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January 12th, 2021:

Here’s the official budget forecast

“Could be worse” remains the watchword.

Texas lawmakers will enter the legislative session this week with an estimated $112.5 billion available to allocate for general purpose spending in the next two-year state budget, a number that’s down slightly from the current budget but is significantly higher than what was estimated this summer when the coronavirus began to devastate the economy.

Texas Comptroller Glenn Hegar on Monday announced that number in his biennial revenue estimate, which sets the amount lawmakers can commit to spending when they write a new budget this year. But he acknowledged that Texas’ economic future remains “clouded in uncertainty” and that numbers could change in the coming months.

Hegar also announced a nearly $1 billion deficit for the current state budget that lawmakers must make up, a significantly smaller shortfall than Hegar expected over the summer. That number, however, doesn’t account for 5% cuts to state agencies’ budgets that Gov. Greg Abbott, House Speaker Dennis Bonnen and Lt. Gov. Dan Patrick ordered this summer or any supplemental changes to the budget lawmakers will have to make.

Hegar’s estimates portend a difficult budget-writing session for lawmakers. But Hegar acknowledged that things could have been a lot worse. The $112.5 billion available is down from $112.96 billion for the current budget.

See here for the previous update. I continue to hope that Congress will throw a boatload of state and local aid our way in the coming months, which will also help, but at least we’re not in truly dire territory. And bizarrely enough, there may be a silver lining in all this.

But advocates hope the pandemic, combined with the revenue crunch, could lead to an unlikely bipartisan agreement. Before the pandemic hit, Democrats saw a takeover of the Texas House as key for advancing the prospects of Medicaid expansion in the state. But as COVID-19 has ravaged the state economy and thrown even more Texans into the ranks of the uninsured, Democrats are guardedly optimistic this could persuade enough Republicans to put aside their political hangups and support expansion—even as Republican Attorney General Ken Paxton leads a national lawsuit to eliminate the entire Affordable Care Act.

Texas is one of 12 remaining states that have refused the federally subsidized Medicaid expansion, despite having the highest rate and largest population of uninsured residents in the country. Expanding Medicaid would cover 1 million uninsured Texans and bring in as much as $5.4 billion to the state, according to a September report by researchers at Texas A&M University.

State Representative Lyle Larson, a moderate Republican, voiced his support for expanding Medicaid soon after the election, pointing to six GOP-led states that have done so in the past three years. “It is a business decision,” Larson wrote on Twitter, noting that the move would help with the revenue shortfall and COVID-19 response, address rural hospital closures, and expand access to care. Dallas County Representatives Morgan Meyer and Angie Chen Button, both Republicans, pulled out razor-thin victories to keep their House seats after voicing support for some type of Medicaid expansion in their campaigns.

Even conservative state Senator Paul Bettencourt acknowledged that the fiscal crunch will force consideration of Medicaid expansion. “My back-of-the-napkin analysis shows that’s a $1.6 billion item, like that—boom!” he told the Dallas Morning News in September. “I’m pretty sure we don’t have that falling out of trees,” he said. “You can put Medicaid expansion up at the top of the list. There will be a debate.”

But there’s still plenty of staunch opposition. “For those that promote [expansion], I haven’t heard what they’re willing to cut,” state Senator Kelly Hancock, a Republican who chairs the Business and Commerce Committee, said in November. “It’s easy to talk about it until you have to pay for it, especially going into this budget cycle.”

As with casinos and marijuana, the smart money is always to bet against Medicaid expansion happening. But this is a bigger opening than I’ve seen in a long time, and while that’s still not saying much, it’s not nothing.

Abbott speaks about the vaccination effort

It’s going great! We swear!

More than 877,000 Texans have received a COVID-19 vaccine since they first began arriving in Texas nearly four weeks ago, and that number is expected to increase by at least 50,000 more per day, Gov. Greg Abbott said Monday.

“Never before in the history of this state has Texas vaccinated so many people so quickly, “ Abbott said during remarks at the Esports Stadium Arlington & Expo Center, a newly-designated “vaccination hub” that local health officials said can vaccinate thousands per day. “It’s stunning to see what we’ve accomplished.”

The Arlington center, home to the city’s mass vaccination effort since December, is among 28 sites designed by the state as hubs.

