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.
The current legislative session has been described as possibly the "worst in recent memory" for Latino Texans. What are likely coalitions that might be able to mitigate the budget cut proposals under consideration?
To figure this out, I visualized Texas county data matching Latino population density and per capita budget cuts. Demographic data on total population and Hispanic density is based on 2010 Census data made available at the Texas Tribune data portal. Projected budgets cuts are based on Center for Public Policy Priorities (CPPP) estimates; the $10 billion cut scenario was utilized for the Medicaid visualization. My complete source file can be found here.
Let's start with public education. The blue line represents the state average per capita K12 cut: $127. The 2010 Census data indicated that Texas is 38% Hispanic, so counties above that are above average in terms of Latino density. Finally, the larger the size of the bubble, the larger the plotted county's total population. Examining the chart yields that a likely best strategy for pro-education advocates is to build a coalition of Harris and Dallas-area county legislators along with targeted low population counties with high per capita cuts that are represented by conservative legislators.
On the Medicaid front, there is a stronger correlation between Latino density and size of per capita cuts. The average state cut is $406 under the $10 billion cut scenario. This is represented by the red line. Two Rio Grande Valley counties - Hidalgo and Cameron - are particularly hard hit under any of the CPPP scenarios. Legislators from the RGV might be able to form a pro-Medicaid coalition with the eclectic mix of small- to mid-size counties that also will be experiencing very high per capita cuts.
Overall, the current budget promises to wreak havoc on all of Texas, as well as disproportionately burden many Latino communities across the state. It is the culmination of years of reckless, ideologically-driven budgeting. Hopefully, the extreme nature of proposed cuts will create a space for new, surprising coalitions to propose a more balanced approached to repairing the budget mess. Such an approach would include use of the Rainy Day Fund and practical, fair revenue increases.
The Texas Attorney General is suing against "Obamacare" in order to protect "States Rights" to control health insurance companies doing business in Texas! But, maybe there's a thing called Abbottcare (or, Perrycare) that Texans should examine more closely.
Once, Abbot was in favor of mandates, now he's not. It's not just the hypocrisy "I was for it, now I'm against it." It is also the hypocrisy of the entire "States Rights" argument being used to cover up over a decade of Republican neglect of Texas health care reform by Texas' 100% statewide Republican elected officials.
On Dallas KRLD talk radio 1080 early this afternoon, I heard Dallas County Republican Chairman, Jonathan Neerman, assert that all Republicans support the end to the pre-existing conditions exclusion for health insurance.
This surprised me.
For one thing, when I called Congressman Lamar Smith's office back in November to inquire about any Republican proposal to end pre-existing conditions, I was told there was a proposal and if I would wait on hold the staff person would find it. The staff person never returned to the line. So, I concluded there was no Republican plan to end pre-existing conditions that Congressman Smith was willing to endorse.
So, when Jonathan Neerman, the Dallas County Republican Chairman, asserted as a fact that "all Republicans" are against the practice of excluding pre-existing conditions, I was just wondering how Lamar Smith missed that, and how Republicans might propose ending the practice.
I would have thought that if all Republicans support this "limited and incremental" reform, and if all Republicans believe in "States Rights", then all Republicans would have pressured the State Insurance Board to require that insurance companies doing business in Texas abandon the pre-existing conditions exclusion in policies of insurance companies under the jurisdiction of the people of Texas.
Jonathan Neerman was responding to a KRLD talk show host (Scott) about the baby (Houston Tracy) born March 15th in Crowley, Texas, who had a pre-existing heart condition. Coverage was denied by his father's health insurance as soon as the condition was known. (See, http://bit.ly/9w4b0U) Neerman claimed that Republicans were universally opposed to pre-existing condition exclusions" and would have taken care of that problem if the Democrats hadn't shut them out of the Health Care Reform debate.
In my opinion, Democrats should make this a cause celebre in Texas leading up to the election in November.
