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Jane Nelson

Double secret illegal Medicaid amendment amended

Yes, I know, it’s all so confusing.

It's constitutional - deal with it

It’s constitutional – deal with it

The House on Sunday night accepted Sen. Jane Nelson’s and other lawmakers’ clean up of an amendment by a freshman state representative from Collin County that would require a rubber stamp from the Legislature before Medicaid could be expanded to cover more able-bodied adults.

Basically, they feared Rep. Jeff Leach’s provision could screw up two things — some shifts of the state’s most disabled individuals between so-called “Medicaid waiver programs,” as the bill attempts to improve and shrink the cost of their long-term care services; and the scheduled addition to Medicaid of foster children through age 26 and a subset of youngsters now on the Children’s Health Insurance Program. Under the federal health care law, some current CHIP recipients — those ages six through 18 and just over the poverty line — will have to be shifted to Medicaid. That and the extension of coverage for former foster children are noncontroversial requirements of the federal health care law.

The long term care bill, which would expand use of managed care in Medicaid, received final House approval and was finally sent to the governor. The vote was 146-1.

Last week, Leach, R-Plano, added the provision to the measure by Nelson, R-Flower Mound. Effectively, it would have barred the Texas Health and Human Services Commission from accepting anyone into Medicaid who was not eligible under this year’s rules as of Dec. 31. Leach said he wanted to make sure lawmakers, not just Gov. Rick Perry, have a say on whether Texas expands Medicaid to cover uninsured adults of working age. Texas currently covers almost none.

Rep. Richard Raymond, a Laredo Democrat who was House sponsor of Nelson’s bill, said the new language added by House-Senate negotiators makes sure Leach’s amendment does no collateral damage.

“We have been able through the years to get waivers” for disabled and elderly Texans to stay out of nursing homes and large group homes, he said. But the bill will put those services under managed care, he noted.

See here for the background. Basically, the committee report clears up the aspects of Leach’s amendment that could have caused real problems, and leaves the largely symbolic “do nothing without the Lege’s OK” provision in place. As I said before, it’s not like Medicaid expansion is going to happen without major changes to the state government, if it ever does.

Senate to consider expanded gambling

I didn’t really take it seriously when I heard that Sen. John Carona had filed his own gambling expansion legislation, but it seems it’s got some traction.

Sen. John Carona

A proposal from Dallas Republican Sen. John Carona would establish a commission that licenses 21 casinos throughout the state, including three mega-resorts in Bexar, Dallas and Tarrant counties and two smaller locations at Retama Park in San Antonio and Sam Houston Race Park in Houston.

Carona, chairman of the Senate Business and Commerce committee, told reporters Monday the proposal would keep the estimated $3 billion Texans are spending at casinos in bordering states inside state coffers while creating more than 75,000 jobs. The committee, which will consider the measure Wednesday, is likely to pass the proposal on to the full Senate, he said.

“No one can really determine yet what chance of ultimate passage it has this session,” Carona said in an interview in his Capitol office, noting his vote tally indicates both chambers are a few votes shy of approval. “It is a difficult bill because of the presumed political consequences of it, but the polls show there is overwhelming public support.”

House Appropriations Committee Chairman Jim Pitts, R-Waxahachie, who has supported similar measures in the past, said the chances of gambling passing the Legislature this session are “slim-to-none.”

However, Pitts said the final decision on the state’s school finance trial could provide a boost for gambling in Texas. If the current ruling – that the state’s public education funding is inadequate and unconstitutional – stands, lawmakers will be searching for a new source of revenue that does not create a new tax, he said.

[…]

Under Carona’s proposal, three casinos would be licensed in coastal counties, 12 would be reserved for racetracks and three would be designated for federally recognized Native American tribes.

The majority of revenue generated – 85 percent – would be dedicated to the Property Tax Relief Fund, which supports local programs, such as public education and emergency services. Remaining revenue would belong to city and county governments and fund programs to counter gambling problems. The constitutional amendment must gain two-thirds support of the House and Senate before moving on to voters in a statewide referendum.

Sen. Carona’s measure is SJR 64. If you’ll pardon the expression, the smart money is on nothing happening, as has always been the case before. The Trib goes into some more detail.

[Carona has] been working on casino legislation for the last few sessions, but his plan this year is much more comprehensive. In the past, gaming bills have either had the support of casinos or race tracks. But not both.

That split support had doomed the efforts. This time, Carona said, both groups are on board.

“Let me make clear that this legislation has very broad support,” he said. “While not all stakeholder concerns are resolved in this bill, we have come a long way. And it is my hope that we’ll continue to work together to bring forward a bill that is best for Texas.”

The senator said his legislation is still fluid — many changes could be made. So for now, there’s no price tag on how much money casino gambling would generate. But billions are expected from the three giant destination resort casinos and 18 other facilities that would be authorized under his resolution.

[…]

But hey, if you want to pass something in the Legislature, you need to do one of two things: Show what problem the legislation would fix or, as casino supporters did this week, show an enemy that would be defeated by this bill. And according to casino supporters, we have met the enemy — and it is Oklahoma.

“In particular, we’re hemorrhaging money to Oklahoma,” said John Montford of Let Texans Decide. “Not only do they recruit our best high school football players. They also snooker us each day by building their gaming empire on the backs of Texans.”

Texas Association of Business President Bill Hammond was even less diplomatic when explaining what he sees as the benefits of casinos in Texas.

“Texans will no longer have to travel to third-world countries in order to game,” Hammond joked. “It’s unfair and unconscionable that we are making these people travel to these third-world counties that surround Texas.”

The state’s hatred of Oklahoma aside, there are still several roadblocks to casinos in Texas. Carona’s resolution needs a two-thirds vote in the House and Senate before it heads to the ballot as a constitutional amendment this November.

And on the Senate side, Jane Nelson, R-Flower Mound, has a history of threatening a filibuster over gaming legislation. As debates have neared in the past, she has even put tennis shoes on her desk on the Senate floor to let people know she’s ready to go if needed.

And, of course, if a resolution passes the House and Senate, then there’s the final statewide vote — a vote that will certainly include groups opposing casinos on moral grounds along with some backed by those neighboring states’ casinos that don’t want to lose business.

The 100-vote threshhold in the House is pretty daunting. Speaker Joe Straus will not be an ally, since he stays away from gambling bills to avoid talk about conflicts of interest, and there’s likely to be enough social conservative opposition to make it at best a close call. Still, even getting a bill out of committee in the Senate is farther than the gambling expansion forces have gone in the past. If Carona’s bill can actually make it to the floor in both chambers, who knows? Stranger things have happened.

You can’t undo the damage to women’s health

At the very end of this story, in which Rep. John Zerwas and Sen. Charles Schwertner, both of whom are physicians in real life, say that they (mostly) stand with Rick Perry on not expanding Medicaid, they also say this:

Regarding the budget cuts in the last legislative session to family planning and women’s health care, both lawmakers said they support an initiative this session to restore funding by way of primary care programs.

“We’re going to recommend a funding level for [women’s health] … at about 50 percent higher than what they had originally asked for,” Zerwas said.

That’s mighty big of them, isn’t it? We’ve also recently heard about some similar sentiments elsewhere in the Senate:

Health and Human Services Committee Chair Jane Nelson, R-Flower Mound, touted a recommendation Thursday to add $100 million for women’s health services to the Senate’s budget proposal.

The recommendation was adopted by a working group of senators who serve on the Senate Finance Committee. Nelson heads the working group.

“It’s time for us to unite behind solutions we can all agree are in the best interest of keeping Texas women healthy. I believe in the power of prevention, and our plan will ensure that Texas women have access to the best possible preventive services such as cancer screenings,” Nelson said in a statement.

She also said the state must expand its provider network, provide more access for women in rural areas of the state and “recognize that family planning is a critical component of our efforts to support the health of Texas women.”

Nelson said the Senate’s starting-point two-year budget contains about $114 million for women’s health. Her workgroup proposed adding $100 million for women’s health through the Community Primary Services Program.

That program is different from the family planning program, whose funding was slashed by about $73 million, or two-thirds, two years ago by the GOP-dominated Legislature.

