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Affordable Care Act Brings $10 Million to Texas Health Centers

Emily Cadik — Fri, 17 May 2013 15:30:00 GMT

The U.S. Department of Health and Human Services (HHS) has made in important step in implementing the Affordable Care Act by providing $9.8 million to Federally Qualified Community Health Centers (FQHCs) in Texas to help them offer in-person enrollment assistance to uninsured Texans. Nationwide, $150 million is being distributed to FQHCs.

The funding will allow FQHCs to hire and train staff, hold community outreach events, educate consumers about their coverage options and eligibility, and assist them in enrolling in the health insurance options available and affordable to them.

According to Stacey Pogue from the Center for Public Policy Priorities, "Three of four people who will be eligible for coverage through the new Marketplace say they want in-person assistance to help to learn about and enroll in coverage." This funding for FQHCs will go a long way towards making that happen.

There are close to 70 FQHCs in Texas, representing more than 300 sites in all regions and close to half of Texas counties. About one million Texans make use of FQHCs each year, and about half of them are uninsured. Of particular importance to Texas is the fact that FQHCs do not deny care based on immigration status. They're an indispensable resource, and a great way to reach and work with uninsured Texans.

Read more after the jump.
Congressman Gene Green (D - Houston), who represents a district with one of the highest uninsured rates in the nation (43 percent of adults and 26 percent of children), said, "Helping eligible Texans access health insurance coverage is critical, and Federally Qualified Health Centers play an essential role in our healthcare delivery system... By providing them the tools to help enroll their patients, it will ensure that the Affordable Care Act works as it is intended."

But Texas has the highest uninsured rate in the country, at 28.8 percent and growing. Over 6 million Texans are uninsured. The health exchanges available through the Affordable Care Act will make a big dent, as will the assistance from FQHCs in getting Texans enrolled. But Texas will still likely retain the unfortunate distinction of highest uninsured rate in the nation without Medicaid expansion. Most other states are taking advantage of it, and without it we'll be left even farther behind.

This funding for FQHC outreach is an important step in getting eligible Texans enrolled in health insurance. But we can go even farther by fully implementing the Affordable Care Act - and that means expanding Medicaid too.

Report Shows Investing in Kids Pays Off

Emily Cadik — Mon, 13 May 2013 15:30:00 GMT

A new report from the Center for Public Policy Priorities's KIDS COUNT Project, Invest in Texas Kids. It Matters., confims that when Texas invests more in its children, children have better outcomes.

Over the past twenty years, investments in per-child spending have tracked with child well-being. Not only did students perform better in school during periods of higher investment, but there were positive trends in the areas of health, safety and other behaviors as well.
The CPPP concluded that, "when Texas kids do better, the U.S. does better" - from 2000 to 2010, half of all of the growth of the youth population in the U.S. took place in Texas., and one out of every eleven kids in the country lives in Texas. If we don't invest now, we'll pay the price later. As the report points out, Texas is ranked as one of the best states to do business, but "one of the worst states to be a kid." Read more after the jump.
It's more than just education spending that leads to these positive outcomes - it's also in the areas of health, nutrition and protective services. Of the spending areas, health and education had some of the biggest multipliers, meaning investments in these two areas were correlated with positive outcomes in the areas of education, health, safety and other positive youth behaviors. Investments in nutrition were also related to better outcomes in education.

According to CPPP researcher Kaeley Bobbitt, "These data confirm that investments in children are wise investments. When we decide to prioritize children by investing in programs that support their growth and development, they do better, and healthy, well-educated, and well-cared for children help ensure Texas' future prosperity."

Unfortunately, our legislature is not making these critical investments. According to CPPP estimates, "more than a quarter of Texas children lived in poverty, more than half did not attend preschool, almost three-quarters of Texas fourth graders were not proficient in reading, and more than one out of every 10 Texas children lacked health insurance." And per-child spending remains about 12 percent below where it should be.

As the legislature closes out the session, it's worth remembering that the investments we make in kids - or lack thereof - have impacts that are real, immediate and far-reaching.

Lilly Ledbetter Fair Pay Act Passes Texas House, Heads to Senate

Emily Cadik — Wed, 08 May 2013 20:00:00 GMT

Texas may soon take some important strides in gender equality.