“Our goal is, by the end of the week, we have no vaccines left,” said Tarrant County Judge B. Glen Whitley. The county’s health district was allotted 9,000 doses in the most recent shipment this week.

The hubs are meant to streamline vaccinations at a time when the state is seeing an unprecedented surge in COVID-19 cases, deaths, and hospitalizations. Texas continues to prioritize vaccinating health care workers, people who are 65 and older, and those with medical conditions that increase their risk of hospitalization or death if they contract the virus.

The large sites will receive most of the state’s next shipment of 158,825 COVID-19 vaccine doses this week. Just over 38,000 doses will go to 206 additional providers across the state, including several in rural counties that until recently had not received an allotment.

Officials promise bigger allotments in the weeks and months to come, but a patchwork local system of vaccine distribution, among other issues, has created a tumultuous rollout to the long-awaited vaccine.

On Monday, Abbott said Texas expects to see an additional 310,000 first doses per week for the rest of January and up to 500,000 second doses earmarked for those who have already received the injection in Texas. Continued increases are expected, Abbott said, depending on the federal government allotments.

[…]

The data on the number of doses administered has a reporting lag of at least two days, Abbott said, but added that Texans will start to see a significant uptick in those numbers as this week’s vaccinations are reported.

“You are going to see those numbers increase, as it turns out, somewhere between 50,000 and 75,000 per day,” Abbott said.

Texas Health Commissioner John Hellerstedt said the rate and scale of the state’s rollout has been “a really amazing operation” and said the creation of the hubs would ratchet up the rate of administration.

“Through the kind of vaccination operation we see here, we’re very confident it’s going to accelerate here even more,” Hellerstedt said. “It is really the way forward.”

That’s a lot of number being thrown at us. For sure, 50K per day is a big improvement over the “100K per week” we were at earlier in the year. That was a six-years-to-full-vaccinations pace, whereas 50K per day will get everyone vaccinated in 20 months. At the promised high end of 75K per day, we’re at about 13 months. Still not great – we sure would like to finish this task before 2022, wouldn’t we? – but at least in a timeframe we can envision. Note though that we are not at that pace yet – the 310K first doses per week rate is less than 50K per day, and puts us back at an almost-two-years duration. Again, I do expect things will get better, assuming of course that Abbott and the rest of our state leaders don’t reject federal assistance in the name of stupid partisan politics, but every week it takes us to get up to speed is that much longer to get to where we want to be. The hub approach is a sensible model, but it’s going to take a lot of effort and resources to make it work.

The Minute Maid mega-vaccine center

More like this, please.

The city partnered with the Astros organization to transform [Minute Maid Park] into a site to provide the Moderna vaccine to up to 3,600 health care workers, residents ages 65 and older, and patients with underlying medical conditions. Vaccine distribution was moved from the Bayou City Event Center, which was needed for a different event, giving the city a sneak peek at how the stadium would operate as a mega-site when it officially opens in the coming week.

Divided into three sections, the stadium’s lower level was reserved for the elderly and those with mobility challenges. Volunteers first led participants to a section to complete additional paperwork for the vaccine, then to a waiting area and the official vaccination stations, and finally, an observation area, where health workers watched for any adverse or allergic reactions at least 15 minutes.

[…]

[Mayor Sylvester] Turner, who toured the site, greeting residents with fist and elbow bumps and encouraging volunteers and essential workers, said Minute Maid Park is the largest vaccination site that the city has hosted so far — inoculating 350 people an hour and tripling the total amount of people vaccinated last Saturday at the Bayou City Event Center.

U.S. Rep. Sheila Jackson Lee, who attended an afternoon press conference at the ballpark, said it’s also the first model of a mega-site in the country, which could serve as an example for other major cities also looking to establish similar sites.

The outcome, however, was more than Turner and health officials had originally expected.

The city had around 1,000 doses of the vaccine as of Thursday and decided to scale back vaccinations for the weekend when a delivery was not received, but by Friday morning, the city unexpectedly received an additional 2,600 vaccines, Turner said. The city and the Houston Health Department quickly switched gears, scheduling appointments with people who had pre-registered to ensure that the vaccine was distributed and not sitting, wasted on shelves. They also opened up registration, receiving an additional 1,000 applicants within 20 minutes, Turner said.

Marcel Braithwaite, the Astros’ senior vice president of business operations, said the stadium had already begun preparing earlier in the week and officials were confident in the infrastructure.