We are also aware of a bipartisan legislative group that is rethinking those family planning cuts. Before anyone dislocates a shoulder patting themselves on the back, however, I’d like to point out that some things, once broken, can’t be fixed.

Now, seven months later, the clinics remain closed. Shaw, who still runs other programs at Hill Country Community Action, recently told me that only 110 clients have called the agency for directions to other providers. The receptionist refers patients to Round Rock or Waco. When I called those providers, I was surprised to find that they could offer me next-day appointments. Though 98 percent of Hill Country Community Action’s clients had received well-woman care for free, this is not the case at other clinics. No longer able to participate in the Women’s Health Program for political reasons, Planned Parenthood in Waco must now charge patients for care. A well-woman exam, for example, costs $99. Women’s Health Program clients can be seen for free in San Saba at a local Scott & White provider, but that clinic charges full-fee to those who don’t qualify: women under 18 or over 44 or who can’t prove that they are legal citizens. An office visit at the Scott & White clinic would cost $83. Similarly, Lone Star Circle of Care in Round Rock provides services on a sliding fee scale based on income. None of their services are free.

It was more difficult to track where other displaced clients had gone. A Scott & White staffer told me by phone that she hadn’t seen an increase in new patients since Hill Country Community Action closed its clinics. Similarly Lone Star Circle of Care, via an email from director of communications Rebekah Haynes, said that the number of patients the Round Rock clinic had seen from San Saba was relatively small. The Planned Parenthood health center in Waco had seen a significant uptick. Danielle Wells, assistant director of communications for Planned Parenthood of Greater Texas, said by email that in 2012, the Waco health center had served 10 to 15 times as many patients from the zip codes once served by Hill Country Community Action as the year before. Clearly, some displaced patients have found new providers, but others haven’t. Time will tell what effect the closures will have on the reproductive health of those others, but public-health policy analysts are expecting an increase in unintended pregnancies and the number of births covered by Medicaid.

Texas’ new family-planning infrastructure is in flux. The Texas Legislature has three months left in its 83rd regular session, and advocates are lobbying for lawmakers to restore money while public-health specialists are scrambling to study the impact of the state’s defunding of family-planning clinics. In San Saba, even if funding is restored, it would be difficult to reopen the clinics. The staff has mostly moved on to other jobs. Gina Woodward now works for her family business, having hung up her stethoscope for good. After months at home, Melody Ball started a job in another field this month. Eva McDuff is still without work. I asked Tama Shaw if she might revive the family-planning program if funds are restored from the state or federal government. “It would take too much startup money, because the facilities are gone,” Shaw said. “We couldn’t start up again. Everything is gone.”

Those are the last three paragraphs in a story about a small community clinic in San Saba that had to close its doors after getting shafted by the 2011 Lege; see also this story from last year about other clinics around the state getting devastated. Some services will be restored in some places for some people, but sometimes you can’t un-ring the bell, or perhaps more appropriately, you can’t un-fertilize the egg. Everyone who voted for those cuts in 2011, no matter what they do this session, will forever have that stain on them.

Is there a way forward on expanding Medicaid in Texas?

It’s a little hard to know what to make of this.

It’s constitutional – deal with it

The Affordable Care Act is the federal law that Texas Republicans love to hate, but one top lawmaker says expanding health care for the working poor could happen if federal authorities are willing to strike a deal.

Republican Sen. Jane Nelson, chair of the Health and Human Services Committee, said she hopes the Centers for Medicare and Medicaid Services will allow Texas to receive $27 billion to expand Medicaid. But she said the key is to allow lawmakers to develop a Texas-specific program that will not blow the state’s budget.

“I am still open to anything that will allow us to have the flexibility that we need, and that will also give us the assurance that it’s not going to put us deeper in debt,” Nelson told The Associated Press in an interview.

[…]

Gov. Rick Perry has rejected the Affordable Care Act as an affront on state’s rights and said he wants the federal money with no strings attached in a block grant. The Perryman Group, an independent economic consulting company, estimated that Texas will miss out on $90 billion in increased economic activity and leave at least 1.5 million people uninsured if it does not expand Medicaid.

Nelson said a block grant was not the only way to reach a deal. She said a waiver that would allow the state to develop a tailor-made program within certain federal boundaries might be enough.

[…]

Nelson is among those who want to require some recipients to contribute toward their health care costs — such as paying income-based premiums or co-payments — something federal authorities have until now have rejected under Medicaid. She said Medicaid can also be made more efficient.

Last week Nelson announced legislation intended to make it easier to identify and punish those who defraud the program.

“We’ve got to address these root problems before I will support expanding it,” Nelson said.

Nelson identified Rep. Garnet Coleman, D-Houston, as a key player in working toward a deal with federal officials. Coleman has said he supports a limited requirement for some Medicaid patients to pay part of their health care costs, adding that he believes a deal is possible. Health and Human Services Commissioner Kyle Janek has said his staff is working with federal authorities to see what’s possible.

I don’t know where that $27 billion figure cited by Sen. Nelson comes from. The number usually thrown around is $100 billion in federal funds for the first decade of expansion. If I had to guess, I’d say the $27 billion is for the first two or three years when the feds are picking up all of the tab; it goes down to 90% reimbursement after that. It would have been nice for the story to be more clear on that. As for the Perryman study, see here for the background.

Beyond that, it’s not clear what kind of plan Nelson has in mind. This is the first I’ve heard of this, and there’s no detail in the story to indicate what Nelson’s basic idea is. It’s true that the Obama administration has been flexible in working with the states on matters relating to the Affordable Care Act, but such flexibility only goes so far. What is the state willing to do to be in compliance with the law? If Rep. Coleman really is on board with this, then I have some optimism that a deal can be made, but let’s get some information first. And unless part of the plan is to get Rick Perry’s assurance that he won’t veto whatever bill gets passed, it’s all a waste of time.

Dewhurst and Nelson push Medicaid reform

I’m reserving judgment on this for now.

Sen. Jane Nelson

Lt. Gov David Dewhurst and Sen. Jane Nelson, R-Flower Mound, on Wednesday touted Senate proposals they say would bring down spending on Medicaid, the state’s health program for the poor, by instituting quality-based payment reforms for long-term care services and measures to catch Medicaid fraud and abuse.

“Our Medicaid costs have doubled, doubled since 2002-2003,” said Dewhurst, adding that Medicaid costs are crowding out room in the budget for “services people in Texas want to see,” such as public education, higher education and transportation.

Dewhurst said Senate Bills 7 and 8, filed by Nelson, the chairwman of the Senate Health and Human Services Committee, would bring down ballooning state Medicaid costs. “What we’re trying to do, Senator Nelson and myself, is improve the quality of health care for our Medicaid population” by providing incentives that lead to better patient outcomes.

The idea of payments based on medical outcomes rather than simply payment for services rendered is of course one of the cornerstone reforms of the Affordable Care Act. Given the Republican origins of many parts of the ACA, it’s hard to say if Dewhurst and Nelson are cribbing from it or if they’ve just gone old school. Either way, I’m quite certain that they would recoil from any attempt to compare their bills to the ACA, because of socialism or something like that.

SB 7 would redesign long-term and acute care services for the disabled and elderly — the most costly services in Medicaid — by instituting quality-based payment systems and expanding Medicaid managed care to cover services provided in nursing facilities.

SB 8 would ensure that providers found guilty of Medicaid fraud in Texas or other states would be barred from participating in the state’s program, strengthen prohibitions against marketing to Medicaid patients, add medical transportation services to managed care and enable the Health and Human Services Commission’s Office of Inspector General to establish a new data system to catch Medicaid fraud earlier.

Nelson highlighted that the OIG has identified more than $6 billion in fraud and waste between 2004-2011 in Medicaid, and she said a computerized claims monitoring program could be used “to identify outliers, anomalies and red flags in the Medicaid program so we can deal with those abuse trends on the front end.”

I want to hear from the professional wonks about this, but the Trib story doesn’t have any such quotes. Looking elsewhere, I do find some reactions. Here’s one in the Statesman:

Anne Dunkelberg, associate director of the Center for Public Policy Priorities, said Nelson’s goals of eliminating fraud and trying to create a Medicaid payment system that doesn’t provide incentives for too much or too little care “are goals everyone shares.”

