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Culberson’s stock purchase

Interesting.

Rep. John Culberson

In a heated confirmation hearing for then-Georgia U.S. Rep. Tom Price for Secretary of Health and Human Services, Democrats raised pointed questions about the congressman’s trading in stocks of companies regulated by the House committees he serves on.

One in particular, Innate Immunotherapeutics, a small Australian biotech firm, generated particular attention because it had sold nearly $1 million in discounted shares to two House members: Price and New York Republican Chris Collins, who turned out to be the firm’s biggest investor.

Amid the controversy in January, Price said everything he did was “ethical, aboveboard, legal and transparent,” though he agreed to divest himself of that and other stocks that could raise ethics questions.

Collins also denied any wrongdoing, though he is now reportedly being investigated by the Office of Congressional Ethics for his role in touting the stock to investors from the halls of Congress.

But the public heat did not dissuade two Texas congressmen from quietly buying into the Australian company Jan. 26, two days after the Price hearing before the Senate Finance Committee, records show. John Culberson of Houston and Mike Conaway of Midland, are among at least seven Republican House members who have invested in the company. The two Texans bought in at what was then close to a 52-week peak in the stock price on the Australian Securities Exchange. The transactions were first reported by Politico.

[…]

Culberson’s stock buy, which he valued at between $1,000 and $15,000, was particularly unusual, because by the congressman’s own account, he is not an active stock trader.

Beside his stake in Innate Immunotherapeutics, his most recent financial reports to Congress list holdings in Apple stock and some past investments in “military collectibles.”

In a statement, Culberson offered this motive for the stock purchase in the fairly obscure foreign company that works to develop treatments for multiple sclerosis: “One of my father’s best friends died of MS, and we have a family friend with multiple sclerosis, so I’m always on the lookout for breakthroughs on treating MS. This one looks promising. I rarely buy or sell stock.”

He declined interview requests this week and staffers offered no details about the exact amount and timing of his stock purchase, which coincided with that of Conaway. Nor have they explained why Culberson waited until April 6 to report the stock buy, well beyond the 30-day window required to inform the House clerk’s office.

Through a spokeswoman, however, Culberson dismissed Democrats’ accusations that he might have used non-public information.

“Representative Culberson originally learned of the company through press reports,” his spokeswoman, Emily Taylor, said Thursday. “He continued his own research on their promising MS treatment, which is an issue important to him, and that led to the purchase.”

I don’t know how big a deal this is. The circumstances are fishy and Culberson’s explanation is weak, but unless Tom Price gets into a heap of trouble for his actions, I don’t see much happening to Culberson. That said, having stuff like this turn into blaring headlines seems to me to portend a rough campaign season. If nothing else, having all these candidates and a national focus on CD07 guarantees that every little thing will be news, and that’s not something Culberson has had to deal with lately. Better get used to it.

If we really cared about improving mental health in Texas

We would have expanded Medicaid at our first opportunity.

It's constitutional - deal with it

It’s constitutional – deal with it

Federal health officials say people with mental illness and addictions are being left behind in Texas because the state hasn’t expanded Medicaid to more low-income adults.

The health care program for the poor is controversial for many Republicans. The U.S. Supreme Court ruled that expansion was a voluntary part of the Affordable Care Act, and 19 states have declined to expand it.

A new federal report estimates that expanding Medicaid in Texas could help 406,000 mentally ill and uninsured Texans get treatment, according to Richard Frank, an Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services.

“If states are serious about addressing mental illnesses, opioids, and other substance use disorders, expanding Medicaid offers a unique opportunity to do so,” Frank said in a national conference call with reporters. “It will bring people into effective treatment and is fully paid for under the Affordable Care Act.”

The new federal report discusses how untreated mental illness affects homelessness, job productivity, and jails and prisons. The report says states that did expand Medicaid were able to save money on programs for mental health or the uninsured, or divert the money to other programs.

A copy of the report is embedded at the link above. This is the same song we’ve been singing since 2011, with this being roughly the 1000th verse. The positive effect of getting access to reliable mental health care for these people cannot be overstated – among many other things, it would keep a lot of so-called frequent flyers out of jail – but the state Republican leadership does not care and will not hear it. You know how whenever there’s another gun massacre, the only thing we’re all allowed to say is that we should do more to promote mental health as a way to maybe not have so many gun massacres? The part we’re not allowed to say is that the Republicans in this state won’t do a damn thing to actually promote mental health. It’s the same old story, and the only way it ends is with electing different leaders. The Statesman has more.

