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Tom Suehs

Testifying about the Women’s Health Program

More hearings like this, please.

Right there with them

The Texas Department of State Health Services got an earful today from lawmakers and women’s health advocates at a public meeting in Austin to discuss proposed rules for the Texas Women’s Health Program — specifically, the state’s plan to sacrifice 90 percent of federal funding for the program in order to exclude Planned Parenthood and prevent participating physicians from discussing abortion in any capacity with patients.

“Try to get the politics out of the way and do what’s best for Texas women,” said Rep. Donna Howard, D-Austin, before an eruption of applause from the audience. She emphasized a point reiterated by others testifying at the hearing: that the Women’s Health Program provides cancer screenings, birth control and wellness exams for 130,000 low-income women but does not provide abortions.

One of the proposed rules for the program states that a participating physician could not “promote elective abortions” by providing “counseling concerning the use of abortion as a method of family planning” — even outside the scope of the Women’s Health Program. Physician groups, including the Texas Medical Association, the Texas Association of Obstetricians and Gynecologists and the Texas Academy of Family Physicians, oppose the proposed rule, arguing it will put a “gag order” on physicians that could interfere with patient-physician relationships.

“We strongly oppose any interference into a physician’s ability to use his or her medical judgment as to the information that is in the best interest of his or her patient,” the groups wrote in a letter to DSHS.


Although Planned Parenthood clinics account for less than 2 percent of the providers participating in the program, 45 percent of women participating in the program chose to receive care at Planned Parenthood.

Opponents of the state’s decision to knock Planned Parenthood and other providers out of the WHP worry the state will not be able to provide an adequate health network. But the state and proponents of the reformed Texas Women’s Health Program say that won’t be a problem, as Planned Parenthood clinics make up a small portion of the 2,500 providers enrolled in the program.

What a silly argument that is. As we have discussed, the vast majority of existing providers in the WHP served at most ten clients. Claiming that the loss of Planned Parenthood will cause no disruption in service to the WHP patients is like saying there would be no disruption in the smarphone market if Apple were to disappear because hey, they’re just one manufacturer. You can find that letter to the DSHS here, and for more see State Rep. Ana Hernandez Luna’s op-ed in the Chron, and this letter from Senate Democrats to outgoing HHSC Chair Tom Suehs.

Medicaid expansion: Not as expensive as the state claimed it would be

Remember last year when the state Health and Human Services Commission claimed that Medicaid expansion would cost the state of Texas $27 billion over ten years, causing every Republican in the state to have a fainting spell and a hissy fit about how that would bankrupt us all? Turns out that estimate was a wee bit too high.

On the heels of Gov. Rick Perry’s declaration that Texas will not expand Medicaid because it is too costly, his health and human services commissioner said Thursday that fully implementing health care reform would cost the state about $11 billion less over 10 years than previously estimated.

Executive Commissioner Thomas Suehs told a Texas House subcommittee that the new estimate is between $15 billion and $16 billion in state costs over a decade, compared to the previous estimate of $26 billion to $27 billion.

The state would get an additional $100.1 billion in federal money over that time, according to the Texas Health and Human Services Commission – money that Suehs acknowledged would be attractive to local entities grappling with the cost of caring for the quarter of the state’s population that currently is uninsured.

“If I was a county hospital district, I would be knocking on your door saying we need to re-debate” Medicaid expansion, perhaps with a push for a local option, Suehs said. That idea, in which a local agency would deal directly with the federal government to expand Medicaid in its area, has been cited by Bexar County Judge Nelson Wolff.

I’ll get back to that “local option” in a minute, but for now take a look at the reasons why HHSC says they overshot the mark. The interesting thing is that in an ideal world that original HHSC esitmate would be closer to the mark because more people who would be eligible for Medicaid under the Affordable Care Act would be getting it in a more timely fashion. Of course, the dirty secret is that under those same assumptions Texas would be paying a lot more for Medicaid now. A lot of people who are eligible today for Medicaid don’t get it, in large part because of policy decisions made by Texas such as means testing and six month enrollment periods. The same is true for CHIP, whose enrollment levels have never returned to those before the 2003 cuts. Our stringent enrollment requirements and stingy benefits, both of which are big contributors to the large number of uninsured people in Texas, are matters of policy and priority, just as Medicaid expansion is. Rick Perry and legislative Republicans don’t want to spend any money on that. It’s just not something they care about. For all their carping and whining about the federal government making them do something about this, they themselves have never proposed a solution to deal with the problem. Well, they are proposing something now, but I’ll get to that in a minute as well.

What does that “local option” mean?

“It (the federal portion) is a huge amount of money. You just can’t leave that on the table, particularly when the burden falls on public hospitals that are funded by local taxpayers,” said Wolff. He is head of the commissioner’s court, which approves the budget for University Health System, a main provider of health care to low-income Bexar County residents.

Harris County Hospital District president and CEO David Lopez said he wants to talk with Perry’s office about possible funding alternatives.

The local option would have to be discussed by all the area’s health care providers, Lopez said.”It’s more than just a public hospital issue. All providers in our community are impacted by this, so they should all be part of the discussion.”

Sen. Leticia Van de Putte, D-San Antonio, said she does not think a local option is available in the law as written, but she is making inquiries about what is possible. “This is real money, and it means real health care for Texans,” she said.

I’ll have to do some research, because this is the first I’ve heard of this, but I gather that a “local option” means that local entities such as counties or hospital districts would apply to the federal government for some amount of money to cover the needs that the state has abdicated by opting out of Medicaid expansion. I have no idea how this would work, whether we’re talking about a restoration of funds to covered uninsured patients who show up at emergency rooms – which, you will recall, is the most expensive and least efficient way to deliver health care – or if these local entities would somehow be administering their own mini-Medicaid programs, or something else entirely. How this is a better idea and a less burdensome regulatory context than simply expanding Medicaid is a question I can’t answer. (The same could be said about having fifty individual statewide Medicaid programs instead of one federal program, but that’s beyond the scope of this discussion.) Whatever this is, I’d call it better than nothing, which is what the state wants to do right now, but in the absence of any details I can’t say how much better than nothing it is.

On the matter of funding to cover uninsured patients, some hospitals are in for more hurt than others if nothing happens.

Bruce Siegel is the chief executive of the National Association of Public Hospitals, which represents the nation’s safety-net hospitals. His members include more than 60 hospital systems, largely in urban areas. As public institutions, they tend to see a greater share of Medicaid and uninsured patients, and also provide more medical services that ultimately do not prove profitable.

That all made the Supreme Court ruling of the Medicaid expansion as optional a huge deal for Siegel and his members. “It’s a pretty grim menu of choices,” he says. We spoke Thursday afternoon about why he’s taking governors’ threats to opt-out seriously, what that would mean for public hospitals and how his group will push the White House for a fix.


SK: I was writing about DSH payments last week and I was hoping you could explain why they’re so important. They amounted to $11.5 billion last year, which isn’t nothing, but is a pretty small part of Medicaid’s $393 billion budget.

BS: It’s important to keep in mind these payments don’t go to every hospital. They are designed to target those who serve lots of uninsured people. So DSH payments are very important for public hospitals in places like Mississippi, Alabama and Texas, really a lot of Southern states. They’re not going to most hospitals. They’re targeted to a very specific purpose.

SK: Let’s say a big state like Texas, which got nearly $1 billion in DSH payments last year, doesn’t participate. Game out what happens to the public hospitals in that state.

BS: The average American hospital has an operating margin of 7 percent. The average among our members is 2 percent.

We project that if you took away DSH, the margin drops to negative 6 percent. If that happens, you can’t keep up a negative 6 percent margin for more than short time. After a year or two, you have to think about what happens next. You’re having to think about what you shut down after a year or so.

We think there are essentially three options. One is you start cutting back on services. You start figuring out what isn’t bringing in much revenue. And that could be things like community clinics or trauma services. You make some hard decisions.

You may be forced to go to local taxpayers. You find yourself basically putting this in the lap of taxpayers and tacking on the bill for your uninsured to their bills.

In the worst circumstance, you simply decide you can’t go on in that situation and close your doors. It’s a pretty grim menu of choices.

SK: How do you fight this at the state level?

BS: We’re working in state capitals, trying to give our members facts to work with about what this does and doesn’t mean, so they can have an intelligent discussion. There are different strategies for each state. We’re raising awareness that you can’t have it both ways. You can’t say no to the coverage program and cut the DSH program in half, and have this work. We need to get to a consensus that is a huge problem.

