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health insurance

Expanding Health Insurance Coverage for Young Texans


by: JessicaAdair

Thu Aug 14, 2014 at 11:52 AM CDT

(Thanks to Jessica and Young Invincibles for sharing this with the BOR audience! - promoted by Katherine Haenschen)

Newly appointed Chairman of the Senate Health and Human Services Committee, Senator Charles Schwertner, held a hearing at the Capitol on the state of health insurance in Texas.

This hearing will set the tone for what’s bound to be a long debate over how to cover millions of uninsured Texans, while managing the cost of health care.

Here’s how we got here, and here’s what you should keep in mind.

More below the jump!

There's More... :: (0 Comments, 543 words in story)

What should we be talking about?


by: Kirk Watson

Tue Oct 08, 2013 at 06:33 PM CDT

If you were us, what would you be talking about?

Every other year, in the interim between the last legislative session and the next one, both chambers of the legislature continue to work.

A lot of what we work on falls in the category of interim charges or interim studies. They're a little like extended research projects: we spend time meeting (typically as committees) and learning about subjects that the Lieutenant Governor (in the Senate's case) or the Speaker of the House (in the House's) put on a list of things to review and analyze. The studies help set the priorities for the ensuing legislative session.

Obviously, these are (as Ron Burgundy would say) kind of a big deal. And the members of the Senate Democratic Caucus think they're too important to leave to the folks who've been failing to deliver on Texans' priorities for all of these years.

So I and the other Democratic Senators want your help in deciding what those priorities should be.

The Caucus has set up a web page where you can give your thoughts on what Texas should be focusing on in this interim.

Just go to bit.ly/14PzGfq and let us know what needs to be on the list.

There are so many areas where Texas can do better - for our kids, our economy and our future - than it's been doing. This is your chance to help make sure the state's priorities are where they need to be.

Please CLICK HERE and let us know what you think. Texas needs to hear it. I'll be sure your ideas are submitted to the Lieutenant Governor and encourage him to put them on the list.  <!--more-->

Good and bad health news


The last weeks have been pretty earth-shaking for anyone who cares about health or healthcare in Texas. And not always in a good way.

Most of the developments have come out of the implementation of the Affordable Care Act.

The good news is that the Health Insurance Marketplace is now open to help Texans sign up for health insurance. Last week, I joined a number of other community leaders to help spread the word about this opportunity to get health insurance - and the need for Texans to take advantage of it.

(By the way, if you're interested in getting health insurance or know of anyone who would or should be, go towww.healthcare.gov or just call 2-1-1 in Austin.)

Texas Needs Health Insurance


Unfortunately, this great, crucial progress was obscured by raw, destructive politics, mostly from the Governor's office.

 

Navigator news


First, the Governor seems intent on making life as difficult as possible on healthcare navigators whose job it is to help Texans sign up for insurance. Worse still, the Governor appears to be using - or misusing - a bill I passed during the regular session that had the exact opposite goal: to make it easier for Texans to find insurance in ways that make sense for Texas.

Last week, I spoke at a hearing on potential regulations for navigators. Here are highlights from the Texas Tribune's writeup:

At an informal hearing held by TDI on Monday to take input on Perry's directive, state Sen. Kirk Watson, D-Austin, said he feared legislation he authored to ensure navigators could effectively help Texans find coverage in the federal marketplace had been wrongly co-opted by Perry in an effort to derail implementation of the Affordable Care Act.

"These provisions were put in place to prevent precisely what I fear may be in motion here today," said Watson. "And that is a politically motivated effort to circumvent federal and state law concerning navigators and an even larger coordinated nationwide effort to shut down implementation of the Affordable Care Act."

Watson told the agency that Senate Bill 1795, which he authored in the last legislative session, requires TDI to make a "good faith effort" to work with the U.S. Department of Health and Human Services to improve the federal navigator rules before implementing additional state rules. Only after "a reasonable interval" does the law allow the insurance commissioner to begin a rule-making process.

Watson alleged that the agency's decision to schedule a stakeholder meeting to begin the rule-making process shortly after receiving the governor's directive and to hold the stakeholder meeting on the day before the launch of the federal marketplace - "a critical day for navigators" - indicated that the agency's rule-making process could be intentionally impeding implementation of the navigator program.