One million plus Texas Obamacare enrollments

It keeps going up.

It's constitutional - deal with it

It’s constitutional – deal with it

Just over one million Texans had signed up on the federal health insurance exchange as of last Saturday, signaling a steady drumbeat of interest and giving local advocates a chance for some celebration.

“I will take it,” Ken Janda, president and CEO of Community Health Choice, a Houston-based non-profit health plan offering insurance plans through the Affordable Care Act’s federal marketplace, said Tuesday when he heard the numbers.

The 1,040,246 Texas enrollees included those signing up for the first time and people renewing existing coverage, according to U.S. Department of Health and Human Services statistics released Tuesday.

Nationally, 8.2 million had signed up as of last week, topping last year’s numbers for the same time period by about 2 million, she said, the agency announced.

“We have never seen this level of activity,” HHS Secretary Sylvia Burwell said during a conference call with reporters and community groups across the country. Calling the demand “unprecedented,” she added: “This is what we wanted to see.”

For comparison, the numbers were 734K in 2014, and 850K for 2015. They won’t change the mind of anyone whose mind needs to be changed, but this law has made a big difference in a lot of people’s lives. People can believe whatever BS they want to believe, but a million people who can see a doctor and who can not have to worry about being bankrupted by an illness know better. Kevin Drum, who looks at the national numbers, has more.

Lots of newly insured folks in Texas

Thanks, Obamacare!

More than half of 1.2 million Texans who enrolled in private health insurance plans through the federally operated marketplace this year were new customers, according to a government report released Tuesday.

The analysis from the U.S. Department of Health and Human Services said 57 percent of Texans who enrolled in 2015 – about 681,500 people – were first-time consumers, who did not buy health insurance through the HealthCare.gov platform last year.

[…]

The vast majority of shoppers qualified for tax credits to help pay their insurance premiums. In Texas alone, more than a million people – 86 percent of those who enrolled – were granted tax credits. The average tax credit seen in Texas was $239 per month, Dr. Meena Seshamani, director of the federal Health and Human Services’ Office of Health Reform, said during a conference call with reporters Tuesday.

Before tax credits were applied, the average monthly premium in Texas would have been $328, the report showed. Once the tax credits took effect, the average monthly premium for marketplace plans across the state was $89.

There was indeed a data dump this week, because sites like Daily Kos, which points to Medium, and Wonkblog, which points to the Kaiser Family Foundation, are highlighting the state of play and what the effect would be if the Supreme Court buys the ridiculous argument in King v. Burwell (which the plaintiffs’ own lawyer agreed was BS) and throws out the subsidies for healthcare.gov recipients. The effect in Texas would be substantial, perhaps finally big enough to get people like Erin Meredith to pay attention. Regardless of that, follow those links and look at those charts and remind yourself that this law has helped a lot of people, and anyone who says otherwise is at best misinformed or (in the case of elected officials and hacks from outfits like the TPPF) lying. Ask the people who have insurance now when they didn’t before and who stand to lose it if the Supreme Court decides to take it away from them.

Approaching a million Obamacare signups in Texas

We are well ahead of last year’s pace.

It's constitutional - deal with it

It’s constitutional – deal with it

More than 256,000 Houston-area residents have selected plans or been re-enrolled in coverage through the health insurance marketplace mandated by the Affordable Care Act, and federal and local health officials and experts believe a last-minute surge could significantly increase the numbers before the 2015 open-enrollment period ends later this month.

There have been about 75,000 more local sign-ups than in 2014, during the inaugural year of the marketplace. About 1 million Houston-area residents remain uninsured.

During a conference call with reporters on Wednesday, Marjorie Petty, the U.S. Department of Health and Human Services regional director overseeing Texas, released updated sign-up data showing nearly 969,500 residents statewide selected coverage or were automatically re-enrolled between Nov. 15 and Jan. 30.

The latest update was the first to include local figures. The Houston area recorded 256,982 plan selections and re-enrollments for the period, up from the estimated 180,000 residents who enrolled in coverage last year.