Again, the point is to reduce the number of people who rely on emergency rooms – the most expensive and least efficient way to deliver health care – by getting people onto insurance so that they can have access to non-emergency health services. Maybe expanding Medicaid isn’t the best way to do that, but any program to expand health care access is going to involve some up front cost. Some part of that is mitigated by reducing costs elsewhere such as this, which is why the Affordable Care Act cut the subsidy for uninsured patient care to hospitals. Without the expansion of Medicaid, however, you get the worst of all worlds. What does the state’s Republican leadership plan to do about this? Going by the rhetoric of retiring Medicaid director Billy Millwee, speaking to a bunch of zealots at the TPPF, it’s mostly slogans.

Despite Perry’s announcement that Texas will not expand Medicaid, the state will likely see a jump in those enrolling in the current program, Millwee said. Because the individual mandate — which requires all citizens to purchase health insurance — was ruled constitutional, those who were “eligible but not enrolled” in Medicaid will now join the program, he said.

“Medicaid is crowding out other programs,” Millwee said. “In my mind, it is starting to enable poverty.”

Millwee called the current Medicaid system “antiquated” and suggested the state instead receive block grants — federal funds with relatively few restrictions — to expand its health care system.

Expanding Medicaid would “add a lot of people” to the program without increasing their actual access to coverage, Millwee said, because of the scarcity of doctors accepting new Medicaid patients.

Last year 31 percent of doctors accepted Medicaid patients, The Texas Tribune reported earlier this week. Millwee attributed this number to the complexity of Medicaid, saying doctors are not paid as well under the current system as they could be under a block grant system.

That remark about poverty is the sort of thing that could only be said by someone who doesn’t worry about where his next meal is coming from to a bunch of people who think poor people have no one to blame but themselves for their situation. I’m sure they all congratulate themselves for their rectitude every Sunday at church. Having said that, there is some truth to what Millwee says, in the sense that as people move up the income ladder from the very bottom to a step or two above the very bottom, they suffer the equivalent of extremely steep marginal tax rates as they lose eligibility for various programs, including Medicaid. There’s no reason why Congress and the State Lege can’t address this in a fashion that makes more sense, but what with all the wailing and gnashing of teeth by the TPPF types about millionaires paying slightly higher marginal tax rates, which as we know will cause them to stop creating jobs, that seems to get lost in the shuffle.

Then there’s the talk of block grants, for which five GOP legislators shilled on the Chron’s op-ed pages on Saturday. This is a GOP wish list item, and the SCOTUS ruling that invalidates the ACA provision penalizing states for rejecting Medicaid expansion has given them fresh hope of getting it. The thing to remember is that a block grant is a single lump sum of money, with the lure for states being that it has few restrictions on how it can be spent. But the thing about a block grant is that if you run out, either because the amount you were given was insufficient to meet your need or because you spent it foolishly, that’s all there is. If you’ve been paying any attention to the budget ideas of the Congressional GOP – the Ryan plan, in particular – you know that the strategy for controlling future costs is to ensure that block grants remain static or grow at a fixed rate that’s sure to be less than the rate of growth of the actual expenses. To be blunt, this is all about controlling expenses by cutting them. How it would expand coverage, as Millwee claims, is not explained, but look at it this way: You would be putting your faith in the people who have kept Texas at the bottom of the national list for health care access to do something about it once we’ve given them what they want. If that sounds like a winning scenario to you, I’ve got some beachfront property in Midland you might be interested in.

Finally, as far as the lack of doctors is concerned – what, you mean tort “reform” hasn’t solved all of our problems yet? – who says we have to have doctors accepting Medicaid? Why not seek out ways to encourage more nurse practitioners to do the kind of checkup and maintenance work they’re perfectly capable of doing? Maybe there are some burdensome regulations holding them back that the Lege could address. All I know is that going on a dozen years of Republican control of state government we’re no closer to solving this problem on our own, and we’re resisting a comprehensive solution that’s been presented to us. It’s all a matter of priorities.

Suehs to retire

Texas Health and Human Services Commissioner Tom Suehs will call it a career this August.

Tom Suehs

Suehs’ announcement follows news last month that Billy Millwee, the state’s Medicaid director, was retiring, leaving an even bigger void than anticipated at the top of an agency facing billions of dollars in unpaid Medicaid costs and struggling to institute a federal waiver that calls for complex hospital payment reform.


It’s been a rough several months for Suehs and other HHSC officials. They’ve got doctors outraged over Medicaid and Medicare cuts on one side. On the other, public and private hospitals are duking it out over who wins and who loses from a complicated new formula to determine how much they’re reimbursed for uncompensated care. Meanwhile, counties and hospital districts are facing their own mini turf wars, as they work to form the regional partnerships required by the waiver.

The high-profile health care resignations compound an already big leadership void; Texas Education Commissioner Robert Scott is leaving next month. Combined, public and higher education and health and human services make up nearly 85 percent of the state’s general revenue budget.

Suehs was a pretty decent Commissioner, his recent crackup over Planned Parenthood notwithstanding. Lord knows, he was better than Albert Hawkins, though all he really had to do for that was not implement a doomed-to-fail privatization scheme in a manner to ensure the failure was as spectacular as possible. Still, as I said he did a decent job overall, and I wish him the best in retirement. I hope Rick Perry picks someone nearly as competent as a replacement.

The state shows its intent in Planned Parenthood lawsuit

As we know, Planned Parenthood filed a lawsuit against the state of Texas in order to block the “Affiliate Rule” that Rick Perry is using to deny Medicaid funds to their clinics for the Women’s Health Program. In the opening arguments of the lawsuit, the state clearly shows what its priorities are.

Right there with them

State officials will have to end a key women’s health program if Planned Parenthood wins a legal battle to continue participating, Texas’ solicitor general told a federal judge Thursday.

“In the end, Planned Parenthood would rather shut down the Women’s Health Program in its entirety” than be excluded, said Solicitor General Jonathan F. Mitchell with the state attorney general’s office.

Planned Parenthood said there’s no need for the state to end the program if the group prevails.


Planned Parenthood is suing over the state’s decision to exclude clinics associated with abortion providers from the Medicaid Women’s Health Program, even though the clinics themselves don’t provide abortions.

Planned Parenthood, which has been a large part of the program, said the provision violates its constitutional rights. The state disagrees.

The group’s lawyer, Helene T. Krasnoff, said its ouster from the program will damage Planned Parenthood financially and cause disruption for Women’s Health Program participants who rely on services through its clinics.

The program provides health screenings and birth control services to low-income women.

“There is no evidence they will be able to find another provider,” Krasnoff said. “All the evidence is to the contrary.”

Here again is the complaint filed by Planned Parenthood. If you skip down to the section where they ask for relief from the court, among other things they ask the court to “Issue preliminary and permanent injunctive relief, without bond, maintaining thestatus quo and restraining the enforcement, operation, and execution of the Affiliate Rule, andTex. Hum.Res. Code §32.024(c-1)if that statute requires that Rule”. That is, they ask that things be restored to how they were before the Affiliate Rule was put into place and barred them from participating in the WHP. It would be the choice of the state of Texas and Rick Perry at that point to either go back to how things were, which presumably would mean collecting those 9-to-1 federal matching funds again and saving millions of dollars, or to decide to end the Women’s Health Program entirely. The comments of Solicitor General Mitchell tell you what you need to know about that. This has always been about putting politics above all else, and if Judge Lee Yeakel grants the plaintiffs’ motion – he has said he’ll rule by April 30, which is to say tomorrow – we’ll know just how far Perry and his cronies are willing to take it. Burka has more, and a statement from Melaney A. Linton, President & CEO of Planned Parenthood Gulf Coast is beneath the fold.


Rick Perry’s vision for women’s health in Texas

More talk than action, and the numbers don’t add up. Are we surprised?

We can fund it with corndog sales

Texas health officials have delivered a proposal to the federal government that outlines their plans for transitioning the Women’s Health Program from a program primarily supported by federal funds to one that runs on state money. They want the federal government to keep paying for the Medicaid program through October “to ensure that current and future clients of the program have access to family planning services without disruption.”


The transition packet outlines the state’s plan to find new providers to participate in the program. As it stands, about half of the clients in the Women’s Health Program go to a Planned Parenthood clinic in Texas, and the network receives about 40 percent of the program’s reimbursement funding. Planned Parenthood has filed a federal lawsuit against the state, arguing they are being denied their constitutional right to participate in the program.