Dunkelberg said her organization, which advocates on behalf of low-income Texans, will watch certain issues, particularly attempts to target fraud in the Medicaid transportation system, which many children, elderly Texans and disabled people rely on to make medical appointments.

Fairly nondescript, but not negative, which is good. Here’s the Chron:

It’s important for the state to take steps including making every effort to prevent providers from defrauding the state, said Bee Moorhead, executive director of the interfaith advocacy group Texas Impact. But Moorhead said the legislation touted Wednesday “is not the heart of the matter.”

“The biggest Medicaid problem Texas has is (that) so many people should be getting it, but aren’t,” she said.

Moorhead said more than 1 million children are eligible for health care but aren’t getting services. She also noted the opportunity for Texas to add 1.6 million people to Texas Medicaid over a decade through the expansion.

More of the same, so it would seem there isn’t anything particularly controversial. Going after fraud is relatively low-hanging fruit, and is unlikely to generate much opposition. Who doesn’t want to prevent fraud, and to punish those who do offend? I’d just note that any line item based on “money saved from fraud detection and prevention” is likely to be questionable, and anti-fraud measures have their own costs, since it takes people and other resources to investigate, prosecute, and collect repayments.

Expanding Medicaid is indeed the heart of the matter, but we know how that’s going to go.

Dewhurst also announced at Wednesday’s news conference that Texas would not expand Medicaid to cover impoverished adults, as outlined by the federal Affordable Care Act. “One size does not fit all in the health care arena,” he said, explaining he would rather apply for a block grant from the federal government to run the state’s Medicaid program independently.

Republican lawmakers have been under pressure to expand Medicaid to bring down the rate of uninsured and cut uncompensated care costs for hospitals and local government entities. Some Republicans in other states — such as Arizona Gov. Jan Brewer — have agreed to support the Medicaid expansion.

The Legislative Budget Board — headed by Dewhurst and House Speaker Joe Straus — issued a performance review on Wednesday morning recommending that the state empower counties to choose whether to expand Medicaid. Supporters of the Medicaid expansion say turning the decision power over to counties would relieve political pressure on Republican leadership.

The LBB report recommends that lawmakers pass a statute allowing counties to use local revenue to fund the expansion. In that way, local money that is currently spent on uncompensated care for the uninsured could be used to pull down $2.5 billion in federal funds for the 2014-15 biennium and cover 1.3 million impoverished adults in the six most populous counties.

The Chron quotes Dewhurst as saying expansion is off the table “at the present time”, for whatever that’s worth. I can’t say I expected Dewhurst to say anything different about Medicaid expansion – it would have been a bombshell if he had – but there are other aspects of the ACA that will affect Texas whether Dewhurst et al like it or not. This may not have been the venue to address that, but it would be nice to hear what he and others think about that. Be that as it may, here’s what that performance review says about Medicaid expansion:

Of the 535 hospitals in Texas, 108 hospitals owned by city, county, or hospital districts accounted for 48 percent ($1.5 billion) of charity care spending reported in fiscal year 2011. Most of the charity care (94 percent) local public hospitals provided was attributable to six hospital districts—Bexar, Dallas, El Paso, Harris, Tarrant, and Travis. Local public hospitals that account for a significant amount of uncompensated care spending report that 90.8 percent of patients receiving some form of charity care were non-elderly adults. With certain exceptions, federal law allows states to use intergovernmental transfers to obtain funds for use as the non-federal share for Medicaid services. By using local funds as the non-federal share for expanding Medicaid to newly eligible population, Texas could generate an estimated additional $2.5 billion in Federal Funds for fiscal years 2014 and 2015.

I had previously noted an announcement by the Center for Medicare and Medicaid Services saying that there would be no option for a “partial or phased in Medicaid expansion”. My interpretation of that was that it meant the county option for Medicaid expansion had been mooted. Obviously, the LBB and I can’t both be right, and I’d assume they’re the ones that are correct. I haven’t heard much on this option, if it still is one, since September, so I have no idea if anyone in the Lege is currently pursuing this. Dewhurst said that neither he nor Sen. Nelson endorsed the idea, which isn’t the same as saying they opposed it but which does present an obstacle. The Chron story has reactions from the type of people who might want the Lege to provide this option:

Local officials said their first choice would be for Texas to expand the program statewide. That would provide a uniform program across Texas and ensure a funding source while relieving them of some of their costs of uncompensated care.

The Legislative Budget Board assumed the higher match would apply for newly eligible adults with a county-based expansion.

If counties were to do an expansion, local officials said it would be important for private hospitals to contribute, not just leave the cost to local taxpayers. They suggested a fee as one option.

David Lopez, president and chief executive officer of the Harris Health System, said, “If this becomes a local option, then … everybody needs to have skin in the game.”

Ron Cookston, executive director of Gateway to Care, a Harris County-based nonprofit collaborative focused on health care, said letting communities manage expansion could have a real benefit, but a state-level expansion would be preferable.

“If it is not done at the state level, there is going to be, community by community, variations in the services … ,” Cookson said. “That creates an infrastructure nightmare.”

That second paragraph makes it sound like the LBB isn’t fully certain that county-based expansion is an actual option. It would be nice to have some clarity on that. As I said before, one does have to be concerned that if some counties opt to expand Medicaid on their own, some others will try to leech off of that, which is unfair all around. The county folks clearly understand this. Full statewide expansion is the only way to deal with that, but that ain’t happening, at least for now.

One more thing, from Trail Blazers:

Dewhurst and Nelson repeated their opposition to expanding Texas’ Medicaid program to add non-disabled adults between 18 and 65 whose incomes are below 138 percent of the federal poverty level. The federal health care law provides full funding of adding the adults for three years and will pick up at least 90 percent of the cost after that. But Texas Republicans have said they fear federal deficit-reduction efforts will undo the federal government’s promise to pay most of the cost. Nelson said she’s “concerned about the cost three years from now.”

If that’s your concern, then tell your colleagues in Congress to tone down their deficit obsession, which as we all know only really manifests when there’s a Democrat in the White House. The White House has already come to the realization that including Medicaid in any deficit-reduction “grand bargains” would undermine their own efforts to expand Medicaid, so I’d largely consider Nelson and Dewhurst’s concern to be no big deal. Unless Republicans get their way at the national level and disembowel Medicaid via the Ryan budget or something similar, of course. As above, I don’t really expect them to embrace my line of thinking here. The Observer has more.

Fix what’s broken first

What Texas Watch says.

Texas Watch

Imagine this scenario. Texans are facing a physician shortage. Under-served rural and poor communities struggle to attract doctors to serve their needs. Politicians scramble to find a solution to the crisis. That is where we were 10 years ago. Things aren’t so different today.

Back then, the lobbyists and political spinmeisters promised that if we gave up our ability to hold a dangerous doctor accountable, then we’d see the physician supply problem – and a host of other problems in our health care system – evaporate. So, voters narrowly passed an amendment to our state’s constitution that gave politicians the ability to eviscerate legal accountability when you are needlessly harmed by medical negligence.

Flash forward to today. Under-served communities continue to struggle to attract good doctors. Our state ranks near the bottom in per capita physicians. Not to mention the fact that our health care costs are higher and quality of care is worse. And, yes, politicians are scrambling to find a solution.

Evidently the policies enacted 10 years ago haven’t worked. Otherwise, why would this still be a problem needing additional legislative action?

This time, they are considering legislation by Sen. Jane Nelson, chair of the Senate Health & Human Services Committee, to improve physician supply by increasing the number of residency slots available, rewarding medical schools that find ways to keep doctors in Texas, and forgiving medical school loans for doctors who agree to see poor patients. These are laudable goals and lawmakers should support the bill.

The real question, however, is this: Since we know that tearing up our constitution under the guise of better health care is a failed policy, why don’t we restore the patient protections first? Not only has this failed idea not solved the doctor supply problem, it hasn’t lowered health costs for families or the state. Nor has it improved the quality of care. We are, in fact, dead last in the nation in terms of quality of care.

