With the State of Texas needing to find ways to trim billions of dollars to balance its budget, shifting pharmacy services from a fee-for-service system to a Medicaid managed care system in order to save money may seem like a good idea at first blush. A closer look at the proposed Medicaid managed care "carve-in" of pharmacy services, however, reveals that any such savings predicted from the program are elusive, manufactured, and fleeting, at best.
Currently, pharmacy services for Medicaid patients are delivered by community-based pharmacies who are reimbursed by the state through a fee for service structure. This simply means that the state reimburses a pharmacy a pre-determined rate to cover the cost of the product (drug) and the cost of doing business (paying the pharmacist). The administrative cost of this approach to the State is a mere 1% of total program outlays.
The Texas legislature is proposing that Medicaid pharmacy services be shifted to a restricted managed care system where "middlemen," known as Pharmacy Benefit Managers (PBMs), would set the rules for administering pharmacy services to Medicaid patients. It is asserted by proponents of this change that this move would save money, but such "savings" come only in the form of a premium tax on health insurance plans, which would in turn be passed on to all consumers of private insurance products in Texas.
This premium tax "benefit" to the State is nothing more than a tax and is dwarfed by the economic damage that a the resulting restriction in access to pharmacy services would impose on the State and its citizens.
On Friday evening just minutes before midnight the Democrats and Republicans in the U.S. Congress managed to cobble together a desperate last minute effort to agree on spending cuts in the budget in order to avoid a government shut down. The Tea Party wing of the GOP is apparently not very happy about the compromise at all, mostly because Tea Party Republicans seem to be incapable of understanding the basic tenets implicit in the responsibility ones assumes when one is elected into office. In other words the Tea Publicans did not get the message that Washington no longer does it is my way or the highway politics anymore. That went out with the W. Bush era after its Administration drove our nation into a financial hell hole.
Somehow Tea Publican members of Congress seem to think their legislative ideological and intrinsically reckless decisions have absolutely no impact on the American people at all.
Of course the GOP and its Tea Party people really don't care much about governing responsibly on behalf of the the people. Over the past few months we have learned that most are self serving cowards who serve an ideology that is both ludicrous and cruel.
It's unclear where the adults are, but they don't seem to be in Washington. Beyond the malice of the threat to shut down the federal government, averted only at the last minute on Friday night, it's painful how vapid the discourse is and how incompetent and cowardly our leaders have proved to be.
Oh I love Facebook. Often, people post some pretty interesting things. Such as, uh, last night. The screen shot below was posted. I've double-checked. The advertisement for Rick Perry's Fed Up is real.
So are you Fed Up? Because apparently you should be - President Obama says so! Oh wait, that's Rick Perry... I'm Fed Up with Rick Perry!
I'm not sure and all, but it strikes me as odd for someone who's fed up with our president to be imitating him...
The "DREAM Now Series: Letters to Barack Obama" is a social media campaign that launched Monday, July 19, to underscore the urgent need to pass the DREAM Act. The Development, Relief, and Education for Alien Minors (DREAM) Act, S. 729, would help tens of thousands of young people, American in all but paperwork, to earn legal status, provided they graduate from U.S. high schools, have good moral character, and complete either two years of college or military service. With broader comprehensive immigration reform stuck in partisan gridlock, the time is now for the White House and Congress to step up and pass the DREAM Act!
Dear Mr. President,
My name is Saad Nabeel and I am writing to you from Bangladesh. Prior to my arrival in this nation, I lived in the United States for 15 years. My parents brought me to America at age three. It is the only home I know. I used to attend the University of Texas at Arlington with a full scholarship in Electrical Engineering. Through no fault of my own I was forced to leave my home, friends, possessions, and most importantly, my education behind.
November 3rd 2009 is a day I will never forget. My mother called me and told me that my father had been detained by ICE and that we needed to leave immediately to Canada to seek refugee status. Being an only child, I had to take care of my mother and go with her.