In late April, the Texas House passed a bill to tweak state laws to conform to the national version of the Lilly Ledbetter Fair Pay Act (the first bill that President Obama signed into law in 2009). It's now heading to the Senate, where a companion measure has already made its way out of committee, thanks to State Sen. Wendy Davis (D-Fort Worth).

In 2012, the Texas Supreme Court ruled that the federal version of the Ledbetter Act doesn't offer protection in state cases. This bill, introduced in the House by Rep. Senfronia Thompson (D-Houston), would extend the Ledbetter Act's protections to state cases, meaning women have more time to sue for wage discrimination and to seek restitution in state courts. Without it, women essentially have to become aware of discrimination and take action within six months of their first paycheck.

The law passed the House by a margin of 79-50, which means there are 50 members of the Texas House - all Republicans - who do not believe women should have more than 180 days from their first discriminatory paycheck to file suit against an employer.

Despite this disappointing opposition, if the bill becomes a law, Texas will be the first state in the nation to tweak its state laws to support the federal act.

The bill will also be an important step in addressing Texas's vast gender wage gap. According to the National Women's Law Center, women in Texas earn 82 cents for every dollar earned by a man. Read about how the wage gap affects different groups of women after the jump.
Austin NOW, the Austin chapter of the National Organization for Women, has some fascinating and disturbing statistics about wage discrimination:

The wage gap persists in female-dominated industries. In education and health services, women on average make just 77 cents for every dollar paid to men. In more traditionally male-dominated fields, the gap widens: in the financial industry, women make only 74 cents for every dollar made by men, and in manufacturing, women make just 71 cents.
The wage gap persists among people with professional degrees. Women with professional degrees are paid just 67 cents for every dollar paid to men with professional degrees. Women with doctoral degrees are still paid less than men with master's degrees, and women with master's degrees are paid less than men with bachelor's degrees.
The wage gap is even worse for women of color. African American women earn 60 cents and Hispanic women earn 45 cents for every dollar that a white man makes. That puts Texas at 39th in the wage gap for African American women and 47th for Hispanic women.
The wage gap results in huge losses for low-wage workers.Women make up 59 percent of low-wage workers and nearly two-thirds of the minimum wage workforce. The typical woman who did not finish high school and who is working full time, year round, is paid about 71 percent of what of her male peer is paid, a gap that translates into an annual loss of more than $8,550 per year. This translates into a loss of over $342,000 over a 40-year career.

The Ledbetter Act may not be able to fix the systematic discrimination that women face in the workforce. But it will at least give women the rights to defend themselves.

Medicaid: Come for the Health Care, Stay for the Quality of Life

Emily Cadik — Mon, 06 May 2013 14:00:00 GMT

A few years ago, Oregon was able to add 10,000 more residents to its Medicaid rolls, even though it had to leave 80,000 people in need off. Since the 10,000 were selected through a lottery, the situation made for an ideal randomized experimental design for comparing outcomes between the new Medicaid enrollees and the uninsured.

Last week, the second batch of results from the experiment was released, showing that those with Medicaid were consuming more health care - especially preventative care. According to the Washington Post, "Here's what we can say with certainty: Medicaid works as health insurance."

But it's not just the increase in care that set the new Medicaid patients apart from those without health insurance. Other benefits included:

A 30 percent decrease in depression rates,
A decrease in the percent of participants who faced out-of-pocket medical expenses totaling more than 30 percent of their annual income from 5.5 percent to 1 percent, and
A 50 percent decrease in the likelihood of experiencing financial strain, like delaying payments on other bills or taking out loans to cover medical expenses.

Read about the conservative response after the jump.
One of the main criticisms against Medicaid, used by Republicans to prevent a Medicaid expansion in Texas, is that it's a worthless form of health insurance. Rick Perry alleged that, "In Texas, only three out of every ten doctors are accepting new Medicaid patients, and we fear that number may actually decrease if expansion went through." (This was a lie. It's actually six in ten.) Also in the same press release was an absurd claim that Medicaid "provides poor care that's even been proven in some cases to be worse than no insurance at all." This study shows that's just not true. If people couldn't find doctors to accept Medicaid, we wouldn't be seeing these increases in care.

Some conservatives are using this study as evidence that Medicaid doesn't work because the health outcomes (blood sugar, cholesterol, etc.) weren't appreciably different between the insured group and the uninsured, with the notable exception of increased diabetes detection and management.