Politicians – including Gov. Perry – should stop defending this policy that has torn a hole in our constitution. Instead, they should restore accountability so that when one of the very few doctors who commit most of the medical negligence harms a patient, they are held responsible for it. They and their insurance companies – not taxpayers or the injured patient – should bear the cost and face public scrutiny for their decisions.

Let’s move forward to address the physician supply problem honestly and without cynicism. Sen. Nelson is on the right track. Incentivizing good doctors and hospitals to serve Texans is a great idea worthy of support. But the first step is admitting when we have made a mistake and fixing it.

I don’t really have anything to add to that. Tort “reform” has always been a crock and a scam, and the only beneficiaries of it have been the insurance companies and bad doctors. And because it’s in the constitution, we’ll probably never get rid of it.

On peeing in a cup

Another solution in search of a problem from the Republican leadership.

Out of the more than 250 bills filed Monday, the first possible day to file legislation for the 83rd session, one measure — concerning drug testing for welfare applicants — is already drawing the support of the state’s top lawmakers and the criticism of civil liberties advocates.

Senate Bill 11 would require applicants to the Texas Temporary Assistance for Needy Families program to undergo a drug test. If applicants fail the test, they would not be eligible to apply again for a full year, unless they attended a substance abuse treatment program. The bill was written by state Sen. Jane Nelson, R-Flower Mound, and several other Republican lawmakers.

“This will help prevent tax dollars from going into the pockets of drug abusers,” Gov. Rick Perry said Tuesday at a news conference. He said that the goal of the bill is to “empower every Texan to reach their potential,” because “being on drugs makes it harder to begin the journey to independence.”

“It is a legitimate function of government to help people that are not able to help themselves,” added Lt. Gov. David Dewhurst. He said that because “virtually every” business he has encountered uses random drug testing on employees, it’s a good idea for the state and will lead to reduced unemployment by proving to employers that the people they are hiring have been certified by the state as drug-free.

“We owe it to all Texans to structure our welfare and unemployment programs in a way that guarantees that recipients are serious about getting back to work,” he said.

“This is not all about punishment,” Perry added. “This is also an incentive to get people off of these drugs.”

But critics of the bill say the bill is needlessly punitive and will mainly harm innocent children, whose parents are found to have even a minor amount of drugs. “The purpose of TANF was really to help children,” said Terri Burke, executive director of the American Civil Liberties Union in Texas. “If you don’t give the moms the money, then the children lose out.”

She pointed specifically to the bill’s provision that would require the Texas Health and Human Services Commission to report applicants with drug abuse problems to Child Protective Services. “Now we’re going to take the child of a parent who has smoked a couple of joints and give them to CPS,” she said. “If there’s a genuine concern about drug abuse, let’s do something about it. There’s no evidence that poor people abuse drugs more than other folks, but we keep coming up with bills that target poor people.”

“Adding insult to injury,” Jim Harrington, director of the Texas Civil Rights Project, said in a press release, “is that Perry would pay for the drug testing out of the very TANF funds that should go to provide assistance to people. In other words, he’s taking about $350,000 worth food and assistance from all families from the general TANF grant just to try to find a few violators. This is simply callous and perverse.”

I don’t have much to say that hasn’t already been said by Lisa Falkenberg, Burka, Jason Stanford, BOR, Stace, or EoW. I’m particularly fond of Rep. Joe Deshotel’s response, noted in that BOR post, which was a call to add a drug test requirement to the application to run for state office in Texas. Lord knows, for the amount we spend on Rick Perry’s travel detail, we ought to get some assurance he’s not taking the opportunity to toke up while out on the road.

All other concerns aside, the bottom line is that this has been done in other states, most notably Florida, and there were no savings to be had and very few users getting caught. Burka astutely noted the parallel to the failed program of steroid testing for high school athletes, another expensive way for the state to (if you’ll pardon the expression) piss its money away chasing something that wasn’t there in the first place. For a gang that likes to rhapsodize about getting government out of people’s lives, they sure sing a different tune when it comes to the lives of people they don’t like.

Is there still a chance gambling legislation can pass the Senate?

All signs still point to “no” if you ask me, but gambling legislation never goes quietly so it might look otherwise on the surface.

The quiet formation of a special Texas Senate subcommittee to consider a controversial casino gambling resolution has sparked a behind-the-scenes fight that could affect passage of the state budget and school finance legislation .

Three senators said several colleagues have discussed the possibility of voting against the state budget, amid the questions. They did not want to be identified because those discussions were private.

“I’m afraid that this gambling issue is being raised and it could hold the schoolchildren of Texas hostage so the gambling interests can get their issue passed,” said Sen. Jane Nelson, R-Flower Mound. “I am fully prepared to talk about this issue for a long time. It would really be wrong to use gambling money to finance public education in this state.”

Five senators confirmed Monday that the new panel formed Thursday by the Senate State Affairs Committee to hear a gambling resolution by Sen. Rodney Ellis, D-Houston, quickly triggered concerns from GOP senators about whether the move was a prelude by proponents of casinos to shoehorn the issue into legislative discussions about how to pay for Senate-proposed changes in financing public schools — expected to cost about $4 billion more than the House version.

[…]

Ellis said Monday that he has withdrawn his request for a hearing, leaving the new panel with nothing to do.

“I can see the handwriting on the wall,” Ellis said. “I don’t think this is the right time to try to advance this. I can see I don’t have the votes.”

Seems like a lot of sound and fury to me. There’s some suspicion that a few Senators might vote against the budget, or at least threaten to, unless a gambling bill gets passed, but I don’t think it will come to that. Anything can still happen up to the point where a budget passes, but I don’t see it for gambling. The point I raised before the session began, that this Legislature is inherently less friendly to gambling than the previous Lege was, still stands. I have yet to see any statement from a known gambling opponent who is now willing to reconsider. Maybe in the next Legislature.

Senate map is out, controversy precedes it

Before we had a State Senate map, we had a brawl brewing over one proposed district on it.

Accusing the state Senate’s Republican leaders of a “shameful partisan attack,” Sen. Wendy Davis said Tuesday that a new redistricting map for her Tarrant County senatorial district violates the federal Voting Rights Act by ripping apart a powerful minority coalition that was crucial to her election over a Republican incumbent in 2008.

After reviewing the map for the first time Tuesday, the Fort Worth Democrat fired off an angry letter to the head of the Senate Select Committee on Redistricting and said she plans legal action to challenge the plan, which revamps her 10th senatorial district.

“I’m very sure we will be in a court battle,” Davis told the Star-Telegram.

Sen. Kel Seliger, R-Amarillo, chairman of the redistricting committee, is expected to release the proposed map for the state’s 31 Senate districts today. The committee plans a hearing Thursday to take public testimony.

Davis said she was not given an opportunity to provide input for the plan or review preliminary maps, despite repeated requests. She vowed to fight the proposal “with every resource I can muster.”

“I will not allow the voting rights of hundreds of thousands of constituents in Tarrant County to be trampled to satisfy the partisan greed of the Senate leadership,” Davis said.

[…]

Davis said Seliger’s plan would shift African-American voters in southeast Fort Worth, Everman and Forest Hill into redrawn District 22, represented by Sen. Brian Birdwell, R-Granbury. Hispanic neighborhoods in north Fort Worth would become part of District 12, represented by Sen. Jane Nelson, R-Flower Mound.

Putting aside the minority voting strength issue, it’s hard to see how folks in an urban area like that can be served by a Senator from another county in a district that’s mostly rural. What communities of interest do Granbury and Flower Mound share with Fort Worth? Regardless, minority voting strength will certainly be the focus of any legal action that may be taken against the upcoming map. A press release from Sen. Davis that talks about the cracking of these communities is here, a letter from Davis to Sen. Seliger over the latter not meeting with her before the map was created is here, and a letter from four current Fort Worth City Council members to the Justice Department is here.