“These numbers would not be as strong as they are without local leadership,” Petty said. “We are making progress across the country and in Texas.”

[…]

Despite Petty’s optimism, millions of Texans and thousands of Houstonians will remain uninsured because state leaders have not come up with a way to expand Medicaid to cover them. Since California expanded the program to cover more of its residents, Texas has overtaken it as having both the highest rate and highest number of uninsured residents.

Elena Marks, president and CEO of Houston’s Episcopal Health Foundation, said Wednesday’s updated numbers are encouraging – until one considers that about 6 million Texans are uninsured.

“If you look at the glass as half full, more adults are becoming insured at a faster rate and in a shorter period of time,” she said. “We ought to be proud we’ve made this much progress.”

See here for the last update. Local leadership is definitely to be applauded for this, since Lord knows the state leadership is doing exactly nothing to help. The goal for Texas this year is 1.25 million signups, which would be an increase of over 60% from 2014. The latest national figure has enrollments at ten million. And there’s still more than a week to go till the deadline. KUHF has more.

What’s the health insurance enrollment status in Texas?

The short answer is that we don’t know. The longer answer, as this Express-News story indicates, is that we’ll never really know.

It's constitutional - deal with it

It’s constitutional – deal with it

Self-sufficiency. Distrust. Desire for flexibility.

Those are some reasons many consumers bypassed health insurance plans sold on government-run exchanges and instead chose to buy coverage directly from insurance agents or brokers before open enrollment ended March 31.

No one is sure exactly how many people did this. There is no singular source that aggregates nationwide health insurance enrollment numbers outside the exchanges. But these consumers will push the total number of enrollments for 2014 health coverage beyond the 7.1 million Americans who went through the federal- and state-operated exchanges.

In Texas, “it could be a big number,” said Stacey Pogue, senior policy analyst at the Center for Public Policy Priorities in Austin. “It could be more people than enrolled in the marketplace in Texas. But we don’t know. It certainly will be a significant number of people.”

The state Department of Insurance doesn’t collect enrollment figures.

Those who did not go through the exchange weren’t able to apply for tax credits or subsidies to reduce their premiums. That’s because tax credits can only be obtained through government-run markets.

There are a number of reasons why some consumers went a different route, independent agents and brokers say. Some made too much money to qualify for tax credits. Some didn’t believe in accepting subsidies. Others feared giving personal information, such as Social Security numbers, to the U.S. Health and Human Services Department.

“Frankly, I have talked to a number of consumers who are concerned about what they feel is an invasion of privacy,” said Carla Adams, president-elect of the San Antonio Association of Health Underwriters and an independent agent. “All of the information that they have to provide once you go on to the exchange … that makes some consumers nervous.”

[…]

Some consumers bypassed the exchange because they wanted the flexibility to choose doctors or hospitals they preferred instead of being limited to a smaller network, several agents said.

For instance, some shoppers who selected certain types of plans on the exchange after verifying their doctor was part of the network learned two weeks later that the doctor was no longer accepting patients with that form of coverage. Loretta Camp, co-owner of Davidson Camp Insurance Services in San Antonio and an independent agent, said her agency intervened in such cases so patients could stay with their doctors.

Local agents also helped consumers going through the federal exchange who wanted professional help to select the most cost-effective plans.

There is no extra cost for consumers who use agents’ or brokers’ services, several experts in the insurance field said. Insurance carriers pay agents’ commissions.

“The reality is, what I’m experiencing with consumers, they’re confused when they try to get on the exchange themselves,” Adams said. “They have no idea what the true differences are between these plans or how to compare, and they’re overwhelmed. Someone like an agent who understands the inner workings of these plans can help them navigate through the differences.”

The state of Texas, of course, tried to make it as hard as possible for non-profits and charitable organizations to provide navigator services, but that’s neither here nor there at this point. We don’t know how many Texans got coverage through the federal healthcare.gov exchange yet. The most recent numbers were 295,025 enrollments as of March 1 – see here for the breakdown – but I haven’t seen anything more up to date than that. The main thing to keep in mind is that whatever the final figure for Texans enrolling via healthcare.gov is, the real number – the number of people who got coverage is higher, perhaps much higher. It would be nice to know how much higher, but that number isn’t available. We’ll have to rely on polling data for that. Here’s hoping we get that soon for Texas.