Under Perry’s directive, health officials say they are executing plans to operate the program without Medicaid funding and will rename it the Texas Women’s Health Program. They plan to house the program under the Department of State Health Services and to “transition the Medicaid program to a program funded exclusively with state general revenue.” Officials have not confirmed where that funding will come from, or whether it will be diverted from other sources. In response to an inquiry from Democratic lawmakers last month, HHSC Commissioner Tom Suehs hinted the state could free up state dollars to fund the Women’s Health Program by seeking federal block grants for other programs.

In addition, the state plans to expand the program’s scope of reimbursements services to include paying for treatment of sexually transmitted diseases. The Medicaid Women’s Health Program was intended to provide early detection and diagnoses; women were referred to other medical providers for treatment of their health issues.

Though family-planning providers have expressed confusion and uncertainty over their futures, HHSC officials maintain there will be a “seamless transition for clients and providers.”

The state’s proposal outlines plans to conduct a campaign that will include more robust referral services and outreach via radio, mailings and brochures. The commission plans to expand its call center’s scope of services to help clients find providers.

Before you get impressed at the idea of Texas expanding services and outreach, remember two things. First, they have to find enough non-Planned Parenthood providers to make up for all of the clinics that will no longer be able to receive this funding. This Chron story gives the reasons why, but for the most part it’s that it’s not a moneymaker for providers. Second, just this Monday at his no-tax-a-palooza Rick Perry was calling Medicaid a “ticking time bomb” that threatens to wreck his state’s budget. You may recall that at Perry’s direction, the last Legislature underfunded Medicaid by nearly $5 billion, a hot check the next Lege will have to use the Rainy Day Fund to cover. Perry’s bright idea to solve the Medicaid crisis he talks about is by implementing block grants. Block grants work to control costs because once they run out, that’s it. Whatever your need is, this is how much you have to spend. You get to control costs because you get to decree what they are. Can anyone envision a scenario where that is consistent with expanding a health care program that must first work to bring in a passel of new providers to replace a well-established nonprofit? Me neither. Either this state-funded alternative to the WHP will be so penurious that no one will want to participate, or its costs will grow at least as rapidly as Medicaid, thus bringing that ticking time bomb closer to kaboom. Well done, Governor! This whole thing continues to be vaporware, and getting an extension on the deadline to have its ducks in a row is unlikely to help the state of Texas figure it out.

Planned Parenthood sues Texas

Two can play at that game.

Planned Parenthood affiliates in Texas filed a federal lawsuit Wednesday to block a rule aimed at excluding their health centers from the Medicaid Women’s Health Program.

The lawsuit, filed in federal court in Austin, asks the court to file a preliminary injunction to block a rule aimed at excluding Planned Parenthood from participating in the program.

Texas legislators approved a rule in 2005, denying participation in the program to any clinic affiliated with an abortion provider.

They delayed enforcement due to concerns that the law violates federal regulations requiring Medicaid programs to be open to any qualified provider but began enforcing it last month, although funding to Planned Parenthood has been continued through April.

The lawsuit argues that the rule places an unconstitutional condition on Planned Parenthood’s eligibility to participate in the Women’s Health Program by seeking to restrict how funds not provided by the program are used.

Here’s the press release that Planned Parenthood Gulf Coast Inc., one of the six affiliate plaintiffs, sent out about the suit:

Right there with them

In the lawsuit filed today, the Texas Planned Parenthood affiliates argue that the rule, which was purposefully designed to make them ineligible to continue to participate in the Women’s Health Program, violates their constitutional rights because it imposes an unconstitutional condition on their participation in the program and thereby harms the tens of thousands of low-income women who rely on them for basic, preventive health care. The lawsuit also claims that the rule violates Texas state law because the Health and Human Services Commission overstepped its authority in adopting a rule that conflicts with the purpose of the laws that created the program.

Planned Parenthood affiliates in Texas are being represented by attorneys from the Texas firm Graves, Dougherty, Hearon & Moody, and are joined by Planned Parenthood Federation of America attorneys in the suit.

In Texas, the Women’s Health Program is fundamental to improving the health of Texan women, serving as a vital source of health care coverage for women of all ages. Currently more than one-quarter of Texan women are uninsured, and women in Texas have the third-highest rate of cervical cancer in the U.S.

“Planned Parenthood is very important to me and my family. When my mom was my age and pregnant, she was diagnosed with cervical cancer at Planned Parenthood. They helped her with additional testing and a referral to where she could get treated,” said Rene Resendez, a 24-year-old uninsured student from West Texas who has relied on Planned Parenthood and the Women’s Health Program since 2007. “Without the Women’s Health Program and Planned Parenthood, I don’t know what I would do, or where I would go for the cancer screenings I know I need. Planned Parenthood has been a place my family can trust and I should be able to decide who provides my healthcare.”

Planned Parenthood health centers in Texas have been critical to the success of the Women’s Health Program. Planned Parenthood is the single largest provider of care within the Women’s Health Program and consistently delivers high-quality care to low-income women. In fact, over 40 percent of the women who receive services through WHP chose to rely on a Planned Parenthood health center.

“Planned Parenthood belongs in the Women’s Health Program and is standing up for tens of thousands of their patients today,” said Randall Ellis, senior director of Government Relations at Legacy Community Health Services, a federally qualified health center in Houston. “It takes the entire spectrum of providers, including Planned Parenthood, to meet the needs of the growing population of low-income Texans without access to reproductive and other basic health care services.”

If the new rule is enforced, Planned Parenthood would be barred from participating in WHP after April 30, leaving tens of thousands of Texan women unable to obtain preventive health care services from the health care provider of their choice.

“This rule impermissibly penalizes Planned Parenthood, and has the effect of restricting Texans’ access to health care,” said Pete Schenkkan, attorney with Graves, Dougherty, Hearon & Moody. “We are asking the court to ensure Planned Parenthood can continue to provide Women’s Health Program services to these women.”

You can see a copy of the complaint here. One of the background facts they mention in the press release is that the federal government made it clear to all 50 states that a rule excluding a comprehensive women’s health care provider like Planned Parenthood restricts the rights of patients and would not be allowed in the Medicaid program. I seem to recall that one of the arguments that folks like Rick Perry make against Obamacare is that it’s “government intrusion” into your health care decisions. The fact that what the state has done here is exactly that seems to have escaped his notice. I should add that as State Rep. Garnet Coleman pointed out in his interview with me, there are private physicians in Texas who perform abortions, and they and their patients are as affected by this legislation as Planned Parenthood is. If you are a WHP patient seeing one of these doctors for any reason, you’d have to find a new doctor or lose your coverage. Planned Parenthood was clearly the target of the fanatics in the Legislature as well as Rick Perry and Greg Abbott, but they weren’t the only casualty. I hope this lawsuit can rectify that, though if it gets appealed to the Fifth Circuit all bets are off. Juanita, Trail Blazers, Postcards, BOR, Stace, and the Trib have more, while State Sen. Jose Rodriguez has a statement lauding Planned Parenthood for their action.

The Texas bait and switch

You almost have to admire the sheer brazenness of it all. Almost.

Starring Rick Perry as Woody Allen

In a fiscal switcheroo, Texas could free up state dollars to fund the embattled Women’s Health Program by seeking federal block grants for other programs, the state’s health commissioner wrote in a letter to House Democrats on Tuesday.

Texas is losing more than $30 million in annual federal funding for the Women’s Health Program over the state’s decision to force Planned Parenthood clinics out of the Medicaid program. Gov. Rick Perry has vowed that the state will find the money, despite a bleak budget, to continue to operate the contraception and cancer screening program without federal help.

In response to questions from state Democrats, Health and Human Services Commissioner Tom Suehs wrote on Tuesday that his agency is “exploring a number of funding options that would not create additional budget needs.” One of those options is to apply for newly available federal block grants for existing state programs, Suehs wrote, so the cost savings could be funneled into the Women’s Health Program. “State funds and federal block grants are interchangeable in many programs,” he wrote.


“The governor and Commissioner Suehs are going to rob state funds and federal block grants that were set aside for one program to pay for services that would have already been funded,” state Rep. Jessica Farrar, D-Houston, said in a statement. “This problem was completely avoidable.”

I guess they decided they couldn’t just find $30 million in other state funds lying around, despite Perry’s empty promises. What should happen next is an edict from whoever doles out these block grants stating that they can only be used for their original, intended purpose. Let Greg Abbott file another lawsuit, he has nothing better to do with his time anyway. Trail Blazers has more.

Perry’s empty promise on the Women’s Health Program

Our Governor talks big, but his words have no meaning.

The state will find the cash to continue a women’s health program whose federal funding is threatened because of a decision to keep Planned Parenthood from participating, Gov. Rick Perry said Thursday.