Now that we've passed through the bulk of the media's writing about Bill White's absence from meeting with, appearing with, or being within 250 miles of President Barack Obama, I'd like to offer a perspective that I've refrained from writing over the past couple of weeks.
I'd like to preface these remarks by stating this post is entirely an editorial commentary, one readers should feel free to agree or disagree with. They are not intended to counter or support great thoughts offered by other writers on staff, in particular Todd Hill's posts here and here. It is simply to engage in some thoughts, not about this particular action by White, but what it may or may not signal for the campaign or for a potential White administration.
Let's begin with what is widely known or accepted. Barack Obama has seen a precipitous drop in job approval in Texas going from a 62/35 positive rating at the start of his presidency in January of 2009 to a 33/61 negative margin (pdf) about a year later in February of 2010. And assuming that Texas is reflective relatively to generic national tracking polls, Obama's approval ratings from February haven't gotten any better.
So on its face, it would seem the political decision made by White to not associate or appear with the president was very much indeed about the politics. But the White campaign went far out of their way to make the point that they really weren't like that Obama guy and distanced himself both physically by hundreds of miles, but on style and policy merits as well.
For example-
Dallas Morning News: "I was in the oil and gas business when he was a community organizer," White said, bringing his bid for governor to East Texas.
"There are some people, including me, who believe that the president is spending a lot more money than we're taking in, is spending too much money in Washington," White said in an interview.
"I don't believe in borrowing so much money. When I served as the chief operating officer of a federal department, I cut the budget. And now you see the budgets of other Cabinet departments go up."
Austin American-Statesman: "White has said that he is against the federal health care law because of how it could affect the federal deficit and that he opposes cap-and-trade legislation. He calls himself a fiscal conservative and has been critical of spending and borrowing by the federal government, but he believes that because the stimulus package is a done deal, Texas leaders should work to maximize federal dollars for the state, White spokeswoman Katy Bacon said.
The White campaign did have prior scheduled campaign stops as they noted in the earliest press responses, but campaigns have many options for how they can accommodate those arrangements- possibly a phone call, a separately schedule sit down meeting, or simply attending the President's speech as a participant where you could simply comment on the merits of Obama's higher education goals (something that would be very in tune with White's education oriented agenda). It's possible to balance the worries of being beaten over the head by Perry about a White-Obama lovefest without depressing base activists who still appreciate and support the work of the President.
There was no compromise here which is what is frustrating for many Democratic activists and Obama volunteers I've talked to, including those involved with statewide organizing. The fear of association and worry about about an iconic Obama/White photograph won out with an assumption that the base cares more about defeating Rick Perry and understands this was a tough spot for White.
The White campaign is probably right, after all, it's a similar tactic used by Barack Obama himself in the 2008 campaign through today. Democrats were so tired of Bush/McCain and so interested in winning that Obama was able to compromise and even advocate continuing certain Bush era policies. Voters projected any number of beliefs onto Obama; he was anything you wanted him to be- liberal, pragmatic, post-partisan and it didn't matter because the bigger picture demanded that we simply defeat the Republicans in order to have any chance about changing the direction of the country.
The same thing is true in Texas- the base cares about winning above all else, and it's why at the end of the day, White made the political decision that he did, and why it was the right one in his view to take. Yes, Bill White could have been handled far better. Yes, White's approach flew in the face of his primary campaign theme that he's above "politics as usual". Yes, Perry had a field day with it and White gave him a rare win in the summer news cycle. But in the grand scheme of the campaign, it will be of minor importance to the final outcome on November 2nd because the Democratic base in Texas cares more about winning. They recognize that it can't elect better Democrats until it elects any Democrats.
That's why Democrats frustrated with Bill White should forgive him. But it's also why progressive Democrats frustrated with Bill White should remember, because there will come a day where such behavior and policy critiques will be unacceptable- a day when we are politically powerful enough to choose better Democrats and influence candidate behavior.