ACA enrollments in Texas

As was the case with the rest of the country, there was a big surge in December.

It's constitutional - deal with it

It’s constitutional – deal with it

Texas enrollments in the online insurance marketplace created under the Affordable Care Act rose nearly eightfold in December, according to 2013 figures that the U.S. Department of Health and Human Services released Monday.

Texas ranks third in the number of 2013 enrollments following the troubled launch of healthcare.gov on Oct. 1. As of Dec. 28, nearly 120,000 Texans had purchased coverage in the federal marketplace, up from 14,000 one month before.

The number represents a tiny fraction of the uninsured in Texas, which has a higher percentage of people without health coverage than any other state. In 2012, more than 6 million Texans, about 24 percent of the population, lacked health insurance, according to U.S. census data.

Florida led the nation in the number of 2013 enrollments, with 158,000. In a media call from Tampa, U.S. Health and Human Services Secretary Kathleen Sebelius praised Florida’s high enrollment numbers. Like Texas, Florida has a largely unfavorable political climate toward the Affordable Care Act, and a high rate of the uninsured, at 21 percent. HHS officials offered no explanation for why more people enrolled in some states compared with others.

“The numbers show that there is a very strong national demand for affordable health care made possible by the Affordable Care Act,” Sebelius said in the call announcing the enrollment data, adding that nationwide enrollment had reached nearly 2.2 million.

The Better Texas Blog breaks the numbers down further.

  • 457,382 individual Texans applied for coverage with completed applications, revealing a high level of interest in Marketplace coverage;
  • 390,658 Texans were determined eligible to enroll in a Marketplace plan, and 180,349 Texans were found eligible for financial assistance in the Marketplace. Many of the 210,000 Texans who are eligible to buy in the Marketplace, but ineligible for subsidies likely fall into the “coverage gap” created when Texas leaders refused federal funds to expand health care coverage through Medicaid to Texas adults below the poverty line;
  • 47,177 Texans were assessed eligible Medicaid/CHIP by the Marketplace (a number that would be much higher with Medicaid expansion);
  • 55 percent of Texans who chose a health plan are women; and
  • 26 percent are between the ages of 18 and 34. Young adults are enrolling in the Marketplace, and previous experience from Massachusetts indicates that enrollment by this age group will increase as we near the March 31 enrollment deadline.

These numbers prove that the law and its website are working–more Texans are able to apply for and select health plans that fit their budgets. (Read about our intern’s experience enrolling in a Marketplace plan). People can enroll in the Marketplace through March 31, 2014.

There’s still a lot more growth to come, in other words. Progress Texas adds on.

Ed Espinoza, Executive Director of Progress Texas, released the following statement:

Twelve weeks of ACA has done more to help Texans without health care than Rick Perry has done in twelve years as Governor.

…Texas Still Has a Significant Coverage Gap

In addition to the top-line numbers, a little digging shows how Rick Perry and Greg Abbott’s refusal to expand Medicaid has created a significant coverage gap in Texas:

  • 210,309 Texans who applied for coverage could have received financial assistance for the Marketplace plans.

Many, if not most, of those 210,000+ Texans who couldn’t get financial assistance would have been covered if Texas had expanded Medicaid. We know that one million low-income Texans are left out of health coverage because elected leaders in Texas chose politics over what was right for our people.

Just imagine how many more people could be getting coverage if Rick Perry wasn’t doing everything in his power to stand in the way. Several Texas Congressional Democrats have now sent a letter to AG Eric Holder asking him to step in and do something about Texas’ ridiculous navigator rules, but I don’t really expect anything to come of that. For more on the national numbers, see Jonathan Cohn, TPM, Sarah Kliff, and Ezra Klein.

Texas Left Me Out

This.

It's constitutional - deal with it

It’s constitutional – deal with it

Obamacare advocates are actively recruiting those left out of the Medicaid expansion in Republican-controlled states to lobby state officials to change their minds and participate in that key provision of the health care reform law.

So far, the effort is most organized in Texas, which is also the state with the most people in that Medicaid expansion gap: 1 million. But it’s likely to pick up elsewhere as the Obama administration and outside advocates apply pressure to the 25 states that have resisted expansion for the first year.