In the meantime, the Seliger Senate map has now been released into the wild. I know what you want, so here it comes. First, some pictures. Here’s the Metroplex, source of Sen. Davis’ consternation:

Metroplex Senate districts

SD22, Sen. Birdwell’s district, stretches all the way down to Falls County, south of McClennan. It’s closer to Austin than Fort Worth at that end. Speaking of Austin:

Travis County Senate districts

Sens. Troy Fraser and Judith Zaffirini each wind up with a piece of the Capitol county. Neither Zaffirini nor Sen. Kirk Watson are particularly happy about it. I think if the GOP could draw a map that put a piece of Travis County into every single district, they would. Finally, here’s Harris:

Harris County Senate districts

Sen. Joan Huffman’s SD17 goes south but loses the tail that had snaked east across the coast through Galveston into Jefferson County. Sen. Mike Jackson gets all of Galveston, while Sen. Tommy Williams gets all of Chambers and Jefferson. And I am once again moved into a new district, as nearly all of my part of the Heights gets separated from Sen. Mario Gallegos’ SD06 in favor of Sen. John Whitmire’s SD15.

As for electoral data, see here for 2010 and here for 2008. As the map is drawn, it’s hard to see how Sen. Davis can hold on in a district that topped out at 43.50% for Sam Houston (43.12% for Obama), though I suppose it’s not totally out of the question. Interestingly, the Democrats could have some other opportunities over the long term:

Dist Incumbent Molina Houston old Houston new =================================================== 09 Harris 39.4 47.6 43.4 10 Davis 42.3 47.4 43.5 16 Carona 41.0 46.9 43.4 17 Huffman 43.6 47.6 40.8 19 Uresti 55.1 57.0 57.2 20 Hinojosa 55.7 59.7 59.7

I threw in Sens. Carlos Uresti and Chuy Hinojosa as points of comparison, as they were the least Democratic non-Davis districts, with Obama numbers around 55%. Sam Houston wasn’t the high scorer in their districts, either – Linda Yanez got 60.5% in SD20, and both Yanez (59.0) and Susan Strawn (58.4) did better in SD19. I’m not too worried about either of these guys. I wish I had Molina numbers from 2004 for the new districts to compare, but I don’t. I still suspect these districts are bluer now than they would have been then, and will be more so in 2012, but I can’t quantify that. I also suspect there’s only so much that can be done to protect Sens. Carona and Harris, though it may be enough to get them through most if not all of the decade. As with the SBOE, the draw to determine whether they run again in 2014 or 2016 could make a difference. I am sure that there will be alternate maps filed, starting with one from Sen. Davis, so we’ll see how it goes from here.

UPDATE: Something I had not noticed before: Sen. Zaffirini, whose district stretches from Laredo to Austin, would no longer have a piece of Bexar County.

Under the proposed changes, the number of senators representing San Antonio would slip from four to three because state Sen. Judith Zaffirini, D-Laredo, would have a district that completely avoids Bexar County.

Zaffirini was upset she wouldn’t represent San Antonio if the proposal were to pass. It has her district running all the way from Laredo to East Austin’s historically black neighborhoods.

“I’ve worked hard for Bexar County,” she said. “I especially carry their higher education agenda passionately; I’ve made a difference for Bexar County over the years.”

There’s a good side-by-side comparison at the story.

UPDATE: Greg has more.

Senate pushes back on House efforts to redirect family planning funds

A little sanity is always nice to see.

State budget cuts taking aim at Planned Parenthood may limit the availability of family planning services for many poor Texans and have the unintended consequence of increasing unwanted pregnancies, two key lawmakers said Monday.

State Sens. Robert Deuell, R-Greenville, and Jane Nelson, R-Flower Mound, said they hope a conference committee will restore funding to the State Department of Health Services Family Planning program. Both are members of the Senate Finance Committee and focus on health issues.

“I don’t care for Planned Parenthood, (but) I don’t want to cut access to family planning. I don’t want to decrease access,” said Deuell. “One way to stop abortions is to prevent unwanted pregnancies.”

Nelson agreed, saying, “We need to help women who need our assistance with family planning or contraceptives to not have a baby when they can’t care for it.”

Sure seems obvious, right? Women who aren’t pregnant don’t get abortions. But the so-called “pro-life” crowd has always been more about controlling women than about sound public policy, so here we are.

Fran Hagerty, the chief executive officer of the Women’s Health and Family Planning Association of Texas, predicted the family planning cuts ultimately would cost taxpayers.

“The rule of thumb is, it costs $180 a year” for a woman to receive a physical exam and receive a year’s supply of birth control, Hagerty said, while a baby born on Medicaid will cost taxpayers $10,000 in its first year.

“When you compare that, it’s a no brainer,” Hagerty said. “The number-one factor for low-income women becoming welfare dependent is an unwanted pregnancy. If birth control is not available, they are more likely to stay in poverty and become dependent on the state.”

As long as they can’t get an abortion, the “pro-lifers” don’t care. They can always cut the funding for programs that would help these women so the budget balances in the end. See how easy it is?

Senate restores some funds to Health and Human Services

Still not clear how they’re paying for any of it yet.

The Senate Finance Committee voted Thursday to restore a less-than-expected $4.3 billion in health spending in 2012-13 but promised to try to find more money in the coming weeks.

The panel adopted most of the recommendations made recently by the Medicaid subcommittee, including a widely sought provision reversing a planned 10 percent cut in Medicaid reimbursements for doctors and dentists.

Advocates had feared the cuts would force many physicians, already operating on thin margins, to stop seeing Medicaid patients.

But the committee held off on plans to reduce steep cuts to nursing home and hospital reimbursement rates despite fears that the action would force nursing homes to close and hospitals to pass higher costs on to other patients.

The Medicaid subcommittee, led by Sen. Jane Nelson, R-Flower Mound, supported spending almost $540 million to limit rate cuts to 2 percent for nursing homes and 3 percent for hospitals.

But Finance Chairman Steve Ogden, R-Bryan, backed away, saying the expense was too great — for now. “I don’t know yet how to pay for that,” he said.

Better figure it out fast. And it would be nice if we could find some ways to pay for it that aren’t one-time deals so that we don’t dig ourselves an even deeper hole for next time. Don’t get me wrong, I’m rooting for the Senate to pull this off and make things a little less horrible. With the House busy slashing and burning, I’m just trying to keep it all in perspective.

Smaller cuts from the Senate

Trail Blazers:

The Senate Finance Committee on Thursday adopted a school funding plan for the next two years that would cut basic funding for school districts by nearly 6 percent – or $2 billion a year – to handle a massive state revenue shortfall. The committee voted 13-2 to approve the recommendations of a special subcommittee on education funding that was chaired by Sen. Florence Shapiro, R-Plano, who also serves on the finance committee. The two no votes were cast by Democrats on the panel.

The proposal is less than half the 15 percent reduction in education funding contained in a preliminary Senate budget plan and is well under a House proposal that would trim an estimated $3.9 billion a year – or $7.8 billion over the next two years – from school district budgets. Senators are still looking for potential revenue sources to make up the estimated $5.3 billion that would be needed to fund their budget for public education. Tapping the state’s rainy day fund also has been mentioned as a possibility.

This is considerably better than the House version, not that that’s a high bar to clear. It’s also slightly better than the optimistic scenario that HISD optimistic scenario, a fact that was noted by trustees.

[HISD Chief Financial Officer Melinda] Garrett said the senate finance bill is looking at a 7-8 percent cut in funds which for HISD would amount to a cut of $105 million to $119 million – a lot but still less than the $160 million HISD had projected. In addition to that, HISD projects added costs of $11 million in the next year.

That’s the good news. The bad news, of course, is that the Senate hasn’t figured out yet how to pay for any of this yet. It’s also far from certain that the House would go along with whatever they come up with. Sen. Shapiro’s plan still includes nearly $800 million for new textbooks and discretionary grants, which means she’s still prioritizing the new STAAR tests. I’d rather see every penny go to keeping teachers and support personnel. And the fact that we’re talking about “only” a $4 billion cut to public ed in positive terms gives you some idea of how debased this session has been. But you take your itty bitty teeny tiny signs of progress where you can. Postcards has more.

Meanwhile, another Senate committee did more of the same.

Deliberation about what to cut — and whom to save — ended with a vote to restore $4.5 billion to state health agencies at a Senate Health and Human Services sub-committee hearing this morning. The issue now goes to the full Senate Finance Committee, which will debate whether to add the funds back into the Senate appropriations bill.