“We’re going to fund this program,” Perry said. “Listen, we’ll find the money. The state is committed to this program … This program is not going away.”

Perry didn’t specify where the state would get the money for the Medicaid Women’s Health Program, which provides health screenings and contraceptive services to low-income women.

In a Thursday letter to the Texas Health and Human Services Commission, Perry directed Commissioner Tom Suehs to work with legislative leaders to identify funding.

Nearly 130,000 women are enrolled in the program, which in fiscal year 2012 is scheduled to receive $29.8 million in federal funds and $3.3 million in state general-revenue money.

“We’ve got a multibillion-dollar budget, so we have the ability to be flexible on where monies come from,” Perry said.

Funny, but I don’t remember any talk about “flexibility” back when billions were being cut from the budget. I also don’t recall the Governor objecting when tens of millions were being cut from the Women’s Health Program and bills to continue it were being blocked in the Legislature. Where will we find that money, and why couldn’t we find money like it when the budget was being written? Who will actually provide the services for 100,000+ women that had been going to Planned Parenthood? Why is it even remotely fiscally responsible to turn down a 9:1 funding match over a ridiculous point of ideology? There are no answers, only questions.

Rep. Jessica Farrar of Houston, House Democratic Caucus leader, said of Perry’s funding promise, “I’ll believe it when I see it,” noting cuts approved by lawmakers who crafted the current budget to meet a massive revenue shortfall.

“I don’t see how you’re going to get blood out of that turnip,” Farrar said.

Rep. Garnet Coleman, D-Houston, said that “the real losers in this battle are limited income women of color who are disproportionately harmed” by the new rule.

“Perry and his free-market cohorts have repeatedly said that Texans should have a choice of health provider. But his insistence on banning certain providers from the program prevents poor Texas women from seeing their provider of choice – and that’s just bad medicine,” Coleman said.

What did you expect? The Trib, Burka, and BOR have more, and a statement from Planned Parenthood Gulf Coast, Inc. CEO Melaney Linton is beneath the fold. There will be a rally in front of the Planned Parenthood clinic at 4600 South Freeway on Monday, March 12, at 11:30, as part of PP’s statewide bus tour. See here for details.


A place to start

At least one elected Republican is feeling a bit angsty about the Republican war on women’s health.

For some GOP lawmakers, the issue gets deeply personal, and the line between party loyalty, allegiance to anti-abortion politics and public health is a tough balancing act. State Rep. Sarah Davis, a first-term Republican lawmaker from Houston, said she survived breast cancer because it was detected early.

“It pains me to think that there’d be another 32-year-old diagnosed with breast cancer and not be able to get screened or treated until stage 4, whereas I was treated at stage 1 and had a much better outcome,” she said.

Though she supported the Women’s Health Program during the session, Davis was visibly reluctant to discuss whether she would prefer to keep Planned Parenthood and its preventive services in the program in order to keep it going. The state estimates 44 percent of Women’s Health Program clients go to Planned Parenthood clinics for their well woman exams, birth control and STD screenings.

“It’s a very tough one,” she said. “I think it’s a shame. We’re losing $40 million, and that’s our tax money we paid that we’re not getting back. And it’s going somewhere else outside of Texas.”

Sorry, Sarah. I’m afraid you own this. I don’t remember you speaking out on this issue back when it mattered, during the session. I admit, you probably couldn’t derail the crazy train, but you could have showed a little leadership. Hand-wringing after the fact doesn’t do squat.

Ann Johnson

If there’s a Republican-favored district where an issue like the Women’s Health Program can and should have traction, it’s HD134. Whether you think the court-ordered maps are good for Republicans or Democrats, Dems aren’t going to gain any real ground in the Lege until they can be competitive in places like that. Between the demise of the WHP and the House budget that would have cut $10 billion from public education instead of “just” $5.4 billion, there’s plenty of material to work with in HD134. The new map moved me out of HD134 and back into HD145 again, but I’m still going to do whatever I can to get Ann Johnson elected. This and HD144 are the two legislative races to watch in Harris County. How Dems do in those races will go a long way to determining how much less awful the next legislative session could be.

By the way, I can’t let this pass without noting that HHSC Commissioner Tom Suehs appears to have completely freaked out.

In an uncharacteristically angry letter sent to Gov. Rick Perry, Lt. Gov. David Dewhurst and House Speaker Joe Straus, Health and Human Services Executive Commissioner Tom Suehs argues that if the Centers for Medicare and Medicaid Services (CMS) won’t let Texas exclude Planned Parenthood from the Women’s Health Program, “then no state can ever confidently apply policies and requirements that advance important and legitimate state interests to regulate providers’ participation in Medicaid.”

What that means, Suehs wrote, is that “the state must allow tax cheats, deadbeat parents, and even people suspected of serious abuse to participate in the Medicaid program. This is a risk I am unwilling to expose our clients to.”

Seriously, Tom? You could probably sneeze at the Capitol any day of the week and give your cold to at least half a dozen tax cheats, deadbeat parents, and spouse abusers. Are you saying these people should be denied health insurance? Because it serves such an awesome purpose to force people to use the emergency rooms. Clearly, Commissioner Suehs is from the school of thought that only good people deserve to be helped. How much glass is there in your house, Tom? I continue to be amazed at the ability Planned Parenthood apparently has to turn seemingly normal adults into raving lunatics. I mean, I expect this kind of thing from idiots like Rick Perry, but I thought Suehs was a grownup. Silly me.

UPDATE: Did I mention that Tom Suehs was cracking up? Dude, take a vacation or something before you hurt yourself.

Who cares about women, anyway?

The state of Texas certainly doesn’t.

If there was any hope that the state was seeking a compromise with the federal government over Texas’ Women’s Health Program, it’s fading fast. At the direction of lawmakers and Texas Attorney General Greg Abbott, the Texas Health and Human Services commissioner signed a rule on Thursday that formally bans Planned Parenthood clinics and other “affiliates of abortion providers” from participating in the program — something the Obama administration has said is a deal-breaker for the nearly $40 million-per-year state-federal Medicaid program.

“The Obama administration is trying to force Texas to violate our own state laws or they will end a program that provides preventative health care to more than 100,000 Texas women,” said Allison Castle, a spokeswoman for Gov. Rick Perry. “This boils down to the rule of law — which the state of Texas respects and the Obama administration does not.

The rule, signed by Commissioner Tom Suehs on Thursday, takes effect March 14. Unless some last-minute agreement is brokered, the program, which receives $9 in federal funds for every $1 in state funds, will be either phased out or cut off by the end of March. At least 130,000 poor Texas women will lose access to cancer screenings, well-woman exams and contraception.

“No one’s politics should interfere with a woman’s access to health care,” said Planned Parenthood Gulf Coast President and CEO Peter J. Durkin. “It is shameful that Governor Perry and Commissioner Suehs continue to politicize lifesaving breast cancer screenings and birth control access for low-income women.”

Republican lawmakers worked overtime last legislative session to design language that would keep any Planned Parenthood-affiliated clinics from receiving state family planning and women’s health dollars, despite the fact that taxpayer-funded clinics may not perform abortions. They got the backing of Abbott, who said their efforts were legal, and gave the state’s health commissioner the go-ahead to implement the new language.

But when Texas was faced with renewing the Women’s Health Program this year, officials with the U.S. Department of Health and Human Services said the state’s plans violated the Social Security Act. They gave the program a three-month extension, but said they had no intention of renewing if Planned Parenthood, which provides 44 percent of the program’s services, was blacklisted.

The stalemate appears unbreakable — Republican lawmakers have made clear they’d rather forgo the program and the federal money than allow Planned Parenthood to participate.

I don’t know how much more evidence you need to conclude that the state’s jihad against Planned Parenthood is about much more than abortion. It’s rich to see Perry and Abbott try to direct what the feds can do with their money, since they get their noses so far out of joint when it’s the other way around. Ironically, this happened on the same day that the state joined a lawsuit challenging the rule that would require all employers to include coverage for contraceptives in employees’ health care benefits. That charge is being led by the Catholic bishops, all of whom as far as I could tell were silent on the prospect of 130,000 women losing access to health care in Texas. As State Rep. Garnet Coleman points out, nearly half of all births in Texas are paid for with Medicaid. What will happen to these women and their babies? The state of Texas and the Catholic bishops don’t care. They have an ideology to pursue.