Texas Left Me Out, the combined effort of several community groups, is a website designed to collect those people’s stories and organize them into a cohesive political action constituency. It asks those in the Medicaid gap to sign a petition to stay informed about advocacy events and share their story on the site.

Are they going to turn Texas blue on the backs of people who have traditionally been ignored by Republicans? Are they going to convince an anti-Obamacare stalwart like Rick Perry to buy into the law? That’s a tough sell. But they’re going to try.

“When you personalize a policy, when you make it real, it’s always much more powerful. It’s always going to resonate,” Tiffany Hogue, state health care campaign coordinator at the Texas Organizing Project, one of the groups involved with the campaign, told TPM. “People have really have awakened to the fact that people really are getting left behind.”

Texas Left Me Out had a soft launch in October in preparation for a January rollout. The Texas Organizing Project says it has already contacted 100,000 people who are in the gap and convinced 20,000 to commit to be part of the campaign. They hope that those numbers will grow substantially before the Texas legislature reconvenes in 2015, its next opportunity to expand Medicaid under Obamacare. They’ve set recruitment targets for specific legislative districts to focus their efforts.

The broader coalition is also eyeing the 2014 elections. The presumed Democratic frontrunner for governor, state Sen. Wendy Davis, has enthusiastically endorsed expansion, and a more Democratic legislature would also be more likely to sign onto a major piece of the health care reform law.

The strategy is simple: sheer political force. They’ll ask people to turn up at legislative committee hearings and stage protests at the state capitol. Conference calls and press conferences will be the norm. They aren’t waiting for 2015 either. A group is going to a state insurance department meeting Dec. 20 to rally for expansion.

The website is here. I’m not at all surprised to see that Progress Texas is one of the forces behind it. The goals are ambitious, but we’re not going to get anywhere by thinking small.

And despite the ferocious efforts by Texas Republicans to deny health care coverage to its residents, demand for health insurance is strong.

Texas has the second-highest number of people who have purchased health plans through the embattled online insurance marketplace created by the Affordable Care Act, according to enrollment figures for October and November released Wednesday by the U.S. Department of Health and Human Services.

But as a percentage of the uninsured in the second-largest state — which has the nation’s worst rate of health coverage — the number is tiny: 14,000 Texans had purchased coverage through healthcare.gov by the end of November.

The number of people who purchased coverage in the federal marketplace, which has been riddled with technical problems, was four times higher in November than in October: 137,204 people, including 14,000 Texans, had purchased coverage there as of the end of November, whereas only 27,000 people, including 3,000 Texans, had purchased coverage there at the end of October.

“Evidence of the technical improvements to HealthCare.gov can be seen in the enrollment numbers,” U.S. Health and Human Services Secretary Kathleen Sebelius, said in a press statement.

Florida had the highest enrollment numbers, with 17,900 people purchasing coverage in the federal marketplace, followed by Texas, and Pennsylvania, with 11,800 people purchasing coverage. 2.2 million people, including 245,000 Texans, have now completed applications through the federal marketplace.

Texas has the nation’s highest rate of people without health insurance at 24.6 percent, according to U.S. Census data. About 48 million Americans — including more than 6 million Texans — were uninsured in 2011 and 2012.

Those numbers are two weeks old now, but there’s no indication that the pace has slowed since then. Remember when you hear a Texas Republican whine about Obamacare that they have been in complete control of Texas’ government for over a decade now. If they cared at all about those six million uninsured people, they’ve had ample opportunity to do something about it. But they don’t, so they haven’t. Nothing will change until our state government changes. That’s why efforts like Texas Left Me Out matter.

Premiums for insurance exchange plans released

Guess what? They’re pretty darned affordable.

It's constitutional - deal with it

It’s constitutional – deal with it

“In just 99 days, millions of Americans will finally have the security and peace of mind that have eluded them for years,” U.S. Health and Human Services Secretary Kathleen Sebelius said on a press call, “as coverage starts to kick in on insurance purchased through the new health insurance marketplace.”

To help people comply with the individual health insurance mandate that takes effect on Jan. 1, the federal government will launch an Orbitz-style online marketplace on Oct. 1 for consumers to apply for tax credits and compare and purchase health plans.