State Sen. Jane Nelson, R-Flower Mound, says this morning’s vote “represents our best effort to address our top needs first,” and will restore 505 full-time positions and funding for programs like Early Childhood Intervention and foster care. It will also, she says, significantly reduce cuts to reimbursement rates for physicians, hospitals and nursing homes.

But some senators argue that funding should be restored for more services. “Certainly the $4.5 billion restoration is a positive step, but we all know that we need more,” says State Sen. John Whitmire, D-Houston, who voted against moving the measure to the full Finance Committee. “How can I vote for something that I know is going to create pain [and] cut basic services for thousands of Texans, when I know there’s still an option of … the Rainy Day Fund that’s across the street in the bank?”

As with the Finance bill, this has the same obstacles of needing to identify where the revenue is coming from and convincing the House to go along. Again, I’m glad to see even inadequate baby steps in the right direction, but there’s so much more that is needed. The Trib has more.

Still going through the couch cushions

The Senate is looking for funds wherever it can find them.

Hoping to cushion the impact of proposed state budget cuts to public education and health care, Lt. Gov. David Dewhurst said Wednesday that a special subcommittee will be named Monday to find $5 billion in nontax revenue for use in the next two-year budget cycle.

State Sen. Robert Duncan, R-Lubbock, will head the effort to identify alternative methods of balancing the budget through the sale of state property and financial management tools, like making greater use of some state investments.

“Texans have a lower threshold for taxes as a percent of income than residents of other states,” Dewhurst said in an interview. At the same time, he noted that lawmakers are struggling to adequately provide essential services to Texas’ growing population and that additional revenues may be necessary.

Dewhurst said he believes the Legislature might be able to squeeze more money out of real estate investments and the Permanent School Fund, comprising mineral royalties from state-owned lands. Sale of unused state lands might also help bridge the budget gap, he said.

Duncan said the seven-member committee would examine “all state revenue streams in a robust and open way. It is going to be comprehensive.”

“We will look at everything — inside the treasury and outside,” he said. “A fiscal crisis like we are having is not fun but it allows us to evaluate everything. Are there funds that are just sitting there and are not efficient?”

Duncan declined to say specifically whether university investments or school district reserves would be under review, saying only “everything is on the table.”

“I don’t see any low-hanging fruit. It is a tough job,” he said.

I’m delighted to see them make this effort, and to see them set a target for revenue (unlike the House, which will be happy with whatever it comes up with) even if the level is too low. Recognizing that what we have is completely inadequate for what we need to do is encouraging, even if it will fall short. What’s not encouraging is the continued avoidance of acknowledging the underlying problem.

“I’m glad the lieutenant governor is doing this. Desperation requires you to get creative,” said Sen. Leticia Van de Putte, D-San Antonio. But she added that the Legislature was dodging the real source of the state’s fiscal problem — a 2006 tax-swap scheme that led to declining revenues. “The cure is you’ve got to fix the margins tax (imposed on businesses to lower property taxes in 2006.)”

I suppose the optimistic reading of this is that they have to exhaust every other possibility first before they are willing and able to face the facts. Some of them may reach that realization before others.

How hard will it be to keep Senate Republicans, much less Senate Democrats , in line behind a two-year budget that cuts far, far more deeply than the one passed in 2003? For the past 48 hours, lobbyists and social services advocates have been pointing to remarks Tuesday morning by Sen. Kevin Eltife, R-Tyler, as proof it’ll be cussedly difficult.

“We’re playing a game here with people, and I’m not going to be a part of it,” Eltife said at a meeting of the subpanel of Senate Finance Committee that’s chopping Medicaid and social programs.

“I just can’t,” he said, spurning appeals by Subcommittee Chairwoman Jane Nelson, R-Flower Mound, for senators to “start making decisions” on whether to stand by cuts in GOP leaders’ initial budgets.

[…]

After describing the process as a game, he added, “I can’t sit here and decide that I’m going to pend the blind children’s program. I think they’re all priorities.”

Yes they are, and the more people that come to realize it, the better. But as long as we’re in Rick Perry’s world, I don’t know how much it will matter. All I can say is that I have to hope for better. EoW has more.

Just call it “DewhurstCare”

I’m not sure what to make of this yet.

Lt. Gov. David Dewhurst and Sen. Jane Nelson, R-Grapevine, introduced two bills Wednesday they believe could save the state a significant amount of money and produce “healthy patient outcomes.” The duo repeated those words throughout a press conference in the Capitol, flanked by stakeholders from the Texas Medical Association, the Texas Hospital Association and House Public Health Committee Chairwoman Lois Kolkhorst, R-Brenham.

“We don’t have health care in America — we have sick care,” said Dewhurst, who cited studies from The Dartmouth Institute for Health Policy & Clinical Practice indicating that the state could save up to one-third of its health-related costs by incentivizing doctors and hospitals to use best practices for treating patients, as opposed to paying them for the number of procedures they perform.

Nelson, a state budget writer and chairwoman of the Senate Health & Human Services Committee, said that after weeks of sobering meetings on the state’s financial constraints, there needs to be a “paradigm shift” in the way Texas funds medical costs.

“If I’ve learned nothing else — it is unsustainable. We’ve got to do something differently,” she said.

When asked whether the bills would cost or save the state money — and how much — Dewhurst said he is working with the Legislative Budget Board to determine exact figures. However, he is convinced there will be savings for the state. Unlike President Barack Obama’s federal health care reforms, the lieutenant governor said, these two new bills do not mandate that all citizens have insurance or increase regulations for states.

I guess he mentioned that to reassure the teabagger crowd that he’s not going to force his way into their homes and shove a tongue depressor down their throats or something. I’m not entirely clear on how it is that the individual mandate went from a Republican idea to a shibboleth. The Trib provides a word cloud comparison of these bills to the Affordable Care Act, which doesn’t really tell me anything. I see now that Rep. Garnet Coleman has issued a press release that praises Dewhurst for these bills, which heartens me greatly. The main thing I have to add is that much like Rep. Zerwas’ insurance exchanges, we would not be having this conversation if it weren’t for the Affordable Care Act, which has basically forced the hand of our state leaders. If any of this had been a priority to them at any time before now, they had plenty of opportunities to take action. Still, better late than never, so good on Dewhurst, Nelson, and Kolkhorst for putting these bills forward. Patricia Kilday Hart, who suspects this is Dewhurst’s attempt to put a little sugar in the budget’s castor oil, has more.

Business leaders urged to oppose “cuts only” approach to the budget

Good luck with that.

Former Lt. Gov. Bill Hobby is helping lead an effort to rally Texas business leaders against what he calls a “catastrophic” cuts-only approach to balancing the state’s budget in the face of a massive shortfall, estimated at $15 billion to $27 billion over the next two years.

Hobby, a board member of the Center for Public Policy Priorities, and F. Scott McCown, the group’s executive director, say in a letter being sent today to the state’s hundreds of chambers of commerce that such an approach would undermine the state’s economic recovery, weaken education and leave vulnerable Texans unprotected. The center focuses on low- and moderate-income Texans.

“We simply can’t balance the budget through cuts alone without doing terrible damage to our economy and our future,” Hobby and McCown said in the letter.

They want business leaders to speak up for a “balanced approach” that includes spending the state’s rainy day fund savings account, which is expected to contain $9.4 billion; adding new revenue through such options as increasing alcohol or tobacco taxes; raising taxes on “sugar-loaded” drinks; eliminating “unwarranted” sales tax exemptions; or temporarily increasing the state’s sales tax rate.

You can read Hobby and McCown’s letter here I applaud them for this, and I wish them the very best of luck, but a couple of points. One, let’s not expect too much from the business community. They’re kinda sorta on board with this, but if you read their quotes in the story or listen to what they have to say here, they’re supportive in a very mush-mouthed kind of way. They’re okay with using the Rainy Day Fund – which is a big deal, don’t get me wrong – but not much beyond that. They don’t want to see education gutted, but they don’t want to pay for it, either.