But health insurance isn't just about health - it's also about costs. When you buy car, renters or flood insurance, you're buying into a system that allows you to avoid financial ruin if something catastrophic happens. It's the same with health care.

There are a number of factors that contribute to worse health outcomes for very low-income people: they are less likely to eat fresh fruits and vegetables, less likely to exercise and more likely to smoke, to name a few. Access to health care is a small step in combating these risk factors, but there is much more that needs to be done.

In the meantime, if low-income people can avoid crippling medical expenses and experience a better quality of life by gaining health insurance, it's a worthy investment even if health outcomes for low-income communities aren't reversed.

And yet, as of May 2, most of middle America is still not going to expand Medicaid:

The Oregon study adds one more piece of evidence showing just how much can be gained from expanding Medicaid, especially in a state as populous as Texas. Governor Perry and his allies are running out of excuses.

Texas Legislature May Crack Down on Payday Lenders

Emily Cadik — Wed, 01 May 2013 20:00:00 GMT

Last week, the Senate passed SB 1247, the Payday Lending Reform Bill, with strong bipartisan support. It was considered tougher than expected, in large part due to amendments passed by State Sen. Wendy Davis.

The bill would allow cities to establish payday lending ordinances, impose limits on fees and interest rates, allow civil penalties against payday lenders who try to offer consumers unauthorized products, limit multiple-payment payday loans and auto title loans from extending beyond 180 days or being refinanced, limit the number of credit extensions permitted and impose a "cooling off" period between loans.

Right now, Texas is a pretty good place to be if you're a payday lender. Not so much if you're a consumer. According to the Dallas Morning News: "The Pew Charitable Trusts classified the Lone Star State as one of 28 permissive states when it comes to payday loan regulations. Pew found that 8 percent of Texas residents use payday loans, above the national average of 5.5 percent."

The payday lending bill now has to make it through the House, where the payday lending industry is expected to ramp up its efforts to change the bill from what was passed in the Senate. Sen. Davis doesn't feel too optimistic about its chances there: "They're going over to the House and try to kill it... There are 3,500 payday and auto title storefronts in Texas, more than the number of Whataburgers and McDonalds combined."

But it does have the support of both parties, as well as many consumer advocates. According to the Center on Public Policy Priorities (CPPP): "Texas Impact, CPPP, and other consumer groups supported the committee version of the Senate bill. Among other consumer protections, the committee version would save Texas consumers at least $132 million annually by prohibiting excessive fees."

The Consumer Financial Protection Bureau also released a white paper last week, which found problems with habitual use of payday loans:

"These products may become harmful for consumers when they are used to make up for chronic cash flow shortages. We find that a sizable share of payday loan and deposit advance users conduct transactions on a long-term basis, suggesting that they are unable to fully repay the loan and pay other expenses without taking out a new loan shortly thereafter. Two-thirds of payday borrowers in our sample had 7 or more loans in a year. Most of the transactions conducted by consumers with 7 or more loans were taken within 14 days of a previous loan being paid back-frequently, the same day as a previous loan was repaid... It is unclear whether consumers understand the costs, benefits, and risks of using these products."

The New York Times reported that federal regulators will soon be cracking down on payday loans as well by focusing on the big bank competitors to payday lenders, like Wells Fargo and U.S. Bank, which offer short-term, high-cost loans tied to checking accounts. Soon, banks will have to assess a consumer's ability to repay the loan before issuing it, and to impose a mandatory 30 day "cooling off" period between loans to prevent consumers from taking out even more loans to cover debt on previous loans.

Texas on the Brink: Texas Ranks in Bottom Five States on Important Education Measures

Emily Cadik — Wed, 24 Apr 2013 20:00:00 GMT

Texas on the Brink, the report from the Texas Legislative Study group on the state of our state, has a lot of damning statistics about Texas's standing on a variety of issues. We've already covered democracy and health - today we look at education.
And there are several distressing rankings in which Texas comes in last, or close to it:

Average SAT scores (47th)
Estimated public high school graduation rate (44th)
Percentage of population graduated from high school (50th)

And why might that be? Find out below the jump.
As it turns out, Texas also comes in 43rd for in expenditures for public K-12 schools per student. The Dallas Morning News found that "Texas schools are spending $8,400 per student in the current school year, well under the national average of $11,455. Only Arizona and Nevada spend less among the 50 states and the District of Columbia." Texas also comes in 31st on average teacher salary according to Texas on the Brink.