According to the federal report released Tuesday night, Texas will have comparatively low premium rates for health plans offered in the federal marketplace compared with other states. The average monthly rate for a standard plan in the 48 states analyzed in the report was $328, while Texas’ was $305. Fourteen states and the District of Columbia will have lower rates on average than Texas for a standard health plan offered in the marketplace.

“Texas has historically had a reasonably competitive insurance market compared to some states,” said Gary Cohen, director of the Center for Consumer Information and Insurance Oversight at the federal Centers for Medicare and Medicaid Services. He explained that in some states one insurance carrier may dominate 75 to 80 percent of the market. “Texas has not had that situation,” he said.

Texans will have on average 54 health plan options available in the federal marketplace. The number of available plans will vary depending on the region. For example, people in Austin will have 76 health plans to choose from on average, while people in the Rio Grande Valley will only have 30 options on average.

Four types of plans will be offered in the marketplace: Bronze, Silver, Gold and Platinum. In general, Bronze plans will have lower monthly premiums but higher out-of-pocket costs, while Platinum plans will have the highest monthly premiums but lower out-of-pocket costs. Premium rates and out-of-pocket costs will vary depending on age, the number of people in the household and the region in which the person lives, among other factors. Ultimately, the prices are based on the estimated cost of health care services over the course of a year.

People who have annual incomes between 100 and 400 percent of the federal poverty line will qualify for sliding-scale tax credits to help them purchase a health plan in the federal marketplace. For an individual, that’s an annual income of $11,490 to $45,960; for a family of four, it’s $23,550 to $94,200.

Click over to see some detailed information about what will be available in Texas, or click here to see the full report. Some highlights from the latter:

Individuals will have an average of 53 qualified health plan choices in states where HHS will fully or partially run the Marketplace

  • Individuals and families will be able to choose from a variety of bronze, silver, gold, and platinum plans in the Health Insurance Marketplace, as well as catastrophic plans for young adults and those without affordable options. Health insurance issuers can offer multiple qualified health plans, including multiple qualified health plan choices within a single metal level. In the 36 states in this analysis, the number of qualified health plan choices available in a rating area ranges from a low of 6 to a high of 169 plans. On average, individuals and families will have 53 qualified health plans to choose from in their rating area. Young adults will have an average of 57 qualified health plans to choose from, including catastrophic plans. The average number of choices will likely increase after including final data from state-based Marketplaces, which tend to have greater issuer participation.
  • On average, there are 8 different health insurance issuers participating in each of the 36 Marketplaces included in this analysis. This ranges from a low of 1 issuer to a high of 13 issuers within a state. About 95 percent of the non-elderly population in these 36 states lives in rating areas with 2 or more issuers. Roughly one in four issuers is offering health plans in the individual market for the first time in 2014.

Premiums before tax credits will be more than 16 percent lower than projected

  • The weighted average second lowest cost silver plan for 48 states (including DC) is 16 percent below projections based on the ASPE-derived Congressional Budget Office premiums.11 In 15 states, the second lowest cost silver plan will be less than $300 per month – a savings of $1,100 a year per enrollee compared to expectations. Overall, 95% of the uninsured potentially eligible for the Marketplaces live in states with average premiums below ASPE-derived CBO projected premiums (see Figure 1).
  • Young adults will pay lower premiums and also have the option of a catastrophic plan that covers prevention, some primary care, and high costs in cases of major accident or illness. The weighted average lowest monthly premiums for a 27-year-old in 36 states14 will be (before tax credits): $129 for a catastrophic plan, $163 for a bronze plan, and $203 for a silver plan. More than half of the uninsured potentially eligible for the Marketplaces live in a state where a 27-year-old can purchase a bronze plan for less than $165 per month before tax credits. There are an estimated 6.4 million uninsured Americans between the ages of 25 and 30 who may be eligible for coverage through Medicaid or the Marketplaces in 2014.

Premiums after tax credits

  • Tax credits will make premiums even more affordable for individuals and families. For example, in Texas, an average 27-year-old with income of $25,000 could pay $145 per month for the second lowest cost silver plan, $133 for the lowest cost silver plan, and $83 for the lowest cost bronze plan after tax credits. For a family of four in Texas with income of $50,000, they could pay $282 per month for the second lowest cost silver plan, $239 for the lowest silver plan, and $57 per month for the lowest bronze plan after tax credits.
  • After taking tax credits into account, fifty-six percent of uninsured Americans (nearly 6 in 10) may qualify for health coverage in the Marketplace for less than $100 per person per month, including Medicaid and CHIP in states expanding Medicaid.