Bill Hammond, president of the Texas Association of Business, which has 220 local chambers as members, said his group opposes a cuts-only approach, although it doesn’t back spending the entire rainy day fund and doesn’t want new taxes. It favors keeping spending about the same over the next two years.

Well, we have $15 billion less to spend than we did two years ago, and the entire Rainy Day Fund would only cover 60% of that. How do you expect us to get there from here, Bill? This is likely to have as much effect on the debate as the business community’s pitiably weak opposition to anti-immigration legislation has had. I have more faith in the school superintendents.

The other point I’d make is that if I’d written the CPPP’s letter, I’d have stuck to the revenue ideas already on the table, which include reviewing the sales tax exemptions, fixing the business margins tax – yes, I know, even with this audience – the LBB recommendations, and expanded gambling. I would not have mentioned new things like the sugar tax or other extra sin taxes, since they’re extremely unlikely to get anywhere and might distract from the overall message. Just my opinion.

By the way, if anyone reading this still thinks that balancing the budget with cuts only is a good idea, here’s more evidence that you’re wrong.

State protective services chief Anne Heiligenstein dropped some bad news on Senate budget writers today: Her year-old push to redesign the payment system for foster care providers will be a non-starter if lawmakers approve proposed cuts that would effectively drive down rates by 12 percent.

Abused and neglected children with complex emotional and psychiatric problems often are ripped from their home communities in North Texas and shipped down I-45 to so-called “residential treatment centers” in the Houston area, Heiligenstein has said, saying she’d like to change that. An agreed-upon overhaul of rates and contracting would put a private provider in charge of a region, which would include a duty to make sure there are enough beds close to home.

Sen. Jane Nelson, R-Flower Mound, who’s sponsoring the redesign bill, asked if efficiencies might be found that would allow the effort to go forward.

Not really, said Heiligenstein, head of the Department of Family and Protective Services, which oversees Child Protective Services.

“The presumption for being able to do this is that there would not be a rate roll-back,” she told the Senate Finance Committee. “We will not ask for an increase in foster care rates … , but we need what is currently invested in the system, plus normal caseload growth.”

Is that something you really want to support? BurkaBlog has more.

Diabetes

I’m sure you’ve seen some variation of this story by now.

The number of Texans with diabetes will nearly quadruple from 2.2 million to 8 million in the next 30 years, threatening the solvency of the state’s medical system, according to a state report released Tuesday.

The alarming projections serve as both a “wake-up call and a call to action,” said Sen. Jane Nelson, R-Flower Mound.

About 1 in 12 Texans have diabetes today.

“The numbers are shocking,” Nelson said after the Texas Health Institute report was released. “I want my colleagues and the public to see what will happen if we don’t change behavior, if we don’t do something now.”

[…]

More nutritional meals and exercise can help prevent diabetes. But the tendency to eat more fast food has resulted in a growing epidemic of obesity among Texas children, according to the report, which notes that more than 20 percent of Texas children between the ages of 10 and 17 are considered obese.

Children also don’t get enough physical exercise.

“You put those two factors together, and it’s a disaster,” said Dr. Victor Gonzalez, chairman of the Texas Diabetes Council.

The Trib had the story first, on Monday, and it seems to have made the rounds in the dailies since then. The Trib story talks about what kind of public policy the state could adopt to head off this problem.

In a series of statewide roundtables funded by diabetes giants Novo Nordisk and Roche Diagnostics, health care experts offered a range of strategies. But those that appear most effective — implementing a statewide screening program, expanding diabetes self-management training for patients and closing the benefit gap between Medicaid and CHIP so pregnant mothers can have access to gestational diabetes supplies — come at a cost that lawmakers are unlikely to meet when they’re starting down a potential $25 billion budget hole.

It goes without saying that despite Sen. Nelson’s concern, the state will do absolutely nothing to address the problem. To be fair, the Lege would be unlikely to do anything about it even if we were looking at a $25 billion surplus. That’s just not how we roll around here. In fact, given that diabetes and obesity are strongly correlated with poverty, it’s almost certainly the case that the state will take action to make the problem worse and the future costs higher, all in the name of “fiscal responsibility”. But at least our property taxes will stay low. That’s got to count for something, right?

Who needs Medicaid?

Here’s an early peek at what we have to look forward to next year.

Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.

Far-right conservatives are offering that possibility in post-victory news conferences. Moderate Republicans are studying it behind closed doors. And the party’s advisers on health care policy say it’s being discussed more seriously than ever, though they admit it may be as much a huge in-your-face to Washington as anything else.

[…]

State Rep. John Zerwas, R-Simonton, an anesthesiologist who authored the bill commissioning the Medicaid study, said early indications are that dropping out of the program would have a tremendous ripple effect monetarily. He is not ready to discount the idea, he said, but he worries about who would carry the burden of care without Medicaid’s “financial mechanism.”

“Because of the substantial amount of matching money that comes from the federal government, there’s an economic impact that comes from that,” Zerwas said. “If we start to look at what that impact is, we have to consider whether it’s feasible to not participate.”

State Sen. Jane Nelson, R-Flower Mound, who chairs the Senate Public Health Committee, said dropping out of Medicaid is worth considering — but only if it makes fiscal sense without jeopardizing care. Currently, the Texas program costs $40 billion per biennium, with the federal government footing 60 percent of the bill. As a result of federal health care reform, she said, millions of additional Texans will be eligible for Medicaid.

“I want to know whether our current Medicaid enrollees, and there certainly could be millions more by 2014, could be served more cost efficiently and see better outcomes in a state-run program,” Nelson said.

I don’t know about you, but I don’t recall the subject of a total Medicaid withdrawal being part of the just-concluded campaigns. Was this what all you Republicans were voting for?

Let’s consider the numbers for a minute. If Texas’ cost per biennium for Medicaid is 40% of $40 billion, that’s $16 billion. So you could zero out Medicaid, not replace it with anything, and still have a $9 billion gap in the budget. What else you got?

From what Sen. Nelson is saying, there would be some kind of replacement, though it’s hard to imagine what they might have in mind. But assuming there is something, then the net cost reduction would be considerably less than $16 billion. Given our recent experiments with privatization, would anyone be shocked if whatever they proposed as an alternative wound up costing a lot more, and saving a lot less, than they projected? And what do you suppose the effect of not having that $24 billion in federal dollars come into the state be on the economy?

You can only talk about the numbers for so long before you have to acknowledge the effect on the people who currently rely on Medicaid. They’re still going to get sick and need to get medical help. Who will pay for it in the absence of Medicaid? Cities and counties and their associated hospital districts would be my guess. I wonder what all the state’s Mayors and County Judges think about this.

You know when I said yesterday that Job One for the remaining Democrats in the Legislature will be to remind everyone who voted for a more Republican government that they were about to get it, good and hard? This is the sort of thing I had in mind. There will be plenty more where this came from.

Tuesday Lege roundup

Some more notes about what has been happening in the Lege…

– It looks like the program to test high school athletes for steroids will be scaled back.

Texas lawmakers have reached a deal to slash steroid testing of public high school athletes to less than half of the current program, but still leave it big enough to test thousands of athletes over the next two years.

The deal was struck by House and Senate members negotiating the 2010-2011 budget, lawmakers said Tuesday.

The current $6 million program was designed to test up to 50,000 students by the end of the current school year. The tentative deal for the new program would slash funding to $2 million over the next two years.

Good! Zeroing it out completely would have been better, but I can live with this. Maybe next time it’ll go away.

– There’s still some hope for the omnibus gambling resolution, but Rep. Ed Kuempel has a backup plan ready anyway.

UPDATE: Brandi Grissom tweets that “the fat lady has sung” for the gambling bill.

– If you’re under 21, getting a driver’s license for the first time just got harder.

– A tax on smokeless tobacco, which would fund a medical school repayment fund for doctors who agree to move to rural areas, passed the House.

– And finally, Rep. Senfronia Thompson’s HB982, the alternate strip club tax, has passed the Senate.

The Texas Senate voted on Tuesday to repeal a $5-per-person admission fee on strip clubs that has been ruled unconstitutional and agreed to replace it with a new tax on sexually oriented business.

