Off the Kuff Rotating Header Image

February 20th, 2013:

Medicaid expansion pressure is having an effect

Despite the mountains of evidence in its favor, I still can’t say that I see a path to Medicaid expansion in Texas. But stories like this do give me some hope.

It’s constitutional – deal with it

Adamantly opposed to expanding Medicaid coverage under President Barack Obama’s signature health care law, Gov. Rick Perry and Lt. Gov. David Dewhurst had seemingly squelched efforts this legislative session to insure an additional 1.1 million low-income Texans under the Affordable Care Act.

But a determined campaign, targeting legislators with public pressure and private persuasion, has kept the issue alive by framing Medicaid expansion as an economic bonanza and tax-relief opportunity that would bring $79 billion in much-needed federal money over 10 years.

The arguments, pitched to Republican ears, have carved out a small space in which lawmakers can work toward an agreement that once appeared impossible.

Several key GOP legislators, though skeptical about expanding Medicaid, haven’t ruled out the possibility of a compromise, provided they can get several important concessions. Democrats are ready to deal.

“I’m tempering my rhetoric,” said state Sen. Rodney Ellis, D-Houston. “I don’t want to say anything that backs them in a corner. I want to get this done.”


Last week, the Austin City Council voted unanimously to push the Legislature toward expanding Medicaid, echoing a similar call by Dallas County. Influential lobbying groups also have joined in, including the Texas Medical Association, which recently endorsed expansion if accompanied by reforms that include cutting red tape and increasing provider payments.

[State Rep. John] Zerwas, a medical doctor, said he is feeling the pressure to reverse his opposition.

“Absolutely. If you talk to hospitals, if you talk to counties, there is a substantial amount of money that is promised in the law that would benefit Texans. We do have a substantial uninsured problem,” Zerwas said.

But, he added, the expansion as proposed would be a Band-Aid solution, stressing an unsustainable Medicaid system that has grown so large it threatens spending on education, roads and other vital programs.

Still, Zerwas said there could be room to negotiate if Texas wins important concessions from the federal government to create a flexible system. The amount of needed flexibility “remains to be defined,” he said, but could include running the expansion program as a health maintenance organization and requiring co-pays.

Houston’s Rep. Garnet Coleman, one of the Capitol’s leading Democrats on health care issues, is fine with requiring co-pays and similar concessions.

Coleman, however, draws the line at attempts to use expansion as an opportunity to change Medicaid’s promise to children and disabled and elderly Texans. Talk of adding flexibility, he said, has often meant cutting people and services from the Medicaid system.

“Those of us who support the Medicaid expansion, we can walk away from the table, too, if we don’t think what is proposed is good for our constituents. This is a two-way street,” he said.

I presume Rep. Coleman is talking about block-granting Medicaid, which everyone knows would be used to cut benefits. This isn’t the first time we’ve heard about the possibility of a deal on Medicaid expansion, but this is the first time we’ve seen some details, however sketchy. Obviously, the biggest hurdle is Rick Perry, and he’s painted himself into enough of a corner that I have a hard time imagining him signing anything that doesn’t include block grants as a cornerstone. Maybe I’m wrong about that, but no one has gotten rich underestimating Perry’s fanaticism lately. Still, bringing pressure from the county level is the smart move, though it would really help if Harris County would get into the game. If we can’t get that I’d settle for a resolution from Houston City Council. This needs to be a big issue for the 2014 elections, and it needs to be felt at the county level by folks like County Judge Ed Emmett and County Commissioner Jack Morman as well. If you’re not part of the solution then we need to get someone else who is.

We’re not going to solve our transportation issues without new revenue

The choice isn’t whether or not to pay, it’s how do you want to pay.

Sen. Kevin Eltife

Despite broad agreement that repairing and improving Texas highways will cost more money than it has in the past, legislators split Monday on whether now is the time to impose new transportation taxes or fees.

House members attending the annual Texas Transportation Forum said lawmakers were unlikely to support increasing transportation revenues. Senators, however, said this seemed unavoidable.

“There are times when taxes are the conservative thing to do,” said Sen. Kevin Eltife, R-Tyler.

Across Texas, transportation officials estimate they need an additional $3 billion for new construction and $1 billion for maintenance. With state and federal coffers tight, conference attendees said, new revenue sources are the best solution – but a tough sell to lawmakers.

“It should be looked at as an investment, not an expense,” said William Thompson Jr., former New York City controller, a speaker at the transportation forum.

The recent template for getting projects moving in Texas has been development agreements between the Texas Department of Transportation and regional officials, and $13 billion in borrowing. State transportation Commissioner Ted Houghton said the three most recent Houston-area projects to proceed – construction of part of the Grand Parkway and improvements to U.S. 290 and Texas 288 – advanced through partnerships with the Harris County Toll Road Authority and other adjacent counties.

But now “the credit card is maxed” and new taxes are likely, Eltife said.