In related news, a number of people suddenly noticed last week that Texas’ sonogram law is pretty much the same as the one in Virginia that got derailed after drawing national attention. Texas’ law, on the other hand, got little to no national notice despite fierce resistance here from those who saw this law as the degradation and humiliation of women that it is. We can stare at our navels all day trying to figure out why that is, but it’s really not so hard to understand. It’s about winning elections. Until Democrats start winning more of them, and in particular until they win a high profile one because of an issue like this, this is what we’re going to get. As with every other issue we talk about here, nothing changes until the people we elect to our government change. Neil, Rachel, and Burka have more. Be sure to read through the comments for a pained defense of his legislation by Sen. Dan Patrick and some good responses to him.

As always, the hole is bigger than we thought

Remember how the Republicans in the Lege underfunded Medicaid by $4.5 billion, which they will have to tap the Rainy Day Fund in 2013 to deal with, in order to make the budget for this biennium appear to be “balanced”? Turns out we’re going to need a lot more than that.

Tom Suehs

Kudos to the Quorum Report’s John Reynolds for reporting State Health and Human Services Commissioner Tom Suehs’ latest prediction on the looming state Medicaid funding shortfall which will have to be addressed by the Legislature when it meets in January 2013.

As has been widely reported, the Texas Legislature passed a so-called “balanced” budget by intentionally under-funding the Medicaid program by $4.5 billion, essentially choosing to postpone payment of that bill until 2013. Now, escalating caseload growth will bump that figure into the atmosphere, Suehs told hospital administrators in a speech Wednesday.

According to Reynold’s report:

That multi-billion dollar bill to sustain the Medicaid program – one of the state’s biggest cost drivers – will drop on lawmakers’ desks next January at the same time that demand for services elsewhere in the state budget continues to increase.

Suehs told the Texas Hospital Association that his message isn’t all that different from the one he sent two years ago. “I basically said something to the effect, ‘I don’t see how the Legislature’s gonna get out of this session without some form of revenue.’ I got in trouble for that,” Suehs said. “And I’m going to say the same thing today. I think I have a little bit more data with me today.”

Leaving a shortfall in the current budget has “a compounding effect” on future needs, Suehs told QR after his remarks. Still, he acknowledged at the conference that the level of need in the Medicaid budget concerns him.

“I don’t sleep some nights just thinking about having to lay that type of number out at some point,” he said.

Reynolds goes on to point out that the Legislature probably will spend some $7 billion left in the state’s Rainy Day Fund to cover part of the Medicaid shortfall. But Sueh’s predictions highlight the importance of the new Medicaid “transformational waiver” I highlight in my column in Wednesday’s print edition of the Chronicle. Approved by the Obama Administration in December, the new waiver empowers local hospital districts to re-define the rules for Medicaid reimbursements. Proponents believe the changes, if done correctly, could save taxpayer dollars, and help fund more patients who will be eligible for care under the federal health reform law.

Couple things to note here. One is that the recent uptick in sales tax revenue means that the Rainy Day Fund is a bit fatter than it was at sine die. That has led some folks to call on Governor Perry to call a special session to use some of that extra dough to mitigate the second year of cuts to public education. The TSTA has a petition you can sign if you want to join in that call. I support the effort, but I expect it to go nowhere for precisely this reason, which is the main reason why the Lege and Perry resisted so mightily calls to use the Rainy Day Fund originally. You can’t spend what’s already spent.

Suehs wasn’t the only Perry appointee going off the reservation. Texas Education Commissioner Robert Scott has been talking out of school (as it were) as well.

Scott warned school administrators that the ban on social promotions – a legacy of Gov. George W. Bush – will be lifted unless lawmakers provide money to help struggling students.

More money also will be needed to pay for the state’s new school accountability system, whose high-stakes testing may be going too far, Scott told school officials.

Scott’s statement that believes testing has gone too far drew a predictable rebuke from the sort of people who want accountability and standards but don’t want to pay for them. You do have to wonder what Perry is thinking, with his hired hands making trouble like that. Anyway, in re: schools, even all that Rainy Day money won’t get at the real problem:

Everyone agrees that Texas needs to do a better job of educating the state’s five million students in public schools. Folks like [Scott] McCown and [Sen. Leticia] Van de Putte, who serves on the Senate Education Committee, say it will take more money.

“What folks just don’t appreciate is how much we have cut,” McCown said, noting that state tax revenue would have to increase $13 billion a year to reach 1994 levels – the peak year for a measure of “how much of our total economy went to state and local taxes.”

Political realities mean that significant tax reform won’t happen next session, he said. It will take a modest, smart approach to put Texas on the right road resulting in several billion dollars of additional revenue, he said.

“It would be a responsible use of the rainy day fund and it would include revenue measures such as increasing the cigarette tax and eliminating the high cost gas exemption from the severance tax,” McCown said.

“If we don’t do that, then we are gong to face really serious damage to our schools and just not being able to help people as we move out of the difficult economic times in this recovery,” he said. “Regular Texans have to speak up loudly about what they want but we can have responsible approach to meeting the state’s needs in the next session if they do that.”

Well, that’s what the next couple of elections need to be about. Nothing will change until the Lege and the state leadership changes. EoW has more.

Get ready for another Medicaid lawsuit

That’s the very likely outcome if proposed cuts to Medicaid reimbursement rates go through.

“You cut rates an additional 10 percent, I’m not sure I can comply with the access provision,” Thomas Suehs, commissioner of the state Health and Human Services Commission, told the House Appropriations Committee on Thursday.

He warned that short-term savings from cutting reimbursement rates could be outweighed by a long court fight over whether the state was providing sufficient access to health care for children who are Medicaid recipients.


In 2007, the state ended a nearly 15-year dispute over whether Texas provided sufficient medical coverage to children enrolled in Medicaid. As part of the settlement, the Legislature increased funding for the program by more than $1.8 billion, using state and federal funds.

While the settlement specified only the amount of money the state had to spend on Medicaid for the 2008-09 budgeting period, Texas also agreed to maintain standards of accessibility of health care services for citizens on Medicaid.

Hospital and child advocacy groups say that the proposed reduction of reimbursement rates would result in fewer doctors seeing patients using Medicaid for insurance. That would increase the likelihood that the state violates the accessibility standards it agreed to, potentially setting the stage for another legal battle, they said.

“You’re talking about a payment rate currently, that’s before the cuts, that’s about 50 percent of commercial rates,” said John Holcombe, chairman of the Medicaid committee at the Texas Medical Association. “Now, we’re looking at a situation where we’re going to cut rates again. And if we believe what’s happened in the past will happen again, we’ll see a reduction again in the number of physicians that are willing to see Medicaid patients.”

And in the meantime, all those folks who would have had access to Medicaid will start showing up at the emergency room instead, so even the short-term savings of these cuts is largely illusory as cities and counties get stuck with the tab. People don’t stop needing medical services. It’s just a matter of how to pay for them, and whose budget it comes out of. And I’ll say again, Texas and its handling of Medicaid is a strong argument for federalizing the program and providing a single standard for reimbursements. It’s a shame that wasn’t part of the Affordable Care Act.

One Republican for the Rainy Day Fund

State Sen. Kevin Eltife says what I suspect more than a few Republican legislators are thinking.

“We have to find more revenue,” the former Tyler mayor and senator of seven years said [Thursday] morning during a committee hearing. “It’s insane not use the Rainy Day Fund. We also have to find additional revenue.”

Republican leaders have been adamant about not raising additional revenue and Gov. Rick Perry insisted again in his state of the State address this week that “we must protect the Rainy Day Fund.”


The Senate Finance Committee has heard appeals from parents of children with disabilities and other distressing reports about the impact of severe budget cuts on human services, including health care. The committee is now in the process of hearing testimony about cuts to education.

“We have an investment in public education, higher education and health and human services,” Eltife said. “We have got to find the revenue to make these cuts less of a burden on Texans.

“There’s no other way to do this. We can dance around it all we want and talk about – oh, is it revenue, is it a tax, is it this, is it that? We have to find additional revenue,” he said. “We have to share the pain with cuts and revenue and the Rainy Day Fun. And any other idea in this building is crazy to me.”

Well, yes. We have a revenue problem, first and foremost. And as I’ve said before, the people talking the most loudly about the need for “pain” are largely exempt from it themselves as things stand right now. I couldn’t put it any better than Sen. Eltife has. And I’m glad to see that he’s beginning to have some company, though we’re still a long way from having the supermajority needed to use the Rainy Day Fund. What I am encouraged to see is this:

Rep. Jim Keffer, R-Eastland, said voters in his district are beginning to hear about the cuts and are calling his office flummoxed.

Taking a swipe at Perry, Keffer said many of them had been listening to the governor’s lofty campaign rhetoric and now see a different reality.