The bill now goes to Gov. Rick Perry for his consideration even as House members were poised to debate a competing bill favored by sexual assault victim advocates.

Passed in 2007, the strip club admission fee has been ruled unconstitutional by a judge and is currently under appeal. Money collected under that fee was sent to a fund to help sex assault victims and a pool for uninsured Texans.

The new tax proposed by Rep. Senfronia Thompson, D-Houston, would apply to adult movie theaters, adult video stores, adult bookstores and other sexually oriented businesses that charge admission fees. It would total 10 percent of gross admissions receipts.

According to a legislative analysis, the new plan would send 25 percent of the new fee to a state school fund and the rest to a sexual assault victims fund.

But some advocates for victims say the new bill is a ruse put forth by strip club owners, who would not be required to charge admission to their clubs, and would sharply reduce the money collected to help assault victims.

The Texas Association Against Sexual Assault instead supports a separate House bill by Rep. Ellen Cohen, D-Houston, who pushed the original $5 fee. Cohen’s bill would reduce the club entry fee to $3 and dedicate all the money to the sexual assault fund.

Rep. Cohen’s HB2070 is still pending in the House. More here.

Monday Lege roundup

Lots of legislative action today beyond the voter ID vaudeville act. Here’s a quick roundup of some other bills of interest.

HB1736, also known as the Tim Cole Act for the man who was posthumously exonerated this February, has passed both chambers and is on its way to Governor Perry’s desk. The bill increases the compensation given to those who are exonerated after being sent to jail. Grits has the story, and more info is here and here.

– The statewide smoking ban is stuck no more.

A statewide smoking ban was endorsed by a Senate panel today, after authors agreed to exempt cigar bars, patios of restaurants and bars, and nursing homes.

Sen. Rodney Ellis, D-Houston said the compromises were necessary to resuscitate the measure, which he called a matter of life and death.

“It goes a long way toward reducing the incidence of cancer in Texas,” he said of his bill. It cleared the Senate Health and Human Services Committee on a 5-3 vote.

Committee Chairwoman Jane Nelson, R-Flower Mound, joined the panel’s four Democrats in voting for the bill, which Ellis praised as “much stronger” than a companion measure in the House that was watered down Friday to exempt 224 of the state’s 254 counties, limit enforcement and carve out many loopholes for bars.

So Sen. Nelson was true to her word. Kudos to her for that. SB544 still has to pass the full Senate and then get reconciled with the House bill, once it passes that chamber. There’s still work to be done, in other words.

Solar energy gets a boost.

[SB541] by state Sen. Kirk Watson, D-Austin, would provide so-called renewable energy credit incentives for electric generation from equipment manufactured in Texas and sets a goal for electricity generated from sources other than wind at 1,500 megawatts by 2020.

“This is designed to help bring large, industrial-size solar facilities to Texas,” Watson said. “This is about looking forward to the future — in alternative energy, jobs and manufacturing — much the same we did for wind a few years ago.”

Good. ACT Texas and Environment Texas cheer, and I join them in that.

– Finally, both strip club bills, Rep. Senfronia Thompson’s HB982, and Rep. Ellen Cohen’s HB2070 were scheduled for votes today, the former in the Senate and the latter in the House. You have to figure there can only be one, so we’ll see which one survives.

Statewide smoking ban still stuck

It’s stuck in the Senate, which is a bit odd.

The woman standing in the way of a Senate vote is Sen. Jane Nelson, a Flower Mound Republican who joined [Lance] Armstrong on the Capitol steps in February in a pledge to support it.

Nelson, chair of the Senate Health and Human Services Committee, has not allowed a vote on the bill [SB544], frustrating supporters who considered her advocacy a major boost in getting the bill passed into law.

“I have asked over and over again,” said Sen. Rodney Ellis, the Houston Democrat sponsoring the measure. Ellis said Wednesday that Republican Gov. Rick Perry said he’d allow the bill to become law if it gets to his desk.

Perry spokeswoman Allison Castle said she was unaware of any conversation the governor had with Ellis, but said Perry would review the smoking ban bill if and when it reaches his desk.

Nelson said she still supports the bill and that there’s time to address it before the session ends June 1.

“Everybody wants to panic,” Nelson said. “Things may shake loose very soon.”
Asked why she hasn’t allowed a vote, Nelson said she and Ellis had “an agreement” but wouldn’t elaborate.

Interestingly, the companion bill HB5 got voted out of State Affairs even though at last report committee chair Rep. Burt Solomons had said he didn’t support it and hadn’t asked committee members about it. Well, a watered-down version that exempts bars and limits it to the 26 counties that have over 115,000 people. (Which is an interesting number to pick. According to the Census, six counties had between 100,000 and 115,000 people in 2000: Ellis, Grayson, Gregg, Potter, Randall, and Tom Green. Midland checked in at 116,000. There may be some debate as to just where this law would apply.) Kudos to him for bringing it up anyway. I don’t know what Sen. Nelson’s master plan is, but the clock is ticking. Thanks to Elise for the tip.

Wendy Davis

I’ve been a fan of freshman State Sen. Wendy Davis since I interviewed her last year at the state Democratic convention. You could tell she was smart and ambitious, and if given the chance could really go places. I’ve been happy with her actions so far in her first session – as this nice profile note, she has not been timid about making noise and getting stuff done. She’s also duly impressed her colleagues:

Senators in both parties, as well as outside analysts, describe the Harvard-educated lawyer as an energetic hard worker who meticulously researches the issues and displays an independent streak. Sen. John Carona, R-Dallas, chairman of the Transportation and Homeland Security Committee on which Davis serves, is a big admirer, saying she is on track to become “one of the Senate’s very top leaders in a very short period of time.”

“I’ve been here 20 years,” he said. “She appears to me to be one of the brightest and most capable freshmen I’ve seen to date.”

Davis, 45, works closely with Republicans Sens. Jane Nelson of Flower Mound and Chris Harris of Arlington, the two other senators who represent parts of Tarrant County, although she and Nelson split on a major transportation funding bill backed by North Texas political leaders. Davis, who was heavily involved in transportation on the Fort Worth council, has been a leading advocate of the funding bill while Nelson has opposed it.

In addition to Carona, Davis says her other mentors in the Senate are Democrats Kirk Watson of Austin, Eliot Shapleigh of El Paso and Rodney Ellis of Houston.

“If you look at the agenda that they pursue, they’re very much in keeping with what I believe is important,” she said in taking stock of her record with five weeks left in the session. “If I could put a label on the agenda I brought here, I’d call it a populist agenda. . . . I feel good that we’ve advanced the discussion on some important issues, and we’ve had some success already.”

I foresee a bright future, too, maybe a spot on the statewide ticket some day. No surprise that the Tarrant County GOP wants to paint a target on her back for 2012. I say good luck trying. The county is trending the right way, and barring something hideous in the 2011 redistricting, which seems unlikely given the GOP’s need to protect Sen. Chris Harris in that go-round, it’s just hard to knock off an incumbent Senator. I wouldn’t underestimate Sen. Davis, that’s for sure.

My favorite bit in the story has to be this:

Since January, [Davis] has been a dependable Democratic vote on some of the chamber’s more divisive issues, prompting at least one ardent conservative to long for the days when a Republican held the seat.

“Obviously, we have subtracted one vote from the right, and now have one vote on the left on those key issues that separate our parties,” said Sen. Dan Patrick, R-Houston. As a result, Patrick says, he has been unable to bring up his “informed consent” bill that would require women getting an abortion to undergo an ultrasound. “Not having a Brimer here has cost me an important vote,” Patrick said.

That couldn’t be sweeter if you dipped it in honey and rolled it in sugar. Patrick did ultimately pass his bill, but he had to water it down to do so, a direct consequence of the change in partisan makeup of the Senate. It’s a pleasure having you in Austin, Sen. Wendy Davis.

Revisiting the FLDS saga

Grits sat in on the House Human Services Committee hearing that looked at how the state handled last year’s child-welfare operation at the FLDS ranch, and he’s got a detailed report on what transpired as well as an analysis of the proposed legislation to deal with it, which he refers to as “a Christmas Tree of mischief.” Check it out.