 

Don't forget Medicaid


The implementation of the Affordable Care Act also put a spotlight on another wrongheaded decision by the Governor - his refusal to expand Medicaid so more of our fellow citizens can access affordable, reliable healthcare.

This decision has terrible implications for Texas' economy as well as its people. I detailed a number of those in an editorial that ran in the Statesman last week. Here's an excerpt:

It's past time to get serious about health coverage for Texans.

The Affordable Care Act is law. Its primary components start to take effect Tuesday. Many of its benefits are already in place.

The folks running Texas need to face reality. It's time to put the health of Texans, and our economy, ahead of political histrionics.

Right now, the law extends coverage for young adults, allowing them to stay on their parents' insurance plans until they turn 26. It forbids insurance companies from turning folks down because of preexisting conditions. It expands coverage for preventive care and screenings. It lowers costs for people in the Medicare Part D "doughnut hole." And it enhances consumer protections against insurance cancellations.

The only questions left to answer are whether states such as Texas will create barriers to implementing these good changes and whether they'll expand Medicaid to cover, in our case, about 1.3 million to 1.7 million more uninsured citizens. The federal government would pick up nearly all of the costs of the expansion.

So far, the tragic answers are "yes" to barriers and "no" to more people being covered. The governor and others have made a political circus out of health care in Texas by turning their backs on tens of billions of your tax dollars that now won't come back to Texas for your benefit.

By refusing to secure health coverage for about 1.3 to 1.7 million Texans, those in control are costing Texas about $79 billion to $90 billion over 10 years in tax money we'll send to Washington. A Perryman Group study found that expanding Medicaid would boost Texas' economic output by $270 billion.

And don't forget, Texas already leads the nation in the percentage of residents without health coverage. We should put these billions of dollars to work keeping Texans healthy and cutting down on pricey emergency room visits that, in many cases, are ultimately paid for with local property taxes.

And then there are all the lost economic benefits. Expanding Medicaid in Texas would create nearly 200,000 jobs, according to a study conducted by Billy Hamilton (Texas' renowned former deputy comptroller) and the group Texas Impact.

Clearly, the launch of so many important pieces of the Affordable Care Act means last week was one for the history books.

I just hope it's remembered for the right, healthy reasons - not the harmful, political ones.

Discuss :: (0 Comments)

45 Million More Americans Uninsured Under Romney's Health Care Plan


by: Emily Cadik

Wed Oct 03, 2012 at 11:00 AM CDT

Last week, Mitt Romney claimed that we do have health care for everyone in the country - it's just that some people's health care plans don't include things like check-ups and only include emergency room visits.  

So it should come as no surprise that an analysis of Romney's health policy proposals from the Commonwealth Fund estimates that Romney's health care plan would leave 72 million Americans uninsured by 2022 - 12 million higher than if nothing had been done at all.  On the other hand, if the Affordable Care Act (ACA) is fully implemented, the uninsured rate will drop to 27 million people by 2022. That's 45 million people whose health care is hanging in the balance.

The findings also show that "middle class families in the key battleground states of Florida, Ohio and Virginia, among others, would pay about half as much total for health care if the ACA is fully implemented rather than repealed and replaced with Romney's plans" - a compelling statistic going into the election.  

So how does Romney's plan shake out in Texas, which has the highest uninsured rate in the nation? Texas would actually be hit harder than any other state. Under Romney's plan, 34.3 percent of Texans would be uninsured, compared to 14.7 percent if the ACA is fully implemented.  

Texas clearly has a lot to gain from the ACA, and a lot to lose under the Romney Plan.  But to what extent will health care be a deciding factor in the election in Texas? Allmand Law crated an infographic showing how the current status of the health care system in Texas may impact the upcoming election:

(You can find the full infographic at Allmand Law's blog.)

It turns out about half of Texans either think the health care system in the state is fine or isn't that bad, or they don't' care.  So almost one-third of the state is uninsured, and still half of the state things the healthcare system is good or fine.  It's a small sliver of people who have health insurance and still believe the health care system needs to change.  And while their voices and those of the uninsured may be outnumbered in Texas, it's a reminder of just how much is at stake nationally this November.  