“I’m getting a lot of emails and phone calls from people who are surprised that we even have a budget problem at all based on what his campaign looked like,” Keffer said. “There’s a lot of people waking up to the fact that we have, not just a little deficit, but a big bear.”

Yes, Rick Perry has been lying to you. Please try to remember that the next time you go vote, OK? Thanks.

A few other items of note: Health and Human Services Commissioner Tom Suehs contradicts Governor Perry about the magnitude of the budget crisis, and tells the Senate that one of their money-saving ideas might actually cost a lot more in lost federal revenue. Abby Rapoport brings up the specter of another school finance lawsuit again. And the Trib looks at the difference between symbolic cuts and real ones.

It’s not just teachers’ jobs that are on the line

Many other people will be thrown out of work under a cuts-only budget.

“I don’t know that I’ll be able to stay in business,” said Jerre van den Bent, owner of Dallas-based Therapy 2000, a 3,000-employee agency helping children with developmental disabilities.

Mickey Atkins, president of Austin-based D&S Residential Services, which has 13 group homes for the mentally disabled in Collin and Denton counties, said it couldn’t survive proposed cuts to “Medicaid waiver programs” that keep clients out of institutions.

“We’d be out of business by Sept. 1,” said Atkins, who has 1,500 employees.

George Linial, who represents Texas’ nonprofit nursing homes, with 35,000 residents, said cuts of 34 percent to Medicaid’s spending on skilled nursing facilities would be a death blow to what is a major employer in many rural areas.

“The cuts are basically going to close a lot of nursing homes,” said Linial, president of the Texas Association of Homes and Services for the Aging.

Don’t these people know that cutting government spending stimulates the economy and creates jobs? It must be true, because Rick Perry and the Empower Texas/TPPF ghouls say so. I think it has something to do with offering tribute to the Free Market Fairy. They’re never very clear on the details.

Many other people whose lives depend on Medicaid and other government-aided health services testified as well. You can read about some of their stories here, watch a short video here, and see what HHSC chief Tom Suehs has to say about budget cuts here. To sum it up, go read Dave Mann.

So, who’s less essential? The abused kids, the nursing home residents, the mentally ill, the Medicaid recipients? After just two days of hearings, it’s already clear that legislators either must tap the Rainy Day Fund and raise more revenue—or they will have to employ some twisted logic to decide whose program gets cut. There will be no good options, only less bad ones.

And even the less bad ones will be really, really bad. I hope the message is getting through. EoW has more.

UPDATE: And more from Mann.

These are only “hard choices” for some people

I suspect that for too many members of the incoming Legislature, the decisions they’ll be making about the budget will be ones they’re not at all uncomfortable with.

The Legislature’s Republican leadership will confront weighty questions, such as how many children the state can afford to provide medical care for and what level of care and supervision can be provided for the elderly and disabled.

At lawmakers’ elbows will be the chief of state social services, Tom Suehs. He predicts an agonizing process.

“There are not too many nice and easy decisions,” he said recently. “That’s why they’re going to migrate to cutting some of the optional” services in Medicaid, a health program covering 3.3 million poor children, pregnant women and frail adults.

But Suehs (pronounced “seas”) is quick to add that optional services – which can be taken away from adults on the program, though not from youngsters – are not frills. Cuts will be costly and painful.

“I want to do a better job of describing the balloon effects,” he said. “If you squeeze the community mental health, you’re going to end up possibly with more people in prison, and that’ll cost money over there.”


Suehs’ task is to help lawmakers understand the implication of life without optional Medicaid coverage for hundreds of thousands of Texans who have little other choice.

Among the services the federal government does not require states to provide: prescription drugs, hospice services, kidney dialysis treatments, hearing aids, mental health treatment and eyeglasses.

A Dallas Morning News analysis found that the state would save about $1 billion in state funds over two years by eliminating all six services for the 820,000 adults now enrolled. That’s less than 5 percent of the savings needed to bridge the overall deficit.

“You want to cut drugs to old people? That’s optional,” Suehs said. “You want to cut out kidney dialysis treatments? That’s optional.”

Our elected Republican leaders could, of course, choose to fund these things if they wanted to. But that might mean asking Dan Patrick to pay a few extra dollars in property taxes, and Lord knows we can’t afford to do that. So all you sick and dying people that will need to sacrifice for the greater good of the state, please be dears about it and do so quietly. Thanks very much.

New flash: Dropping Medicaid would be bad

Don’t take my word for it, take the Texas Department of Health and Human Services’ word for it.

Opting out of federal Medicaid, something Republican leaders have been considering as a method to wipe out Texas’ estimated $25 billion budget shortfall, would create major difficulties, the report states — not just for the millions of poor and vulnerable Texans covered by Medicaid, but for the county governments and public hospitals where much of the financial burden would be shifted.

Up to 2.6 million Texans — many of them children — could become uninsured. And hospitals would still be required by federal law to treat medical emergencies, potentially adding billions of dollars in annual uncompensated care costs funded at the local level. Meanwhile, Texans would continue to pay federal taxes to support other states’ Medicaid spending, the report notes.

Texas would “lose billions each year in federal funds; billions of dollars in indigent health care costs would shift from the state and federal levels to local governments, public hospital districts, medical providers, and the privately insured; and 2.6 million Texas residents could lose health insurance,” the report states.

Still, the escalating Medicaid costs facing the state — up 170 percent in the last 11 years, and accounting for a quarter of the state budget — have far exceeded the growth in state tax revenue, inflation and population, and are unsustainable, the report notes. The HHSC report says the best solution is for the federal government to give states greater responsibility over program costs, allowing them to design their own eligibility systems and benefit packages, and making it easier for them to get waivers. They also recommend reforming the new federal health care law, as well as revising how the federal government calculates the state vs. federal contribution to Medicaid.

“Virtually every state in the nation is facing a severe budget shortfall made worse by rising costs in Medicaid,” the report states. “…Without significant reform at the federal level, states are left facing a no-win dilemma.”

Actually, the best solution, which a number of people have proposed and were pushing during the debate over the Affordable Care Act last year, is a complete federalization of Medicaid. This would be a huge relief for state budgets now and in the future and would ensure a single standard of coverage, so that you don’t have states like Texas which deliberately make it hard to qualify as a way of saving itself a few bucks. Needless to say, this ain’t gonna happen, and if President Obama proposed it you’d see Republicans in Texas and everywhere else tell him to keep his dirty hands off of this beloved program of theirs that they intend to kill if they can get away with it.

The Trib has more here, and Dave Mann notes that what this really constitutes is not an attempt to kill Medicaid, but a move to basically privatize it:

The report concludes that the federal government should allow the state to “incorporate market oriented principles and greater accountability into the Texas Medicaid program.

“Under one waiver proposal, the state would establish consumer-directed medical accounts with sufficient funding to allow a client to purchase an individual or family high-deductible private insurance policy and fund a related health savings account.

“The proposal would empower Medicaid recipients to use health saving accounts for out of pocket health care expenses, job training, child care, or other qualifying purchases.”

This would represent a fundamental shift in how Medicaid functions. In the current model, the government reimburses doctors and other providers for the health care services they offer Medicaid patients.

Under the Perry plan, the government would fork over Medicaid money directly to individuals who would then shop for and purchase a private insurance plan. Instead of one money transfer (government to health care providers), we would have three (government to patient to insurance company to providers). Perry and the report authors pitch the latter system as more efficient, despite the added bureaucracy that would no doubt come along with these added transactions.

I don’t know if it would be more efficient. But it certainly would be a boon for the insurance industry and whatever financial institution would maintain these health savings accounts.

You can read the full report here. Those of you who have been paying attention may notice that this is very similar to the Paul Ryan plan for Medicare, basically by replacing the government as the insurer with vouchers for purchasing private insurance. You then can control costs easily by simply refusing to increase the voucher amounts over time, with predictable results for their purchasing power. One way or another, it all leads to the same end. One more thing from the original story:

HHSC raised eyebrows earlier this year with its big-figure estimates for how much federal health reform was going to cost Texas. The latest agency estimate indicates health reform will cost the state quite a bit less — about $5 billion between 2014 and 2019. This estimate excludes non-mandatory rate increases that were included in the original calculation. And it includes roughly $760 million in state revenue from premium taxes expected to be paid by health plans that cover new Medicaid clients.

I guess now that it’s actually been passed, there’s less point in exaggerating about it. Funny how these things work, isn’t it? A statement from Rep. Garnet Coleman is beneath the fold.


No federal sex ed money for Texas

Stay ignorant, kids. It’s what the state of Texas wants you to do.