So forgive, but remember, as we work to elect Bill White in November.
President Barack Obama has come and gone on his whirlwind Texas tour, but there was one press advisory that stuck in my inbox which I felt was important to post (along with the President's remarks) if only for the public record. Below is the list of elected officials that were listed as being scheduled to attend the President's speech on higher education at the University of Texas.
For as much hoopla as was made about Bill White's decision to spend the day out in far West Texas, it's not as if the entire Democratic Party in Texas was absent from spending a couple hours listening to the President. In fact, 35% of the House Democratic caucus was scheduled to attend as well as Republican Rep. Dan Branch and Rep. Dennis Bonnen.
I received word from Rep. Bonnen's office that the the White House release may have been in error. "It should be clarified that Rep. Dennis Bonnen did not attend President Obama's speech at the University of Texas nor was he ever scheduled to attend this event."
U.S. Representative Lloyd Doggett
U.S. Representative Sheila Jackson Lee
Mayor Lee Leffingwell, Austin
State Senator Kirk Watson
State Senator Eddie Lucio
State Representative Elliot Naishtat
State Representative David Farabee
State Representative Mark Strama
State Representative Robert Miklos
State Representative Rafael Anchia
State Representative Valinda Bolton
State Representative Garnet Coleman
State Representative Ruth McClendon
State Representative Dora Olivo
State Representative Carol Alvarado
State Representative Norma Chavez
State Representative Helen Giddings
State Representative Alma Allen
State Representative Jim Dunnam
State Representative Dan Branch
State Representative Harold Dutton
State Representative Veronica Gonzales
State Representative Pete Gallego
State Representative Paula Pierson
State Representative Yvonne Davis
State Representative Joe Farias
State Representative Al Edwards
State Representative David Liebowitz
State Representative Eddie Rodriguez
State Representative Dennis Bonnen State Representative Armando Walle
State Representative Joaquin Castro
In the midst of Barack Obama's visit to Texas on Monday, seemingly under reported was his Austin fundraiser. According to Sen. Rodney Ellis, the total raised for the DNC and affiliated groups was just shy of $1 million.
@RodneyEllis: Texans gave 985,000 dollars for this event with the President.
Democratic Lt. Governor nominee Linda Chavez-Thomson introduced the President at the fundraiser but refused to shake his hand... opting instead for a "warm abrazo" (hug), labor style. She didn't shy away from President, introducing him with the following comments.
"He's taken on the economy. He's taken on health care. He's taken on Wall Street. And he doesn't back down.
What he does do, and Texans respect this, is extend his hand across the aisle in a spirit of bi-partisanship. After all, the challenges Americans and Texas families face don 't come with a Party label on them.
But when his offer is not reciprocated, he does what any Texan would do. He does the work himself, because at the end of the day the work still has to get done.
There's nothing brave about ignoring problems. We had eight years of that. Bravery is going out in the hot sun and doing the hard work it takes to make things grow.
And that's coming from the daughter of a cotton sharecropper, so I know what I'm talking about."
The DNC has stated they will be sending $250,000 of the money raised in Texas back to Texas. Personally, I'm hoping that money gets spent on candidates who stood with the President like Chavez-Thompson. After all, we wouldn't want to associate money raised by Obama for the DNC with candidates who wanted to separate themselves from the event. But in case that doesn't happen, you can donate to Chavez-Thompson here.
Yesterday I had the good fortune of meeting President Obama while serving as a volunteer in the Presidential motorcade during his trip to Dallas. Monday’s activities were emotional on many fronts for me. I could not sleep Sunday night due to the excitement and overall nervousness associated with what I was about to be part of. I found myself wandering my apartment several times throughout the night. Those of you who know me well know that I have a great deal of political memorabilia that contains quite a few John F. Kennedy items. One of my favorite pieces is an authentic newspaper from Odessa with the bold and emblazoned headline of “Kennedy Dead: Governor Connelly Injured.” Reading the sub-headlines and stories associated with this historic paper brought home for me all the vitriol anger and controversy surrounding President Kennedy’s fateful visit to Dallas in 1963. We often think or believe that politics today is worse than in previous decades, but in actuality it is quite equal only magnified in a 24/7 news cycle. But for me, yesterday’s activities helped to again ignite that fierce urgency of now.