Just as Republicans sat on their hands for the 12 years they controlled Congress, Governor Perry and Atty Gen. Abbott have sat on their hands for over a decade while the State Insurance Board was allowing insurance companies to get away with denying coverage based on "pre-existing" conditions. Now, baby Houston is paying the price for the malfeasance and hypocrisy of Gov. Perry, Atty. Gen Abbott, and the entire statewide Republican leadership.
This is just silly. Greg Abbott, along with the Attorney Generals of many other states in this country, is now filing a law suit against the new Health Care Reform just signed by the President.
He doesn't really have an explanation, though. Read and listen to his thoughts, and even Republicans have to wonder: what chance does Texas have in winning? There is a reason that the Chamber of Commerce won't get on board with fighting to repeal this bill in any way, shape, or form.
Abbott lays out one point of the bill he finds unconstitutional and he mentions two parts of the Constitution.
Abbott claims that the individual mandate is the constitutional problem with the bill. An individual mandate that won't kick in until 2014... He's spending our state's resources on something that won't have traction for four years. Is that really efficient in this economy?
Abbott then suggests that the individual mandate is a problem because it expands the commerce clause farther than ever before. But it's the same way Massachusetts (as started by Republican Mitt Romney) regulated commerce within their own state...
Therefore, it's all against the 10th Amendment, because that right should be delegated to the People, since it isn't delegated to anyone in the Constitution. Oh, just like your constituents' Medicare and Medicaid, right?
With Texas incarcerating the most people per capita in the country, and with our state sending more criminals to death row than anywhere else...aren't there bigger problems for our Attorney General's office?
On Tuesday night the House Rules Committee released the Manager's Amendment to HR 3962, the "Affordable Healthcare Act for America". This starts the 72-hour clock for consideration of the legislation which means a vote could occur as early as Saturday morning.
It is important to note that the 72-hour layout period is not standard operating procedure in DC. A coalition of members of both parties pushed for this added measure of accountability. This period allows all members, the media and the public the opportunity to review the bill instead of passing huge pieces of important legislation with no layout in the middle of the night like Delay and his cronies did.
The District-By-District analysis is the best weapon against your anti-healthcare opponents that I've ever seen. Any candidate for Congress should memorize these numbers and quote them frequently.
Still a tough vote for lots of Texas Democrats. We need to make sure it is a tougher vote for Texas republicans who choose the insurance companies, healthcare management degree graduates and HMOs over middle class families..
Moving forward towards November 2010, it is imperative that we arm ourselves and supporters with this information, communicate it frequently, and shutdown misinformation before it can become "fact-like".
Support our delegation by writing letters to the editor, messaging your friends on Facebook, emailing your fantasy football buddies, etc. This is a tough vote that could cost us some seats unless we all dig in and fight shoulder-to-shoulder to breakdown the lies and promote the cause that healthcare reform is necessary AND affordable.
Representative Mac Thornberry of District 13 has contributed to the House Republican Health Care Solutions Group's rather delinquent and feeble answer to Democratic efforts at health insurance reform. It comes as no surprise that the Solutions Group doesn't seem all that interested in real solutions, and, for Congressman Thornberry's part, he's provided two measures which are certain to alleviate zero problems for Americans struggling with the costs of healthcare and health insurance.
The first bill would offer grants to states to form "healthcare tribunals" comprised of industry insiders to replace judges and juries in civil suits against healthcare providers. It would be a lot like mandating that all claims against parachute manufacturers go before owners of companies that make parachutes, an arrangement that's clearly unfair to the claimant. The idea for these "tribunals" comes out of the old, patently false claim that healthcare costs have been driven up by healthcare providers' vulnerability to frivolous lawsuits. Thornberry hasn't mentioned that Texas capped damages in healthcare liability claims in 2003, an experiment in tort reform that attracted a lot of doctors seeking up to 30% lower malpractice insurance rates and better profits but failed abjectly to stop the inexorable rise of healthcare costs.