At the end of the summer, Texas quietly opted to forgo yet another pot of federal money — specifically, $4.4 million that would have gone toward educating youth on abstinence and contraception to prevent teen pregnancy.

The Department of State Health Services began drafting the application for the Personal Responsibility Education Program funds, but the decision was made not apply before the Aug. 30 deadline. Carrie Williams, a spokeswoman for DSHS said, “The [Health and Human Services] Executive Commissioner [Tom Suehs] made the final decision, and the governor’s office was part of that discussion.”

“This is yet another example of politics dominating policy in the governor’s office,” said state Rep. Mike Villarreal, D-San Antonio. “Unfortunately, the governor’s re-election campaign theme of running against Washington has, yet again, hampered our ability to access much needed funds to overcome very real challenges that our state is facing.”


Dr. Janet Realini, the president and CEO of Healthy Futures of Texas, a nonprofit geared toward “reducing teen and unplanned pregnancy,” said that mission would be easier with the “evidence-based” education programs the PREP money would have funded. “I feel this is a great loss for the state,” she said. “This is a huge amount of money, and there’s such a need for these programs in Texas.”

DSHS did apply for $5.4 million in federal funding for abstinence-only education. “Applying for this funding is in line with state goals and strategies,” Williams said, noting that the state’s “first choice is that teens choose not to have sex.” In an e-mail, she said the abstinence-only funds would have been lost to other states, whereas the state’s decision not to apply for the PREP funding opens the door for individual communities to apply for the money directly “if it meets the needs/values in their communities.”

Texas is of course one of the nation’s capitals of teen pregnancy. If our idiotic focus on abstinence-only education produced better results, it would be different, but we’ve spent millions and millions of dollars on it and have nothing but a lot of babies being born to children to show for it. What a waste.

Progress on food stamps

Good news.

With hundreds of new workers on board, Texas has dramatically improved its speed and accuracy processing food stamp applications, Health and Human Services Executive Commissioner Tom Suehs [told] state lawmakers [last week].

But he’ll also tell the joint gathering of the Senate Health and Human Services Committee and the House-Senate panel overseeing the eligibility system that he needs more resources, including more workers.

“Yes, we’ve turned it around,” Suehs told the American-Statesman on Tuesday. But he added: “We still have a long way to go to maintain it there. This thing is still in a precarious situation.”

In August, Texas processed 93.5 percent of applications within the required 30 days, compared with 58.6 percent in September 2009, according to the commission.


In the past year, the commission has added 864 workers to determine eligibility and enroll Texans for food stamps and Medicaid, bringing to 8,380 the number of staffers. The commission has also revamped worker training and stationed workers in office lobbies to handle certain questions so that not everyone has to wait in line.

“There’s no doubt that things have significantly improved,” said Celia Hagert of the Center for Public Policy Priorities, which advocates for low- and middle-income Texans. “It’s clear evidence of what a better funded and staffed eligibility system is capable of.”

I could crab about how we got into this mess in the first place and how it took threats of federal action for the state to take it seriously enough to address, but I’ll skip that this time and just offer my kudos to Tom Suehs for getting this done. There’s still a long way to go, and we may never truly undo the damage of the failed privatization scheme that left HHSC in such a mess, but so far so good.

The food banks pitch in

It’s great that they’re making such a difference. It’s a crime that it took so long and that the problem got to be so bad before they were called in to help.

Last year, food banks had to step up to help hundreds of families when the recession and a meltdown of Texas’ food stamp application process caused them to miss out on months’ worth of benefits.

Now, food banks and pantries in Dallas, Fort Worth, Houston and San Antonio are doing it again as the state works, under federal orders, to reduce backlogs and improve service at the offices where it determines if Texans are eligible for aid.

The need is still evident. Hungry, desperate people are flocking daily to Metrocrest Social Services, a food pantry in Carrollton’s central business district.


One of every eight Texans is receiving food stamps. The onslaught of need walloped a state food stamp application process already listing from hurricanes, a failed privatization effort and cuts to the state eligibility workforce five years ago.

Texas Health and Human Services Commissioner Tom Suehs took over last fall, when rapid turnover and chaos at state offices thwarted thousands of eligible Texans from getting benefits, often for months at a time. He seized on a 4-year-old arrangement, under which the food banks take applications. The initial case work being done by food banks’ outreach workers was pretty good, Suehs said, so why not pay them to do more?

Read the whole thing. First, kudos to Tom Suehs for making as much progress on this as he has, in just over a month. Frankly, we’d probably be no further along if it weren’t for Suehs and for the threat of federal sanctions for the state doing such a lousy job of this. And read that first sentence in the penultimate paragraph again. When Rick Perry talks about how well Texas is doing compared to other places, he’s not speaking to or about those one-in-eight people. Lord knows, he did nothing to help them.

The big picture for health care reform in Texas

The number you need to know is four point two million.

Texas’ uninsured population will drop from 6.5 million this year to 2.3 million once the federal health care overhaul is fully implemented, and about a third of the remaining uninsured will likely be illegal immigrants, [Health and Human Services Executive Commissioner Tom Suehs] said Thursday.

Four point two million people in Texas who do not currently have health insurance will eventually have it, thanks to the Affordable Care Act. Four point two million people. When Greg Abbott talks about his frivolous lawsuit to repeal the Affordable Care Act, he should be asked why he doesn’t want those 4.2 million people to have health insurance. When Rick Perry and his minions talk about the magic of the free market as the real solution to providing health insurance to people who don’t have it, they should be asked what they intend to do for those 4.2 million people. More to the point, they should be asked why they haven’t done it already. Rick Perry, David Dewhurst, and Greg Abbott are all running for their third full term in their office. They’ve had plenty of time and a legislature full of their fellow Republicans to deal with this problem. If they don’t like the solution President Obama and the Congressional Democrats have created, they had plenty of time to come up with one of their own. But they haven’t, and because of that we have all these uninsured people that the Affordable Care Act will help. Four point two million people. That’s the bottom line.

More arguing over health care costs

There are many things to say about this.

The debate over how much federal health care reform will cost Texas put the state’s health and human services chief on the defensive on Wednesday, as he presented a budget estimate to lawmakers that is 20 times higher than federal projections and questioned the mathematics education of an influential U.S. House chairman.

HHSC Commissioner Tom Suehs estimates that health care reform’s top-dollar items — Medicaid expansion to roughly 2.1 million Texans, plus heightened reimbursement rates for primary care physicians — will cost the state more than $27 billion between 2014 and 2024, up $3 billion from his most recent estimate.

But the Congressional Budget Office’s numbers are far different. Between 2010 and 2019, the agency estimates, the reform will cost Texas $1.4 billion. A letter written last month by U.S. Rep. Henry Waxman, D-California, the chairman of the House Energy and Commerce Committee, notes that Texas’ estimate is more than the $20 billion the reform is expected to cost all state governments combined in the next decade.

“I don’t know where he went to school and got his math education. But it’s not right,” Suehs said of Waxman, speaking at a joint hearing of the Senate Health and Human Services and State Affairs committees. (The answer? UCLA.) “I can’t rationalize the CBO’s budget numbers when I know that I’ve got a higher population of uninsured than most states have total population.”

Where to begin?

1. With all due respect to Tom Suehs, who deserves credit for his handling of the food stamp fiasco as well as for admitting that the Affordable Care Act will also lead to many cost reductions for Texas, I’ll take the CBO’s numbers over his any day.

2. As State Sen. Eliot Shapleigh said, it’s quite odd for the Lege to be looking at budget projections that begin four years out from now. The earliest the Lege will have to deal with the actual effects of the Medicaid changes is likely to be 2013, with the bulk of it beginning in 2015; as Sen. Shapleigh also noted, about 85% of the cost Suehs is projecting doesn’t start accruing till 2017. The 2011 Lege, which has to deal with a budget deficit, school finance, and oh yeah, redistricting, can put it off for now. I’m not saying that we shouldn’t be looking ahead to the future, but a lot of people who are in the Lege now – including Sen. Shapleigh – won’t be there in 2013 or later. A very different cast of characters, and not just in the Lege, will be making the actual decisions about how to deal with all this. And the odds are, the Medicaid stuff that Suehs is fretting over will have been revised again by that time.

3. Something that always seems to get overlooked in all these discussions is that whatever amount of extra money Texas winds up spending on health care, that money will be spent on making many people’s lives better and healthier. That’s something we should have been doing all along but are just now being forced to do because things like cutting Dan Patrick’s property taxes have been considered a higher priority.