Discuss :: (1 Comments)

Emergency Rooms: The Poor Man's Health Insurance?


by: Emily Cadik

Wed Sep 26, 2012 at 09:00 AM CDT

Despite Mitt Romney's formerly reasonable stance on health care, the candidate told 60 Minutes on Sunday that we do actually provide care for everyone in America - it just sometimes happens that the only care anyone can get is in an emergency room:
"Well, we do provide care for people who don't have insurance. If someone has a heart attack, they don't sit in their apartment and - and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."

Not only are emergency room visits among the most expensive care available, but it means people who have access to health care only through emergency rooms miss out on the major components of an actual health care plan - like preventative and routine care - that prevent emergencies from the start.

Of course, Romney knew this when he was governor of Massachusetts, and it's one of the reasons he supported universal health care there.   He was also aware of this reasoning when he wrote his book, No Apology:

After about a year of looking at data -- and not making much progress -- we had a collective epiphany of sorts, an obvious one, as important observations often are: the people in Massachusetts who didn't have health insurance were, in fact, already receiving health care. Under federal law, hospitals had to stabilize and treat people who arrived at their emergency rooms with acute conditions. And our state's hospitals were offering even more assistance than the federal government required. That meant that someone was already paying for the cost of treating people who didn't have health insurance. If we could get our hands on that money, and therefore redirect it to help the uninsured buy insurance instead and obtain treatment in the way that the vast majority of individuals did -- before acute conditions developed -- the cost of insuring everyone in the state might not be as expensive as I had feared.
 
It makes a shocking amount of sense.  But now that he's running for president, Romney is content to let emergencies be the only times some people get health care - people who can't afford it and aren't able to access it through the government or employers.

Fortunately, whether they like it or not, states are gearing up to implement the provision of the Affordable Care Act that involves setting up statewide insurance exchanges to help make health insurance more accessible and affordable.  And on November 16, states have the option of either implementing their own exchanges, or letting the federal government do it for them.  So far, only thirteen states and the District of Columbia have promised to set up exchanges.  Six have said they won't.  The rest are weighing options, with some trying not to get too invested in anything before the election gives insight into the probable fate of the ACA.

Regardless of how the exchanges are set up, the health insurance provisions of the ACA can't kick in soon enough in Texas.  With the highest uninsured rate in the country, and home to four of the five U.S. metro areas with the highest share of uninsured residents, Texas needs a whole lot more than emergency rooms.

Discuss :: (0 Comments)

$167 Million in Insurance Rebates Coming to Texas… If Affordable Care Act Upheld


by: Emily Cadik

Tue Jun 26, 2012 at 00:00 PM CDT

(More good news from the SCOTUS decision to uphold the Affordable Care Act!   - promoted by Katherine Haenschen)

As we drum our fingers and tap our feet waiting for the Supreme Court's verdict on the Affordable Care Act, let's take a moment to reflect on one of the many benefits set to kick in soon if the ACA is upheld.  

Think Progress reports:

"12.8 million Americans will receive $1.1 billion in rebates from insurers that have not met minimum spending guidelines in Obamacare, the administration announced Thursday morning. The Affordable Care Act requires insurers to spend 80 to 85 percent of premium dollars on health care services or issue rebates to policy holders. The average rebate is valued at $151 per household. "

Texas residents will be getting an even higher than average amount, with $167 million in rebates coming to Texas.  That's an average of $187 for each of the  895,000 Texas families covered by a policy.

According to the Washington Post, "This requirement - known in the law as the 'medical loss ratio standard' - came into effect on Jan. 1, 2011. Rebates will go to customers in plans that exceeded the limit last year."  

If the law is overturned, though, insurers won't be forced to pay rebates based on a law deemed unconstitutional.  And the likelihood of them issuing the rebates out of the kindness of their hearts seems low.

The amount of rebates varies significantly by state, and also by whether you get insurance through an employer.   For some people the rebates may be less direct, but it still ends up benefiting insurance policy holders in the end:

"Not all money will flow directly to consumers: For those who receive insurance through their workplace, the health insurance plan will send a rebate to the employer. It is then the employer's responsibility to either pass that rebate on to the individual or use it in other ways that may benefit the employee, such as lowering premiums for the next year."
 
