to adopt the conference committee report (CCR) for HB1, the general appropriations bill that sets the budget for state government for the 2016-17 biennium. The CCR included HHSC Rider 50, a direction to HHSC how to contain Medicaid costs by adjusting the rate of Medicaid reimbursement for acute therapy. As Emily dePrang of Quorum Report wrote on August 19:

As proposed, the new rates would slash by 25 to 90 percent what the state pays providers of physical, occupational and speech therapy for poor children with severe disabilities. This would save the state $150 million on Medicaid spending over the next two years, satisfying a budget rider, but would also cause the state to lose $200 million in federal dollars, reducing total funding for the Medicaid Acute Care Therapy Program by more than half. Stakeholders say thousands of providers will be forced out of business, causing between 60,000 and 70,000 children to lose access to medically necessary care, particularly in rural areas.

In other words, a massive budget cut was made in a budget rider that was not in the version of the bill originally passed by the House. It was added by the conference committee as part of what seemed to be a protracted process to finalize Article II, the section of the budget that includes all health and human services spending.  (In April, The Center for Public Policy Priorities published a terrific comparison of the House and Senate versions of the budget which, you guessed it, highlighted the Senate’s proposed cuts to the Medicaid reimbursement for acute therapies as a major difference.)

What’s more, on May 29th, there was discussion on the House floor about this specific rider and the harm it could possibly cause Texas children who depend on Medicaid for therapy. After a passionate exchange with Rep. Sylvester Turner, the only Democratic House member on the HB1 conference committee, Rep. Dan Huberty asked House Appropriations Chairman John Otto, also a member of the conference committee, what could be done to prevent a young man in his district from harm due to these cuts.

Here’s the final exchange between Rep. Huberty and Chairman Otto:

Huberty: I’m not sure if there is anything you can do at this point, but…

Otto: We can certainly talk to the agency about the rider that’s in there. You’re talking about the cost containment?

Huberty: Yes.

Otto: And that can certainly, it was not intended to take anybody off services. It was intended to control cost increases.

Huberty: Is there something we can do Mr. Chairman?

Otto: We can communicate with the Agency.

Cue the letters and the press releases, the articles and the blog posts.

Another thing to note about May 29th are the 34 Democrats who voted against HB1. Statements from two groups of Democratic members were committed to the House Journal, condemning HB1 as it came out the conference committee and stating their reasons for voting against it. Interestingly, one letter describes highly unusual circumstances surrounding the final bill:

Passing a budget is the most significant action we take as legislators. It should be done with full vetting and transparency. Yet, the summary of the conference committee report for HBi1 was distributed to members mere hours before floor debate. Furthermore, limitations were imposed on members’ ability to ask questions of conferees, leaving only a few hours for consideration of a $209.4 billion budget [emphasis mine]

But while the circumstances may have been strange, let’s be perfectly clear: adding a cost containment rider to the appropriations bill is standard operating procedure. There is nothing unusual about Republican lawmakers doing everything in their power to cut Texas to the bone.

What’s not normal is Republicans making a big deal in public about their intentions to maintain access to care, to keep kids receiving therapy. They’ve made ill-conceived cuts before that have had to be worked out by HHSC but this time a lot of influential lawmakers have weighed in, including Sen. Jane Nelson, chairwoman of the Senate Finance Committee, asking the agency to put the brakes on a policy that they themselves conceived and voted for. It’s highly unusual for them to express this level of “concern.” The talk is that they know the feds are looking at what they’ve done and are not amused. It must be hard to maintain the proper level of contempt for government while actually acknowledging that some people severely disabled children need a functional government to help them survive.

It’s interesting to see who among the Republicans are missing in action and haven’t written Traylor. Now that Krause has weighed in, it’s possible we’ll see more Tea Partiers express concern. (Don’t expect remorse.) Tonight, the loudest silence is coming from the master of ceremonies himself, the Lege’s own professional talker. Given how much he likes the sound of his own voice, when Dan Patrick’s saying nothing, we’d all better be listening.

As for the 34 House Democrats who voted against the budget on May 29, well, they’re looking pretty good right now. Not sure what to make of the ones who voted for it. But that’s a story for another day.



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