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June 13th, 2013:

RAND reminds us what we’re not getting

Not expanding Medicaid is a really bad deal for Texas, and all those other states like Texas.

It's constitutional - deal with it

It’s constitutional – deal with it

States that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending, at least in the short term, on the cost of treating uninsured residents, according to a new RAND Corporation study.

If 14 states decide not to expand Medicaid under the Affordable Care Act as intended by their governors, those state governments collectively will spend $1 billion more on uncompensated care in 2016 than they would if Medicaid is expanded.

In addition, those 14 state governments would forego $8.4 billion annually in federal payments and an additional 3.6 million people will be left uninsured, according to findings published in the June edition of the journal Health Affairs.

“Our analysis shows it’s in the best economic interests of states to expand Medicaid under the terms of the federal Affordable Care Act,” said Carter Price, the study’s lead author and a mathematician at RAND, a nonprofit research organization.

“States that do not expand Medicaid will not receive the full benefit of the savings that will result from providing less uncompensated care,” Price said. “Furthermore, these states will still be subject to the taxes, fees and other revenue provisions of the Affordable Care Act, without reaping the benefit of the additional federal spending which will costs those states economically.”

Price and study co-author Christine Eibner used the RAND COMPARE microsimulation model to estimate the likely effects if 14 states choose not to expand Medicaid under federal health care reform. Among the measures studied are the impacts of Medicaid expansion on insurance coverage, federal payments into the states and state spending on care for the uninsured.

The states studied are Alabama, Georgia, Idaho, Iowa, Louisiana, Maine, Mississippi, North Carolina, Oklahoma, Pennsylvania, South Carolina, South Dakota, Texas and Wisconsin. Although governors in additional states oppose expanding Medicaid, the 14 states in the study were the first whose governors said they would not expand Medicaid. At the time of the analysis, these were seen as the least likely to expand Medicaid.


The RAND study found that the cost to states for expanding Medicaid generally would be lower than the expense state and local governments will face for providing uncompensated care to uninsured residents after implementation of the Affordable Care Act.

Researchers estimate that increased insurance coverage triggered by health reform will reduce state and local spending on uncompensated medical care by as much as $18.1 billion annually across all states. Those savings may continue beyond 2020, when the states’ share of Medicaid costs plateaus.

“State policymakers should be aware that if they do not expand Medicaid, fewer people will have health insurance, and that will trigger higher state and local spending for uncompensated medical care,” Price said. “Choosing to not expand Medicaid may turn out to be the more-costly path for state and local governments.”

The study suggests that changes could be made to the Affordable Care Act to help some people targeted by the Medicaid expansion to get health insurance coverage through other means. Those options include a smaller expansion of Medicaid or changes in the new state insurance exchanges to allow more poor people to purchase private health insurance.

The RAND study shows the alternatives could help provide health insurance to some people targeted by the Medicaid expansion. But none of the options examined would provide health coverage to as many people as full Medicaid expansion.

Researchers also outline how failing to expand Medicaid could have more than financial consequences. Based on earlier research showing that past expansions of Medicaid has led to decreases in deaths, the study estimates that an additional 19,000 deaths could occur annually if the 14 states studied do not expand Medicaid.

I was hoping to see state-level data, but the press release doesn’t go into detail, and the full study is behind a paywall. Still, in the abstract, the authors estimate that as a result of these 14 states’ intransigence, “3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016, compared to what would be expected if all states participated in the expansion”. It’s a hell of a parlay, and we all know who to thank for it. The Huffington Post has more.

So many Dome ideas

The Harris County Sports & Convention Corporation has plenty of material to work with as it prepares to make a recommendation to Commissioners Court about the Astrodome.

19 suggestions but demolition ain't one

Harris County Sports & Convention Corp. staff will spend the next week evaluating 19 plans for redeveloping the Astro­dome and putting the finishing touches on the agency’s own proposal to remake the former Eighth Wonder of the World.

Executive Director Willie Loston would not describe any of the ideas in detail on Tuesday, the day after the agency’s submission deadline.

Loston did say, however, that some of them qualify as “proposals,” while others would be more accurately described as “submittals,” meaning they are less developed.

“I think it’s fair to say they’re not necessarily the same,” he said.


Under a resolution approved by the board in April, submitted proposals must be compatible with the Reliant Park Master Plan, abide by the lease rights of the Houston Texans and Houston Livestock Show & Rodeo, and, most importantly for Commissioners Court, come with financing.

If any proposals meet all those requirements, Loston said they will be presented to the board, along with the agency’s public-use option. He would not give details on that plan, either.

“We are committed to at least a public option of one sort or another,” Loston said. “We will be sending something.”

One thing is certain about the sports corporation’s public-use plan: It is not demolition, which is described in the April resolution as a last-resort option that would be recommended only if no other options pan out, including a failed vote.

It will certainly make a lot of people happy if demolition is not on the table, at least as far as the HCSCC is concerned. I presume that’s still the default way forward if there’s a referendum and it fails. If they recommend one of the private options and Commissioners Court goes for it, then I presume there is no referendum and we leave it in the hands of the private developer, who will hopefully have better luck than the last group to get a green light had.

In the continued absence of any privately funded proposals, Harris County Judge Ed Emmett has discussed the likelihood of sending a renovation proposal to voters in an upcoming election. The soonest that could happen is in November, although Emmett said Tuesday that it “ideally” would happen later because the general election ballot will not include any other county-related matters.