“I was fine before I came to this office, and if they kick me out of office I’ll be fine,” Eltife said to applause from the crowd.

I’d need to look up the amount, but all that borrowing we’ve done to finance road projects in Texas is going to cost us a lot of money in interest payments. That’s another thing that will need to be paid for somehow. The solutions being discussed now include not diverting any more funds from the gas tax revenue, which would add about $300 million to the road funds but which would leave a hole of the same size in general revenue – the diversion is mostly to pay for the Department of Public Safety, so ending that diversion is no sure thing – and doubling the vehicle registration fee, which has a reasonable shot at passing and would raise about $1 billion. Personally, I think Sen. Eltife is right, and the sooner we accept that the sooner we can start actually making headway on this. It may be the case that driverless cars will ultimately reduce the amount of road space we need, but who knows when that might happen, and until then there are some crying needs that have to be addressed. Better and in the long run cheaper to accept reality now. The DMN, the Trib, Dallas Transportation, and EoW have more.

Some charter school stories

Now that Sen. Dan Patrick has filed his school choice bill, I thought this would be a good time to review some recent stories about charter schools. There were a couple of interesting stories relating to charter schools in the DMN the weekend before last. This story is about four charter school applications that contained identical language in each.

Concerns about the state’s vetting process for applications come as Gov. Rick Perry and key state lawmakers are pushing to allow even more charter schools, which receive more than $1 billion in state funds each year.

State education leaders say they’re trying to improve the screening process to ensure that applications reflect unique ideas, in keeping with the mission of charter schools.

“They’re supposed to be models of innovation in the classroom and the community,” said Michael Soto, a former state board member from San Antonio. “If you can’t even come up with original wording in your application, how can you be innovative?”

The four applications with similar passages had something else in common: They were prepared with help from a McKinney consultant, Bracy Wilson of Help Charters LLC.

Wilson said the copying in the public hearing summaries was an unintentional mistake. He said other copied areas reflect an effort by charter applicants to “look to the past for best practices” from other charters.

One of the four proposed schools, International Leadership of Texas, won state board approval. Eddie Conger, the superintendent, said his school’s mission — to make students fluent in English, Spanish and Chinese — is genuine. But parts of the application were not.

“I give myself an F-minus on the paperwork,” he said.

Conger is a former Dallas ISD principal who made big strides in improving Thomas Jefferson High School in North Dallas. He said he was encouraged by other charter operators to start a school, which will have campuses in Arlington, Garland and a third undetermined location.

Conger said International Leadership paid Wilson to help prepare the application. It’s Conger’s signature on the application attesting to its accuracy. So Conger, a retired Marine, said he assumes responsibility.


Three of the proposals — from International Leadership, Polaris and iWin — advanced to the state board for possible approval. Applicants said that when board members interviewed them in November, they discovered that parts of their proposals read alike.

“It was a total surprise to me,” said Nora Berry, who had applied to open Polaris Public School in Dallas County. “I had no idea the consultant was working with other applicants.”

Conger said International Leadership paid Wilson and Help Charters $78,000 for helping prepare its successful application. Wilson worked previously at Life School, a group of North Texas charter schools founded by his father, Tom Wilson.

Bracy Wilson ran last year for state representative from Collin County but lost in the Republican primary. His campaign website described him as “one of the leading consultants on charter schools” who has helped clients in numerous states.

Wilson said Texas has one of the most difficult and complex charter application processes in the country, which is why some groups hire consultants.

He said it appears that proxy questions and answers for the public hearings were mistakenly left in the applications. “Each application is reviewed by the respective applicant’s team and, unfortunately, some of these placeholder responses were not identified and replaced with the individualized responses,” he said in an e-mail.

Yet, the locations were changed in each of the summaries.

The summaries also had identical comments. For example, the summaries for both Athlos Academy and International Leadership had these identical quotes from parents: “We’ve been waiting for a school like this,” and “This is the school I want for my children.”

Conger said his school’s public hearing really took place — its application, along with the other three, included copies of the hearing notices that were published in local newspapers and copies of sign-in sheets. But he said the written summary was not “an accurate reflection of the public hearing.”

The applications also show similarities beyond the public hearing summaries. In some cases, descriptions of the proposed school’s philosophy and pledges of support use wording that is identical to previously approved charter schools that Wilson and his firm also worked with.

It’s unclear whether this is a common occurrence or an anomaly, but what is clear is that the process is complex and greatly detailed. To the extent that legislators like Sen. Patrick want to make it easier to start a charter school, this is the sort of thing they’re talking about.

Charter school applications are reviewed by the Texas Education Agency before they go to the SBOE for approval. This story points out that the budget cuts of 2011 have had an effect on their ability to move the process along.