It should be noted that it’s not all butterflies and lollipops, as Wonkblog explains.

Health experts say it is a good sign for consumers that premiums have come in lower than expected. Under the law, the plans must offer a basic set of benefits, including mental health and maternity care, which previously were not included in many private plans. Insurers are also forbidden from rejecting or charging people more because of preexisting conditions.

Many experts worried that those factors would drive up the cost of insurance. They partially credit competition on the marketplaces, where people will be able to directly compare plans from different insurance companies, for restraining premiums.

But they warn that premiums don’t tell the whole story.

The low rates are possible in part because insurance companies created special plans that include fewer in-network doctors and hospitals than many current plans.

This may not be a problem for healthy people who currently lack insurance. But those with illnesses may discover that their specialists are not covered by an exchange insurance plan. Low-income people accustomed to a certain community clinic may find that going there is no longer an option. And everyone may encounter long waits to see a doctor.

In addition, many of the lowest-cost plans may carry high deductibles, despite a cap imposed by the law that limits out-of-pocket costs to $6,350 per person per year.

“Despite the fact that the premiums are lower than expected, enrollees on exchanges are likely to face very high out-of-pocket costs before they hit their cap, and they are at risk of being in very narrow network plans that may or may not include all the providers they need access to,” said Caroline Pearson, vice president of health reform at the consulting firm Avalere Health, which did its own report on rates this month.

It’s still going to be a lot better than having no insurance, and for people who are currently paying exorbitant prices for individual plans, or who can’t get insurance at all because of pre-existing conditions, it will be awesome. That will include millions of Texans, some of whom are friends of mine, and all of whom Ted Cruz cares nothing about. Kevin Drum and the Kaiser Family Foundation have more.

Counties may try to expand Medicaid on their own

The Washington Post reports on the efforts of county and hospital district officials in some of Texas’ largest counties to bypass Rick Perry’s refusal to expand Medicaid for Texas and seek approval to do it themselves for their own jurisdictions.

It's constitutional - deal with it

George Hernandez Jr., CEO of University Health System in San Antonio, came up with the idea of the alternative, county-run Medicaid expansion, and said he has been discussing it with other officials in his county, Bexar. “They are all willing,” he said. He added that he has also been talking up the proposal with officials in other big counties, such as those including Houston and Dallas, and is optimistic they’ll support the idea.

Robert Earley, CEO of JPS Health Network, the public hospital system serving Tarrant County, which includes the Fort Worth area, said he could see the idea catching on.

[…]

Under the federal health law, the Medicaid expansion would begin in 2014, and would cover people with incomes of up to 133 percent of the poverty level. The federal government would pay the entire bill for the first three years and 90 percent thereafter. If there were a county-backed expansion in Texas, the local hospital districts would tax residents to come up with the 10 percent state share. Texans living in counties that participated in the expansion would be eligible for Medicaid under the less restrictive rules, while those living in the rest of the state would not.

An official from the U.S. Department of Health and Human Services declined to comment on the idea, but said, “We look forward to continuing our dialogue with states . . . as we work to meet the law’s goals.”

Alan Weil, executive director of the National Academy for State Health Policy, said that the idea, despite its challenges, “is certainly not far-fetched.”

Weil noted that there is precedent for a federal waiver of this type: After California declined to take advantage of a provision in the health-care law that allows states to accelerate their Medicaid expansion, the leaders of several counties got permission from the Obama administration to do so on their own.

The Texas proposal, of course, represents more than a temporary bridge to statewide expansion; it could be a permanent arrangement.

“And federal authorities might feel differently about that,” Weil said. “But as a general proposition, could you have different counties with different eligibility standards? I think the answer would be yes.”