Emmett expressed doubt about a privately funded Dome proposal panning out, saying he “would’ve heard if somebody had come in and said we have a check for $400 or $500 million.” Still, he expressed confidence that the Sports Corp. will bring a good “solution,” and said he hopes it is something he can support.

“I think the Sports & Convention Corp. is on a positive track and I think on the 19th, when they unveil what they’re going to propose to us, then the real public discussion starts,” Emmett said. “In theory, we could look at the recommendation and say, ‘We don’t like that, bring us something else,’ but in an ideal world they’ll bring us a recommendation that we go, ‘That’s a great idea,’ and then it’s a question of taking that to the public.”

Before anything ends up on a ballot, Emmett said the court will have to figure out the exact price and how to pay for it. A combination of public and private dollars is possible, he said.

The HCSCC board will vote on what to recommend on the 25th, and from there it’s up to Judge Emmett and the Commissioners. I can’t wait to see what they come up with. Houston Politics, which goes into detail about the business incubator proposal, has more.

They name the development after whatever they bulldozed in order to build it

The title of this post is an old joke, but what happened recently at Woodland Park is not. Nonsequiteuse explains.

I was alerted to an egregious clear-cutting along Woodland Park, a City of Houston public park at the edge of the Woodland Heights, by a neighbor’s posting on our online bulletin board:

The Friends of Woodland Park, Inc. would like inform and acknowledge for the neighborhood that it appears there has been unauthorized vegetation removal within the Park. We are currently working with the Houston Parks and Recreation Department (HPARD) to determine the cause and initiate a solution to protect the Park and its inhabitants. Currently information is limited due to an ongoing investigation. We know many of you use the park on a regular basis and would be interested/concerned. So we wanted to assure the neighborhood that we are aware of the matter and are working on it. As more details become available we will report them.

The Friends of Woodland Park is an independent 501(c)(3) nonprofit that was formed and is funded by the sweat, tears, and quite possibly, knowing about thorns and such, blood, to protect the second public park developed in Houston. They organize clean-ups, host movie nights, and work closely with the Parks Department to maintain this gracious public space.

I hopped in the car to see what this “unauthorized vegetation removal” entailed, thinking maybe they dug up some dewberry bushes. I must tell you that my neighbor exercised heroic restraint in writing such a measured notice.

Click over to see the pictures and see Swamplot for more. From what has been reported on the aforementioned neighborhood BB, about three-quarters of an acre was clear-cut. That’s in a park that’s a bit more than 20 acres in total size. A newly installed mulch path was destroyed. Did we mention that this is a public park? The apparent reasoning for this was to provide a better view of the bayou for the three townhomes that are being built on property that abuts the park. Yeah, this is pretty damn incredible.

At this point, the city is fully engaged, beginning with but by no means limited to CM Gonzalez’s office. Swamplot reports that the developer has taken responsibility, calling the clearcutting the result of a “miscommunication”. We’ll see about that. The local news was all over it last night – here’s KTRK for starters. Your Houston News has a press release from the Houston Parks and Recreation Department about the action they’ve taken to stop this. At this point, the word has been spread, the developer has owned up and apologized, and it’s mostly a matter of assessing the damage and figuring out who’s going to do what, and who’s going to pay for what, to fix it as best we can. I hope we can at least undo most of this.

UPDATE: The Chron has a good story on this.

“We’ll do whatever we have to do criminally or civilly to make sure that public property is protected and renewed,” City Attorney David Feldman said Wednesday.


“It’s not just removing a few native plants or trees, it’s a major intrusion,” said Houston City Councilman Ed Gonzalez, who represents the area. ” … To me, it’s just a terrible situation and we need to get to the bottom of it.”

Feldman said the city is trying to assess exactly what was destroyed and the value of the damage.

“I don’t know how many trees were alive, how many trees were dead, but obviously that’s public property,” Feldman said. “It does involve destruction of public property, which is both a criminal matter as well as a civil matter.”

The city recently took action against a hotel owner for over-trimming city trees on South Main, Feldman said.

The Parks Department reported that the cleared property included some healthy trees. Reforestation and replanting will be necessary, and erosion control and possible regrading of the site may be required, officials said. A debris pile will also need to be removed.

[Developer Bill] Workman said a large amount of bamboo and an undergrowth of vines were removed in the clearing.

He said he has met with city officials and he will comply with whatever the Parks Department requires of him. He said the townhome project will go forward.

We’ll see what the city has to say about this.

UPDATE: Hair Balls adds on.

Texas blog roundup for the week of June 10

The Texas Progressive Alliance thinks that we should have tried to get redistricting done right the first time instead of waiting till now to involve the public as it brings you this week’s roundup.


Senate committee passed redistricting bills

As is, no amendments.

After a two-hour hearing this morning, the Senate redistricting committee voted out bills that would make the three interim legislative and congressional maps permanent.

The votes on the bills were all on party lines 8-6.

Greg has the long form version of the amendment debates; he also liveblogged the House hearing, along with PDiddie. The full Senate will debate the bills Friday morning, with additional amendments to come though likely not to be adopted. Which is pretty much as I expected. The House Redistricting Committee will meet on Monday, and I don’t think they’re any more likely to pass amendments than the Senate was. Basically, sometime next week the Lege will pass all the bills, almost certainly intact, and thus accomplish in three weeks what they originally expected to accomplish in three days. Then they can get to the wingnut stuff, which was the plan all along as well. It just took longer than planned. The Statesman, Texas Politics, Trail Blazers, and Texas Redistricting, who compiles an impressive list of Things Greg Abbott Got Wrong – a subject Burka also addresses – have more.