The second bill proposes a commission on healthcare billing codes and a few changes to claims procedures that are likely to make it harder to fight fraud and waste in Medicare. The whole bill is about panels and committees that will almost certainly have no appreciable effect on costs or rising insurance premiums. It's just the sort of thing the Republican leadership is after, a non-solution to a problem that's wrecking the physical and financial health of millions of Americans.
Mr. Thornberry and his colleagues would have us believe that the problems in healthcare are caused by greedy lawyers and incompetent government bureaucrats, but those claims just don't bear out in reality: Tort reform didn't make a difference in Texas, and Medicare consistently outperforms private insurers in measures of customer satisfaction and efficiency. Most of the other measures are similar filler for a non-plan that exists solely as a diversion.
Several House members from Texas, including Rep. Joe Barton, have joined the House Republican Health Care Solutions Group. To see if your Republican congressman is wasting your time with this business, check Rep. Roy Blunt's (R-MO) site.
(Metroplex readers, get on out there and stand up for health care reform! - promoted by Katherine Haenschen)
Organizing for America's 'Let's Get It Done' bus has been making its way across the country calling for real health care reform.
On Monday, the bus stops in Dallas for a rally with OFA's national executive director, Mitch Stewart and other dignitaries. Stand with fellow Texans this Monday to show your support for the President's reform efforts. A quarter of all Texans are uninsured, and too many others risk losing insurance if they lose their jobs or get sick. America can do better. The time for action is now.
Location: Gilley's, 1135 S. Lamar, Dallas, TX 75215
Time: Doors open at 11 a.m., rally starts at noon.
RSVP:Click Here
Directions: Gilley's is just south of the Dallas Convention Center on Lamar. Free public parking available. Gilley's also can be reached by taking DART light rail to the Cedars station (red and blue lines). Turn left on Belleview and walk approximately one block north on Lamar (i.e. towards downtown).
Wednesday evening, Bill White showed up to the first University Democrats meeting of the year ready to speak to hundreds of potential block-walkers. He rocked the club and the crowd ate it up. According to University Democrats President Melessa Rodriguez, the club invited White to speak "because of the importance behind the US Senate race for both our state, and our democratic party."
It certainly sounds like the club wants to spend the Fall Semester helping a Democrat win an election. Unfortunately, that election likely won't occur in the Fall Semester...
I recall conversations with club leaders several months ago about a problem that probably plagued most local political clubs preparing for the Fall. Besides some state Constitutional Amendments, there are no elections until 2010 and there is no legislative session at the Capitol. The mundane droll of city policy can only excite so many activists. And local organizations can only have so much influence with the national politicians.
Yet clubs need to gain new members and retain old ones, so a plan of action with inspiration must be arranged. It seems that some of you clubs have determined the 2010 elections might provide the most excitement. Tom Schieffer, Bill White, and John Sharp have already highlighted meetings, and they will likely continue to do so along with Hank Gilbert and whoever else decides to join the statewide fray. We will have months in the Spring, though, to sort through these candidates fully. We should focus on more pertinent matters now.
A strong handful of activists have correctly identified that more pertinent matter: health insurance reform. And you have showed their support passionately. Unfortunately, the media will only display the opposition to health insurance reform, not that support that many of you are giving.
On September 9, President Obama will address a joint session of Congress regarding healthcare reform. With this, the endgame on the 2009 healthcare reform efforts will begin. Instead of simply showing support, we should work to increase support as much as possible in the final days.
Support can be increased more easily than it might seem. The difficulty in the health reform debate this year has probably been due to a lack of clear information. Both Democrats and Republicans are still utterly confused. Only 37% of Americans can correctly identify what the "public option" is. This has been the largest public policy issue in this country for months, and voters still don't have a clue.