Being part of the Presidential motorcade is a pretty amazing experience. As we sat on the tarmac yesterday waiting for Air Force One to arrive I couldn’t believe where I was. How’d I get here? What brought me to this point in life where I’m participating in such a patriotic duty as serving in the presidential motorcade? What an amazing crossroads. It’s not something a lot of blue-collared boys from Euless Texas think about, or get to do, every day.
As Air Force One confidently rolled down the tarmac and approached the motorcade one could not help but simply be overwhelmed by the pure intimidating beast that is the President’s mode of transportation. Even under a blistering hot and unmerciful Texas sun the bold declaration of “United States of America” across the massive sides of America’s flying fortress makes your skin tingle with pride. I dare say that I had a grin thinking about what I was witnessing.
The pomp and circumstance that goes with participating in such an operation as safely and securely transporting the President is no easy operation to manage, or execute, as we saw with the injury to a Dallas police officer. The White House Advance Team, Secret Service, and various law enforcement agencies that participated in yesterday’s activities were the consummate professionals. All entities went out of their way to make me feel comfortable, informed, and prepared.
I’ve now had the good fortune of meeting Barack Obama three times in my life. In 2006 I attended the Campus Progress Student Convention in Washington DC where a newly elected Democratic freshman senator from Illinois addressed the over 500 attendees about youth engagement in politics. In 2008 candidate Barack Obama came to Dallas and gave a rousing speech to a packed audience of over 17,000 Texans that had many comparing him to Robert F. Kennedy. It was after Obama's rally in Dallas in 2008 that I wrote something to the effect of:
The power of hope is what has sustained my family and defined my life. It is what has managed to build the foundation from which my 28 years of life bore, thus far, for all to see. Hope is all that millions of Americans have these days after the eight years of pure hell we've experienced under Bush administration policies. Hope is what leads me to believe that, with hard work, a little intelligence, giving back to my community, and a bit of discipline, that a gay man from Euless, Texas, can be president someday. This, all of these thoughts, are what wound through my mind as I listened to Obama. It is what I reflected on as we drove home this afternoon. It is what has tears in my eyes as I write. My life is hope.
I can’t help but think that one of many reasons that I gravitated to Barack Obama as a candidate for President was because of the fierce urgency of now which for me continues to be hope for a stronger, more united, and more prosperous nation. The partisan divide in politics is growing wider, the problems of our state and country grow taller, and the extremism that penetrates political discourse today has superseded all attempts at bi-partisan cooperation to do good will for our state and country. It may seem to some that hope has vanished, but I declare that it hasn’t. President Obama has accomplished a number of great things in a very small amount of time after inheriting a collapsed economy, two wars, and a polarized nation. All of those elements—-those reasons I work so hard to help produce a better nation upon my death that is better than it was upon my birth, is because of the fierce urgency of now. It’s time that we as a state and country channel that urgency again and get to work continuing to build a more perfect Union.
Austin Mayor Lee Leffingwell was on hand today to meet with President Barack Obama and will be on hand throughout the day. The Mayor will travel with the motorcade throughout today's events, including a rally at Gregory Gym on the University of Texas campus.
"This is an opportunity for us to highlight what is great about Austin," said Mayor Leffingwell. "I want to thank the President for his support of many local projects and the stimulus funds that have created jobs. Austin is a symbol of our national economic recovery, and we owe much of that to the Federal partnerships we have created".
Rick Perry will simply hand the President a letter about border security in Texas and will likely ask for an increase in federal support in either troop support or federal money since he has totally, mismanaged the border and budget. Bill White is on the campaign trail today.