We first heard about this a few weeks ago, after the Perry announcement and the sheepish admission by outgoing HHSC Chair Tom Suehs that Medicaid expansion would not cost nearly as much as his agency had first claimed. It’s an interesting approach, one that I could see being allowed to happen, and I admire creativity and perseverance of the officials who are pursuing it, but let’s be clear that it’s at best a kludge designed to work around a bad decision. For one thing, it cannot possibly be more efficient to have up to 254 potentially different standards for eligibility in Texas than just one statewide standard. For another, while I expect that many counties would do this if they are permitted to do so, some others will choose instead to be free-riding parasites on their neighbors; this is another reason why a statewide solution is better. Given the choice between no Medicaid expansion and a patchwork of Medicaid expansion done by the counties, I’ll gladly take the latter – it’s way better than the status quo, and could easily wind up covering a significant portion of the large uninsured population in Texas, many of which are now served by these overburdened hospital districts. But again, it’s a patch that’s being applied to a strictly self-inflicted wound.

And this approach now has a champion in Congress.

Congressman Henry Cuellar is asking the U.S. Department of Health and Human Services if Texas counties can bypass their state government in order to expand Medicaid coverage.

The Laredo Democrat says he supports giving counties the choice. He said he set up a teleconference call with HHS after reading an article in the Washington Post that said some of Texas’ largest counties want to make an end run around Gov. Rick Perry’s opposition to the expanded Medicaid program included in President Obama’s health-care law.

“I will be talking to HHS next week. I want to know if it is up to the Texas Legislature to decide if counties can do their own thing or whether it is something we can make happen at the federal level. I want to do all I can to give counties the choice,” Cuellar said, in an interview with the Guardian in Rio Grande City on Tuesday.

[…]

Cuellar recalled his time in the state legislature when he wanted to give Texas counties the opportunity to expand the Children’s Health Insurance Program. “We do not do as good a job with the CHIP program as other states do and I wanted to negotiate with HHS to give our counties the chance to expand it. I was opposed by the other states. They understood that if Texas sent CHIP money back, they could get some of it,” Cuellar said.

The Washington Post story focused on the larger Texas counties that have large public hospitals and hospital districts. Many border counties do not. Asked if border counties could bypass the state government in order to secure expanded Medicaid coverage under the ACA, Cuellar said he is going to ask HSS if such a maneuver is possible. “I want to see if the border counties can group together. I want to see if we can give them an option,” Cuellar said.

Again, given the constraints of Rick Perry’s obstinacy and antipathy towards non-rich people, that’s a great idea. Any opportunity to bypass the Lege should be grasped with both hands. Make that option available to any group of counties that don’t have a hospital district but want to do right by their taxpayers, too. If there’s any justice, Texas would achieve near-complete coverage by this method. It will probably take something like that to change the status quo. It’s still a stupid way to do business, but you gotta do what you gotta do.

There’s one remaining question that I have about all this, and that’s what Harris County intends to do. Bexar County has been the driving force behind this movement. Harris has the same need and a much bigger population, so its participation would be a big deal. I placed a call and was informed that Harris County Hospital District CEO David Lopez is “not granting interviews” on this topic at this time. Disappointing, but I suppose the politics of this are rather tricky for them, and they want to get as many ducks in a row as possible before deciding on a course of action. If you’re an officeholder in Harris County and you like the idea of providing coverage to the million or so uninsured residents of this county, I suggest you bring this up to Mr. Lopez at your next opportunity. You never know who else might be talking to him if you aren’t.

We’re #50!

The state of Texas is dead last in delivering health care.

The 2011 State Snapshots report is based on 155 quality measures gathered by the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. The measures include disease prevention efforts, deaths from various conditions as well as infant mortality and suicides, cancer treatment, and how well health care providers manage chronic conditions such as diabetes and patients with incurable conditions.

Texas is weakest on measures of home health care but showed strengths in nursing home care, said the report, released this week.

Overall, Texas scored 31.61 out of 100 points. The No. 1 state, Minnesota, scored 67.31, with Wisconsin close behind at 67.20.

“For some states, like Texas, we hope it will motivate policy makers and providers to improve the quality of care,” said report researcher Dr. Ernest Moy, a medical officer at the agency’s Center for Quality Improvement and Patient Safety.

Yeah, I couldn’t read that quote with a straight face, either. The report is here. The TM Daily Post summarizes as follows:

State health officials say Texas’ poor rating is a result of inadequate funding and a large uninsured population. About 25 percent of the state’s residents lack health insurance, more than any other state.

This is, of course, a feature and not a bug in our state. Keep that in mind when the geniuses in charge make their decision about expanding Medicaid, which would go a long way towards dealing with those issues. Juanita has more.