For progressives, the public option or some other ambitious alternative is an obvious policy solution to the health care crisis. If it is so blatantly obvious to us, though, then surely other fellow Americans will fall in line if they simply understood what health insurance reform really did.
Ideally, the Democratic politicians would have successfully explained this policy initiative to Americans, but they have failed unconditionally. As activists, maybe you can do better. Make flyers. Invite health policy speakers. Or just hand out cards that say something along the lines of, "The Public Option = Giving people the option of being covered by a government health insurance plan that would compete with private plans." Or even just point people in the rightdirection.
A group of good minds like yours can make a real difference in educating the public on the most important issue of the year. Hey, as yall showed in 2009: it can definitely be done (Particular Kudos to the Texas Freedom Network and Students for Gun Free Schools). Let's get to work.
As the health care debate keeps heating up, there is an onslaught of rallies, meetings, town halls filled with people who have passionate feelings about this issue. These are the voters who will make a difference in November 2010. Lamar Smith has voted no on health insurance reform, no to providing health care to poor, uninsured Texas children, and it's time that we say NO to Lamar Smith.
To get our message across, I need your help to print these flyers and distribute them at every health care and political event you care to attend. This will ramp up the pressure on those who want to stand in the way of progress. They can be printed in black and white or color and be cut in half to save on paper. Hand them out, put them on car windows, use them where ever people are interested in health care on both sides of the issue. I want CD21 voters, including those in Smith's own party, to understand that he's not working for The People. And I need them to know that just like you, I already AM working for The People. The intended audience is all voters, the majority of whom agree with these basic principles: stop the pre-existing condition discrimination, make insurance portable, and end financial crisis due to catastrophic and chronic health care.
For my benefit in creating future messaging, I'd appreciate it if you would look at the flyer and tell me what you think. Collectively, we'll create the message that voters cannot ignore. At Ronnie Earle's event the other day all the cars were flyered with John Sharp info. Yes, blanketing the area is a great way to tell voters there is already an alternative to the status quo in Congress. I need everyone who is able to help out with this.
I hear the audience is growing at both the Schertz and Kerrville Lamar Smith town halls on Monday. I hope to see you there!
After weeks of Representative Lloyd Doggett taking the heat from anti-health care reform protesters, the shoe is finally on the other foot. Representative Lamar Smith, who has avoided facing his constituents on this issue up to now, has scheduled two health care forums in our district to listen to his constituents on Monday, August 24th.
This is our opportunity to voice our support for health care reform and show that this can be done with respect, dialogue, and without needing to use vile, divisive language.
Rep. Smith has scheduled these events only for San Antonio and Kerrville, but will be attending a Chamber of Commerce luncheon on Sept 2nd at the Hyatt in Austin. If you want to let him know that you'd like him to change his vote to yes on reform, please go to any or all of these events. He is looking for letters from constituents, so come prepared with lots of letters.
Local grassroots organizations are working on a combined effort to show a united front for reform. Contact Moveon, Organizing for America and your local democratic party for more information.
We need to make it clear to Rep. Smith that we will remember his no votes at the election booth in 2010. I am counting on that! If you are a supporter of health care reform, please support my campaign.
The events:
Kerrville (open to the public):
August 24, 9:30 a.m.
The Kathleen C. Cailloux City Center for the Performing Arts
910 Main Street
Kerrville, TX 78028
San Antonio (open to the public):
August 24, 12:30 p.m.
Schertz Civic Center
1400 Schertz Parkway,
Bldg. #5 in the Municipal Complex
Schertz, TX 78154-1634
Austin ($55 cost to attend):
Congressman Smith Shares Updates On Policies That May Impact Your Bottom Line
WHEN: Wednesday, September 2, 2009 11:30 AM - 1:00 PM
WHERE: Hyatt Regency Hotel, 208 Barton Springs Road, Foothills Ballroom, 17th floor, Austin, TX 78704
Organizing for America's 'Let's Get It Done' bus has been making its way across the country calling for real health care reform.