“It was more about the logistical flow” and ensuring that there was enough physical space within the building to allow for social distancing in waiting areas and immunization pods, Braithwaite said.

This is great, and as a proof of concept it’s clear that this model can work well. I meant it literally when I said “more like this”, because we’re going to need to replicate this on a much bigger scale in order to make progress against COVID. Remember what I said about the scope of the problem. There’s nearly five million people in Harris County. If we want to get everyone vaccinated by the end of the year, we need to be doing over sixteen thousand inoculations per day, every day. That means we need the equivalent of five of these mega-centers, again operating every day. We need them to be accessible by public transit, we need them open at night so as to get people who can’t get off work (remember those 24-hour early voting centers we had last year? Like that), we need them to take all comers whether they have insurance or a personal physician or access to the Internet to make an appointment, we need people working at these locations who speak a broad variety of languages, and we need all of the personnel for this to be local, both to minimize COVID risk (so no one has to travel) and because literally everywhere else will be doing the same thing so we can’t expect to bring in volunteers from other places. Oh, and baseball season will start in April, so at some point Minute Maid becomes unavailable. How’s all that sound? It’s what we need. And we’re going to need a highly-functional federal government, as well as a much better response from the state government, to have a chance.

Time for our biennial hope for better pot laws

Don’t get your hopes too high. (Sorry, not sorry.)

Five years after Texas legalized medical marijuana for people with debilitating illnesses, advocates and industry experts say the state’s strict rules, red tape and burdensome barriers to entry have left the program largely inaccessible to those it was intended to help.

But with a new legislative session gaveling in next month, some Texas lawmakers see an opportunity to fix the state’s medical cannabis program — known as the Compassionate Use Program — by further expanding eligibility and loosening some restrictions so Texas’ laws more closely resemble those of other states that allow the treatment.

There are 3,519 Texans registered with the state to use medical marijuana, though advocates say 2 million people are eligible based on current law.

Texas’ program pales in overall participation and scope compared with other states: It has fewer enrolled patients and businesses than most other states with medical marijuana programs. At least some form of medical marijuana is legal in 47 states nationwide, but Texas’ restrictions put it in the bottom 11 in terms of accessibility, according to the National Conference of State Legislatures.

“We’re pretty dang close to the bottom. We’re pretty far behind,” said state Sen. José Menéndez, D-San Antonio, referring to how access to Texas’ medical marijuana program fares compared with other states. Menéndez will push legislation in the next session to further expand the program.

[…]

As of Dec. 14, at least seven bills had been filed by lawmakers seeking to expand the Compassionate Use Program. Menéndez is authoring a far-reaching bill that would make more patients eligible, strike the THC cap and lower business fees, among other changes.

“I think we’d see a lot more participation if we had a real medical cannabis program,” said Heather Fazio, director of Texans for Responsible Marijuana Policy.

In the past, medical cannabis bills have faced opposition from lawmakers who see it as a path to legalizing recreational marijuana, Menéndez said. But he says expanding the program will put decisions about who can access the medicine into the hands of doctors.

When the Senate voted to include more patients in 2019, state Sen. Brian Birdwell, R-Granbury, said he was concerned the legislation was more of a “cliff” than a slippery slope.

“I come at this with a highly guarded sense of danger of the direction that this might take us to recreational use,” Birdwell said. “I wouldn’t be comfortable going any further than this because of what I’m seeing in Colorado, Washington and Oregon and what’s happening in those states. I am highly guarded.”

There are a lot more words in there about what Texas does and doesn’t do, and who is affected, and how much better things would be if we had more legal pot, not to mention the economic boost, and you should read them. And then you should remember that nothing is going to pass as long as Dan Patrick – who is for some reason not mentioned in the story – remains opposed to any further loosening of marijuana laws. I support a wholesale loosening of these laws, and there’s plenty of evidence to show that such a loosening would have popular support. Which is why I’d like to see the Democratic slate in 2022 go all in on this. It’s a winning issue, and we’re going to need winning issues if we hope to push Dan Patrick out of there. In the meantime, by all means call your Rep or your Senator and tell them what you support. Maybe your preferred bill will pass the House, or get a Senate committee hearing. That’s likely the best you’ll get for now, but at least it’s something.