The results have caused cuts that directly impact education quality. The Dallas Morning News also found that, "School districts have coped with the funding cuts by increasing class sizes in all grades, laying off teachers and other school employees, and eliminating a variety of programs. In addition, remedial classes for low-achieving students have been sharply scaled back and school improvement projects have been deferred." And according to Texas on the Brink, "31 percent of full-time teachers in high poverty middle schools were assigned to teach courses outside their field of expertise."

The result is a decline in academic performance: "There is also evidence that Texas has been slipping academically. On the SAT last year, Texas high school students matched their lowest scores on the college entrance exam in more than a decade as average scores dropped in math, reading and writing... A Texas Education Agency analysis last year found that schools with the highest performance ratings were generally those that spent more on their students." The education system in Texas is chronically underfunded, and as a result, is chronically underperforming.

As a sovereign nation, Texas's economy would be the 14th largest in the world. But it won't stay that way if we don't invest in the next generation of Texans.

Legislative Study Group Report Shows Disturbing Health Statistics for Texas

Emily Cadik — Tue, 16 Apr 2013 20:30:00 GMT

Yesterday we posted about the Legislative Study Group's Texas on the Brink report, which finds that the state of our state is not great. It takes a lot of factors into account - education, women's issues, the environment and the workforce, to name a few - and there's a lot to unpack. But one of the most timely issues, given the ongoing debate over whether to expand Medicaid in Texas, is health care.

We already know that Texas has the highest uninsured rate in the nation. But some other rankings also stand out:

Percent of low-income population covered by Medicaid: 48th
Percent of population with employer-based health insurance: 43rd
Health care expenditures per capita: 46th
Per capita state spending on mental health: 50th
Percent of women who receive pap smears: 41st
Percent of women over 40 who receive mammograms: 42nd
Percent of women who receive prenatal care in first trimester: 50th

And the lack of investment in health care has noticeable impacts on health:

Cervical cancer rate: 8th
Percent of adults who are overweight or obese: 8th
Prevalence of diagnosed diabetes: 15th
Percent of babies born at low birth weight: 19th

The lack of investment in health care now is going to become an even bigger problem down the road. When the state doesn't invest in preventative care, people don't get that care as much as they should (see this already happening: pap smears, mammograms, etc.). When people don't get preventative care, they are at risk for more serious health problems (see Texas's cervical cancer rate), not to mention higher health costs, which could have been avoided.

Fortunately, the Affordable Care Act will soon make health insurance available for many uninsured Texans via health exchanges. But there will still be millions of low-income Texans who can't afford it - people that we need a Medicaid expansion in order to reach. Most states are taking advantage of the immense resources the federal government is devoting to this expansion. Without it, Texas will fall even farther behind.

How Do We Turn the Uninsured into the Insured in Texas?

Emily Cadik — Mon, 15 Apr 2013 14:00:00 GMT

The Affordable Care Act will soon make a huge dent in Texas's staggering rate of 6 million uninsured, over 1 million of which are children. Since the hard part was of course getting the law passed, it's easy to underestimate the challenge yet to come - getting eligible Texans signed up.

Non-profits and advocacy organizations have stepped up to take on this challenge at a national level, as well as in some states. Enroll America and Get Covered America, for instance, are working to raise awareness of the ACA in order to get the $50 million uninsured Americans insured. But what about in Texas specifically?

A bill in the legislature this session (HB 459) authorizes an ACA Navigator program in state law to coordinate with the federal-level program, which will be ramping up soon. Navigators provide in-person assistance (beyond the existing networks of community health centers, insurance agents and other health organizations) to help uninsured people understand what they're eligible for and get them signed up.

According to Stacey Pogue from the enter for Public Policy Priorities,

"Three of four people who will be eligible for coverage through the new Marketplace say they want in-person assistance to help to learn about and enroll in coverage. Navigators will help meet this increased demand for in-person enrollment assistance and can tailor outreach efforts to Marketplace enrollees who are lower income, less educated, more likely to be uninsured, more racially and ethnically diverse, and more likely to speak a foreign language than people who are insured today."

In addition to hopefully getting a state-level Navigator program, it'll be interesting to see what emerges in Texas to make sure that enormous share of uninsureds are actually taking advantage of what will soon be available - especially given the Governor's resistance to the ACA.