Just another pretty great policy hanging in the balance this week.  
Discuss :: (0 Comments)

6.6 Million Young Adults Newly Insured Through the Affordable Care Act


by: Emily Cadik

Wed Jun 13, 2012 at 01:00 PM CDT

It's going to get harder and harder for opponents of the Affordable Care Act to maintain their resistance in light of the clear and quantifiable impacts the law is already having.

A recent study shows that roughly 6.6 million young adults who have now signed up for health insurance through their parents' plans in the past year as a direct result of the ACA.

According to a new Gallup poll:

"The percentage of 18- to 25-year-old Americans who do not have health insurance fell from 24.5% in the first quarter of 2012 to 23% so far in the second quarter -- reinforcing the general downward trend that began after the healthcare law provision allowing adults up to age 26 to remain on their parents' plans took effect in September 2010."

uninsured

The provision of the Affordable Care Act responsible for this impact requires insurers to allow young adults to stay on their parents' insurance coverage until they are 26 years old.  They don't have to be students, unmarried, financial dependents or living with their parents.  As of 2014, they can still be eligible even if they are offered insurance through their own employers.  Previously, many insurance companies terminated coverage at age 19, with some (but not all) providing exceptions for students.  Clearly, this change is already having a major impact on this age group, many of whom have part-time employment, work for start-ups or are otherwise struggling to find their footing financially.

The news about the higher insurance rates among young adults is especially encouraging in light of a recent finding that "millions of young adults are forgoing necessary care and treatment because of rising health care costs," according to a Commonwealth Fund survey.  The study found that 41% of young adults between age 19 and 29 did not get medical care in a recent 12-month period because of the high cost.  This includes not filling prescriptions, skipping recommended tests or treatments, avoiding doctor visits and failing to get specialist care they need.

While medical costs may not be dropping, at least the ACA is helping more young people get the insurance coverage they need and the medical care they deserve.  

Discuss :: (1 Comments)

The Hidden Costs of a "Carve-In" System for Prescription Drugs


by: MRayPerrymanPHD

Fri Apr 29, 2011 at 08:55 AM CDT

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.

There's More... :: (0 Comments, 299 words in story)

Whole Foods, Health Insurance, and Texans' Public Options


by: Katherine Haenschen

Mon Aug 17, 2009 at 04:16 PM CDT

The debate over health care reform took a decidedly local turn last week with the publication of a Wall Street Journal Op-Ed by Austin-based Whole Foods' CEO John Mackey. Entitled "The Whole Foods Alternative to ObamaCare", the piece basically suggests that de-regulation and an end to Medicare will solve our health care problems. Mackey writes:

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction-toward less government control and more individual empowerment.

Mackey opposes a public option for health care reform, which would empower any American to buy into a government-run program similar to Medicare. The program will provide an affordable alternative to private insurers, thus encouraging companies to lower costs and improve access, or lose customers. Instead, Mackey argues that the Free Markettm can solve our health care woes. Clearly it's doing a great job of that already for the 47 million Americans who lack insurance. For instance, he says if the government no longer requires insurance to cover certain procedures (say, mammograms, colonoscopies, cholesterol screenings), then the individual citizen will be able to "choose" a plan that does cover these procedures. Uh-huh.

This isn't a surprising argument from the very-Libertarian Mackey. However, it's fundamentally wrong. Increasing competition between insurance companies won't necessarily drive costs down unless there is a viable alternative, an affordable plan open to all Americans. Right now, there is no incentive for insurance companies to lower costs. A government-run plan will have the means to offer affordable insurance, thus providing that incentive.

Meanwhile, the people and economy of Texas are hurting from lack of insurance options.

  • Texas has the highest rate of uninsured residents, at 25.2%. The national average is 15.3%.
  • Texas has the highest national rate of uninsured children, at 24%. The national number is 15%.
  • 90% these children live in working families in which the household income cannot cover insurance costs.

According to the Center for American Progress, the lack of coverage-for-all forces insured families to spend $1,100 more in premiums a year to pay for costs incurred by the uninsured. Many uninsured folks end up in the emergency room when a condition has gone from easily treatable (minor UTI) to very serious (kidney infection), thanks to a lack of access to regular care. Even after that ER visit, people often need follow-up care that they can't pay for either. What does an uninsured family do when their kid needs to see a neurologist?