4. Finally, even if the state hasn’t been paying for these health care expenses, that doesn’t mean no one has. Ask your county hospital district administrator what will be the effect of having millions more people on any form of health insurance, be it Medicaid or something else, and see what he or she has to say. What the ACA will do, among many other things, is spread that burden around more equitably. Which is just fine by me. The DMN has more.

State auditor issues recommendations for fixing food stamps

It’s about what you’d expect.

The state agency that oversees Texas’ food stamp program is outdated and staffed by inexperienced workers, leading to long delays and inaccurate processing, said the state auditor in a report released Tuesday.

“To improve the timeliness and accuracy of (food stamp) eligibility determinations, the commission must modernize its eligibility determination processes and continue to improve its management,” said the report by the State Auditor’s Office in Austin.


The auditor recommended that the commission immediately buy inexpensive scanning equipment to create electronic case files and that it take steps to help applicants understand what information they must provide, thereby reducing the number of trips they are forced to take to the eligibility offices.

The commission should also post basic eligibility information, train clerical staff to answer frequently asked questions and make sure it has the right number of experienced staffers, the auditor said.

I think the best solution would be to build a time machine, travel back to 2003, and somehow prevent the disastrous privatization scheme from ever taking place. Failing that, the auditor’s report, which you can read here, has some good ideas, too. The CPPP has more.

Making money on both ends

I’m glad to hear that the food stamp backlog should be cleared up soon. I’m not so glad to hear that one of the guys who bears responsibility for getting us into that mess in the first place now stands to benefit from the work to get us out of it.

Gregg Phillips was the state’s No. 2 social services official several years ago, and he led a push to hire a private company to evaluate applications for public assistance.

Now his Austin-based company, AutoGov Inc., has received $207,500 since November to help the state eliminate errors in deciding whether an applicant gets food stamps or other aid and how much recipients get. AutoGov was hired without other companies having a chance to bid for the work.

Health and Human Services Commission spokeswoman Stephanie Goodman said that the agency’s commissioner, Tom Suehs, and his predecessor, Albert Hawkins, agreed that the company’s software might alleviate the problem.

“They both faced the same problem – high error rates – and thought it offered a potential solution,” Goodman said.

State laws on former employees lobbying or contracting with agencies would not prohibit such an arrangement, given that Phillips had been off the state’s payroll for several years. But critics of the deal say it’s troubling that a former employee is getting paid to try to fix problems spawned by an idea he helped hatch.

A leader of a state employees union complained that Hawkins and Suehs – both appointees of Gov. Rick Perry – again have sought high-tech, low-cost fixes for the loss of experienced state workers.

Mike Gross, vice president of the Texas State Employees Union, also said he’s troubled that Hawkins approved a vendor subcontract with two of his former aides – Phillips and AutoGov’s chief executive, Rose A. Hayden, Hawkins’ former chief of staff. The company is paid as a subcontractor to the larger firm that the state hired to run the system.

“The whole thing smells very bad,” Gross said. “We’re now hiring the guy who got us in the mess in the first place. It is absolutely stunning.”

The Gregg Phillipses of the world are like cockroaches. You can never get rid of them. I suppose after all this time I shouldn’t be surprised. The DMN story has a lot of background, and you can get more here.

Food stamp application backlog to be cleared by April

Here’s a little bit of good news.

Texas’ food stamp application backlog is now expected to be cleared by the end of April, Health and Human Services Executive Commissioner Tom Suehs told lawmakers today.


The commission had projected it would clear the backlog by February. That didn’t happen. Though the backlog disappeared in the Tyler, Beaumont, Austin, El Paso and Edinburg areas, there were still 16,000 applications in February for which decisions were past due, Suehs said. About 90 percent of that backlog was in the Houston and Dallas areas.

Suehs now expects the Lubbock, Abilene and San Antonio regions to clear the backlog by the end of March, he told members of a joint Senate-House panel overseeing the state’s system for enrolling Texans in programs such as food stamps and Medicaid. And he expects the Dallas and Houston areas to be back on track by the end of April.

Getting food banks involved has helped, as you might expect. The problem was shameful and inexcusable, the resolution has taken far too long, but at least it’s imminent. That’s a good thing.

State to audit food stamp delivery process

Better late than never.

Health and Human Services Commissioner Tom Suehs has asked [state auditor John] Keel to audit the food stamp program to improve accuracy and efficiency.

“We must fix our system so that it works for everyone. I’m asking the state auditor to help us identify both immediate and long-term solutions to make sure all Texans are able to get their cases processed on time,” Suehs said.

Keel assigned a team to start the review as soon as he got Suehs’ letter on Tuesday.

“It’s an audit that needs to be initiated immediately,” Keel said Wednesday. “We’re going to study the process and look for efficiencies. We do want to look at other states.”

Employee recommendations also will be considered, said Keel, who would not speculate on how long the audit would take.

I’m sure it will take months, because there’s got to be a ton to find that needs fixing. I feel certain that there’s only so much that can be improved without legislative action, perhaps spurred by a lawsuit verdict, an infusion of money, or a trip through the time machine to prevent the disastrous privatization scheme that has decimated HHSC from ever occurring, but this is not a stone that should be left unturned, so kudos to Suehs for taking the step.

Monitoring the food stamps problem

State Sens. Judith Zaffirini and Tommy Williams will be keeping an eye on the food stamps situation.

Zaffirini said in an interview that she and Williams will work with Health and Human Services Executive Commissioner Tom Suehs on hiring more enrollment workers — as well as training and retaining them — and improving communication between state and local offices.

“Hiring personnel in and of itself will not solve the problem,” Zaffirini said.

The state is not meeting federal food stamp standards, which require applications to be processed within 30 days (and seven for emergency applications). In September, Texas failed to process 41.4 percent of applications by the federal government’s deadline. The federal government — which pays for all the food and half the administrative costs of the program — has told Texas to speed up application processing or risk losing federal funds.

Zaffirini said she told Suehs she wants to see weekly progress reports and a timeline for the hiring.

“We need to ensure that the people who are eligible for the services are receiving them in a timely period,” she said.


Zaffirini said she thinks the state should be collaborating more closely with food banks.

Officials with the Texas Food Bank Network this week sent a letter to federal food stamp officials, saying that programs such as food stamps should not rely on non-profits to address their staffing needs.

“We worry that an over-reliance on comparatively small organizations like ours, while an obvious immediate solution, may divert attention and urgency from the broader, more fundamental failures in our state’s application system,” says the letter from Eric Cooper and Jan Pruitt of the Network to the U.S. Department of Agriculture’s William Ludwig.

You can see the letter the Food Bank network wrote here (PDF). I think they’re right to be concerned that they’ll be depended on for more that they can give. We’ve been dealing with this on the cheap all along, I don’t see why anyone should expect it to be different now. Zaffirini and Williams may be able to make a difference at the margins for the time being, but nothing will change until the state’s leadership does.

Feds to Texas: Fix food stamps!

Yet another (bad) way in which our state has distinguished itself.

Federal officials say Texas should appoint a food stamp czar to take charge of fixing the application backlogs and high error rates plaguing the program.

“All states are feeling the pinch right now because of the economic recession, but I’m not aware of any state that is having it to the degree that Texas is,” said William Ludwig, a Dallas-based regional administrator for the U.S. Department of Agriculture’s Food and Nutrition Service.

Ludwig, who rarely gives interviews, oversees food stamps for Texas and four other states. He attributed the state’s problems last week to a “whole series of missteps, mismanagement over the last four years,” starting with thousands of state workers getting pink slips in advance of a massive privatization effort.

Gosh. What might have happened four years ago? Let me think…

[Texas Health and Human Services Executive Commissioner Tom] Suehs, who became commissioner Sept. 1, met last week with supervisors from across the state and said he was shocked to learn how frequently employees were working overtime, staying late and coming in on the weekends. The state spent $2.5 million in August on overtime for enrollment workers.

Texas wasn’t always in this position.

From 1998 to 2004, the federal government gave the state bonus payments for payment accuracy. Last year, Texas had a higher error rate than the national average.

Some of the worker shortage dates to fall 2005, when former Health and Human Services Executive Commissioner Albert Hawkins informed 2,900 eligibility workers that they wouldn’t have a job after the start of a Legislature-mandated privatization plan. Though officials later decided to retain some of the workers, many had already left.

“The key thing that happened that has really led to us being here is the state gave pink slips” to workers, Ludwig said. “Those were the senior employees who understood the system.”

Privatization was a gift that just keeps giving, wasn’t it? How many more examples do we need to understand what a failure “small government conservatism” is? EoW has more.