State Sen. Dan Patrick, R-Houston, chairman of the Senate Education Committee, wants changes in how charter applications are screened and approved in Texas. For instance, he’d like a national group of charter school authorizers to train Texas Education Agency staff who oversee applications and state board members who review them. He said he’d also like to look for best practices Texas could adopt.

Patrick said such ideas would be part of a charter school bill he plans to file.


Meanwhile, the education agency — which oversees all Texas independent school districts and charter schools — struggles to perform its duties with a reduced staff. The agency has lost a third of its employees in the past two years because of state budget cuts. It has about 700 employees, down from nearly 1,100 employees two years ago

A recent report by the state’s Sunset Advisory Commission said: “Although the agency has recently experienced a drastic downsizing of its staff, its responsibilities have not been similarly reduced. Spread too thin, TEA struggles to perform all these functions well.”

The report also noted TEA’s “inability to address issues of chronic poor performance in a few charter schools.”

Budget cuts do have consequences, don’t they? I figure there’s a fair amount of overlap between charter school proponents and budget cut enthusiasts. Anyone want to place a bet on Sen. Patrick restoring funding to the TEA so that it can do a more effective job of vetting and approving charters?

Other reading of interest: This WaPo blog post summarizes the recent reporting that many charter schools do in fact take steps to cream off the strongest students for their classes, and this post by a school finance expert who has been a charter school advocate in the past posits that “the political movement of charter schooling [is] no-longer operating in the public interest”. It’s long and wonky, but you need to read it. The bottom line for me is that while I believe charter schools have many positive things to offer as a whole, I have a lot of distrust for the people currently leading the legislative charge for them. We all need to be very clear about what “school choice” means if and when it passes through the Legislature.

Early voting starts today for SD06 runoff

It’s runoff time for SD06. Early voting begins today and runs through Tuesday, February 26. Here are the early voting locations, which are the same as they were for the first round:

Location Address
1 Harris County Administration Building 1001 Preston, 1st Floor Houston TX 77002
2 Holy Name Catholic Church 1912 Marion Street Houston TX 77009
3 Ripley House 4410 Navigation Boulevard Houston TX 77011
4 H.C.C.S Southeast College, Learning Hub 6815 Rustic, Bldg D Houston TX 77087
5 Galena Park Library 1500 Keene Street Galena Park TX 77547
6 Hardy Senior Center 11901 West Hardy Road Houston TX 77076
7 Baytown Community Center 2407 Market Street Baytown TX 77520

See Harris Votes for more. With only seven days of early voting, and only three of those days being full 7 AM to 7 PM days, GOTV efforts for both Sylvia Garcia and Rep. Carol Alvarado will be even more important.

One thing Alvarado will have going for her as voting begins is the Chron’s endorsement.

Rep. Carol Alvarado

Runoff candidates Sylvia Garcia and Carol Alvarado are both dedicated public servants with a long history of representing the area.

In terms of political positions, there’s not much difference between them. Both are Democrats who vow to strengthen state education spending and expand Medicaid. They differ chiefly in the way in which they’d go about achieving their goals. Garcia vows to go toe-to-toe against Gov. Rick Perry and other Republicans. Alvarado says that she’d continue to do what she’s done as a member of the Republican-controlled Texas House: work with members across the aisle to get legislation passed.

We believe that Alvarado’s approach will serve her district best. In part, that’s pure pragmatism. Given Republicans’ utter dominance of our state’s government, a Democrat who hopes to accomplish anything at all has to play nicely with the GOP. But it’s also the solution to a larger problem. Both Texas and the United States need more politicians, both Democrats and Republicans, who can find middle ground and nudge the body politic forward. Alvarado is that kind of legislator.

Residents of the district are familiar with Alvarado and her staff, who are frequent presences at civic club meetings and neighborhood events. That sort of ground-level constituent service might not be notable elsewhere, but it is in places like the east side of Houston, Galena Park and South Houston. Many of the area’s neighborhoods receive too little attention from the elected officials who are supposed to serve them.

Members of the Legislature also are familiar with Alvarado. That’s especially important in this runoff because its winner will have to hit the ground running. She’ll be sworn into the state Senate with only a few days left in which bills can be filed. As a third-term member of the House, Alvarado knows the legislature’s ins and outs and has already established many of the relationships she’ll need to serve her district.

Congrats to Rep. Alvarado for getting the endorsement.

For those of you who still want to hear more about issues in this race – I know, how quaint – Stace summarizes a Univision report that has more information than we’ve seen in other recent reports.

I’ll keep an eye on daily early voter turnout. I think there’s a better chance this time around that early turnout will be less than half of final turnout – it was about 60% of final turnout for Round One – and I think there’s a decent chance that total turnout will match or exceed turnout from the first election. I’m just guessing, however – it could easily be the case that turnout declines. Before anyone clucks their tongues about the nature of certain districts, note Greg‘s words about how turnout in SD06 compares to the special election in SD22 from 2010. It is what it is. Just go vote if you live in SD06 and let everything else take care of itself.