Hospitals Turning Away More Uninsured Patients, and Still No Medicaid Expansion

Emily Cadik — Wed, 10 Apr 2013 15:30:00 GMT

The refrain we keep hearing from Perry and company is that Texas just doesn't need a Medicaid expansion - we don't have much to gain and we already have a solid health care network. But as it turns out, the state has basically been taking federal money away from state-run hospitals and using it to fill its own budget shortfalls.

According to the Houston Chronicle:

Texas is diverting millions of dollars of federal money intended to reimburse three state-owned hospitals for uninsured care and shortfalls in Medicaid payments, University of Texas officials say. That money, which is rerouted into a general fund, otherwise would offset expenses that the University of Texas Medical Branch, M.D. Anderson and UT Tyler incur providing care for the uninsured...
The intent of the federal programs is for the state and federal governments to repay the hospitals, but Texas contributes no money and instead forces the state hospitals to provide the state's contribution, then takes the federal contribution for the general fund. The hospitals are never compensated for the cost of caring for the uninsured and for shortfalls in Medicaid payments, according to officials at UTMB, UT Tyler and the Texas Health and Human Services Commission.

Failure to reimburse hospitals means they can serve fewer uninsured patients. They're turning people away that they're supposed to be able to help, and are even receiving money to help.

And it keeps getting worse. For instance, according to the Texas Observer:

In 2011, UTMB denied 91 percent of uninsured Texans seeking medical care, according to a new report from a nonprofit coalition advocating for Galveston County's uninsured residents. That's a sharp increase; in 2005, UTMB turned away just 35 percent of uninsured people seeking care.

Unfortunately, taking the funding for the uninsured for other purposes has been the legislature's band-aid for budget issues since 1986. Rick Peters, bureau chief of the former Texas Department of Health, now the Department of Health Services, from 1986 to 1999, says, "That's how that budget crisis got solved... That freed up a bunch of money to be rolled back to the general fund."

Expanding Medicaid would insure millions of additional Texans - Texans who are more and more often being turned away by hospitals. But according to the Governor, Senator Cruz, Senator Cornyn and many in the Texas legislature, our state doesn't really need it.

Perry, Cruz and Cornyn Spreading More Medicaid Lies

Emily Cadik — Sat, 06 Apr 2013 19:00:00 GMT

On April 1, Governor Perry and Senators Cornyn and Cruz hosted a press conference and issued a joint press release, in which they again made the flimsy case against Medicaid expansion. Sadly, it was not an April Fools joke.

In the press conference, Perry claimed that, "In Texas, only three out of every ten doctors are accepting new Medicaid patients, and we fear that number may actually decrease if expansion went through." His numbers are just wrong.

Read more below the jump.
Politifact did some digging, and found that it's actually more like six in ten. While it's true that 32 percent of Texas physicians accept all new Medicaid patients, an additional 26 percent on top of that admit Medicaid patients with some limitations. That means that closer to six in ten physicians accept at least some new Medicaid patients.

And the numbers were corroborated by recent data from the the Health and Human Services Commission:

The Texas Health and Human Services Commission told us that some 67 percent of the state's physicians had accepted Medicaid at least once during a recent 12-month period. Agency spokeswoman Stephanie Goodman told us by email that 34,290 Texas physicians had claims paid by Medicaid in the fiscal year that ran through August 2011. According to the Texas Medical Board, there were nearly 51,000 practicing physicians in the state at about that time.

In the press release, a similar statement is made in a quote from Brooke Rollins of the Texas Public Policy Foundation, that Medicaid "provides poor care that's even been proven in some cases to be worse than no insurance at all, and over two-thirds of Texas physicians won't accept new Medicaid patients."

Aside from the absurdity of the assertion that having health insurance is actually worse than not having health insurance, their source is highly questionable.

Before becoming President of a 'free-market' think tank, Brooke Rollins was Perry's Deputy General Counsel. She has a background in law and agriculture development. It's not that people who aren't doctors can't speak about Medicaid. But if the Governor and our two Senators are going to try to reject Medicaid by saying the care isn't of a high enough quality, quoting a former Perry staffer with no connection to health care or the medical field is not compelling, to say the least.

That's because the Governor and our Senators are grasping at straws. They're turning down a huge amount of coverage and a huge amount of money for the sake of giving the finger to the President - without any solid arguments or evidence to support them.