Mackey's argument is problematic, coming from the founder of a company whose stated motto is whole food, whole people, whole planet. After all, it's particularly difficult to be a "whole person" when you can't afford health insurance, and in some cases must choose between food on the table and pills in the prescription vial. Mackey wants the free market to empower the consumer with choice, and I'm taking him up on his offer. From now on, I'm shopping at another grocer headquartered in Texas that specializes in quality food and local ingredients, just like Whole Foods. I'm switching to Central Market.

The CEO of Central Market's parent company H-E-B, Charles Butt, hasn't made any strong public declarations on health care access that I can find. However, his campaign donation history is far more Blue than Red (save for a smattering of incumbent Texas Republicans). He also has a long history of supporting Texas Parents PAC, which fights school vouchers and supports increased school spending. I'm putting my money where my mouth is, and going with the Butt at Central Market instead of the ass at Whole Foods.

It's not really about hurting Whole Foods. John Mackey's Blog tries to draw a line between his statements and his company, which naturally has "no official position on the issue." But frankly, I don't want the "Whole Foods Alternative to ObamaCare." I want health insurance for all Americans. And while I advocate for real reform, I'll take my money to a business whose leaders share my values.

I'll be honest: I loved shopping at Whole Foods. For three years, my Sundays have started with a run around Lady Bird Lake and Whole Foods breakfast tacos. But in 14 days I lose my employer-provided health insurance, and paying the COBRA should put a pretty big dent in my Whole Foods budget. So instead of heading to 6th and Lamar every Sunday, I'll take the bus to 38th and Lamar and find something else. And as for groceries, I'll head to the newly-expanded Wheatsville Co-Op.

I don't need to give my money to someone who thinks that the failed policies of the past will help with the health-care problems of the present. What I do need--what millions of Americans need--is affordable health insurance.

What You Can Do:
  • If you're in Texas and you shop at Whole Foods, consider switching to Central Market, a local farmer's market, or grocery cooperative where possible.
  • Spread the truth about health insurance reform. The White House has put together a Reality Check website full of actual facts on health care reform.
  • Call your Congressperson and tell them to support real insurance reform that provides health care access for all Americans.
Discuss :: (20 Comments)

New DFA Petition for Healthcare Reform


by: rwcold

Wed Mar 25, 2009 at 09:50 PM CDT

Fresh on the heels of his successful 50 state strategy, former Vermont Governor Howard Dean has today launched a nationwide drive to get grass-roots Americans activated to support real health care reform.  Contrary to what the health insurance industry would have you believe, millions of Americans want and need the option to buy-in to Medicare-type insurance coverage because they can't get or can't afford private health insurance coverage.  Dr. Dean clearly stated that without the Medicare option for any American, we won't have meaningful health care reform.  Health insurance rates have escalated dramatically for years now, and many Americans who have lost long-held jobs, or whose medical history is not pure enough have found themselves unable to qualify for any comprehensive coverage or else they simply cannot afford the monthly premiums or the high deductibles.  
As President Obama has stated many times, if you like your present health insurance policy, you can keep it.  Neither The President nor Governor Dean are opposed to your right to keep your current insurance policy.  But if you need a different choice-better coverage or a more affordable option, a Medicare-type policy provided by the Federal Government should be available for you and your family.  
Tonight, I spent two or three minutes on-line at Dr. Howard Dean's new web site
www.standwithDrDean.com and I signed his petition to demand a public healthcare option like Medicare for any American who needs it.  You can watch his video on-line and read the petition, but I hope for your sake that you will sign his petition and join thousands of Americans in demanding the option that will make health insurance affordable again for every working American.  You don't have to contribute any money and you don't have to volunteer anything, but I hope you'll feel the same way I do...This is one of the most important issues facing Americans, even in this year of crisis upon crisis.  I contributed to Dr. Dean's organization and I signed up to volunteer because I'm sick and tired of having my health and my family's health and my ten employee's health jeopardized by some insurance company's greed.
It's up to you!  Do you deserve decent health coverage?  Are you sick and tired of being jerked around by some faceless insurance company bureaucrat?  Don't be fooled by the insurance lobby, this isn't about socialism, it's democracy in action!  Step up, demand real reform!  Demand a REAL CHOICE!  Sign the petition!
Discuss :: (0 Comments)

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