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Yet another record year for Obamacare signups in Texas

It’s like a trend or something.

It's constitutional - deal with it

It’s constitutional – deal with it

A record 1.3 million Texans signed up for health coverage during the 2016 Affordable Care Act’s enrollment period, topping last year’s number by more than 100,000, according to the U.S. Health and Human Services Department final tally released Thursday.

Houston enrolled 346,822 for 2016 during the three-month sign-up period which began Nov. 1 and ended Jan. 31. Dallas-Forth Worth enrolled 382,669 and San Antonio enrolled 120,351.

Texas has long been the focus of concentrated outreach efforts by federal officials as the state continues to lead the nation in both the number and rate of uninsured. There were an estimated 5 million uninsured Texans when enrollment began, or roughly 20 percent of the state’s population.

In the final week of enrollment the pressure was on in the state, especially in south Texas. Health and Human Services officials said Thursday the blitz of marketing appeared to pay off as eight of 10 markets in the nation that had the fastest rate of growth were in Texas. Those markets are Corpus Christi, Harlingen, Laredo, El Paso, Odessa-Midland, San Antonio, Abilene-Sweetwater, and Lubbock.

[…]

Health and Human Services Secretary Sylvia Burwell said Thursday during a press call that she was especially pleased not only with the increase but that the numbers included about 4 million new customers. Prior to enrollment kickoff, Burwell had tamped down expectations, saying that 2016 might prove difficult to reach those still uninsured.

Adding new customers, especially younger ones who presumably are healthier, “refreshed the risk pool,” said Kevin Counihan, CEO of Health Insurance Marketplace during the same call.

And just remember, Greg Abbott and Dan Patrick and Ken Paxton and Ted Cruz and John Cornyn would like nothing more than to take that health insurance away from all 1.3 million Texans. Remember also that we could double the number of people who are finally able to get affordable health care if we expanded Medicaid. And even though not many people talk about it, we could then double THAT number if the Affordable Care Act were extended to include all people, including undocumented immigrants. If you think that’s a bridge too far, then you need to work on your bridge-building. Trail Blazers has more.

Fewer Texans having trouble paying medical bills than pre-Obamacare

What else can you say but “Thanks, Obama!”

Fewer Texans say they have problems paying their medical bills in 2015 compared to 2013, according to a new report released by EHF and Rice University’s Baker Institute for Public Policy.

The report found that since enrollment began in the Affordable Care Act’s Health Insurance Marketplace (ACA), the percentage of Texans who reported problems paying health care bills dropped almost 15 percent (25.8 percent in 2013 to 22 percent in 2015). The drop was consistent across income levels and health insurance status, and corresponds with national data showing the percentage of adults reporting problems paying medical bills dropped across the U.S.

Data released this week in a nationwide Kaiser Family Foundation/New York Times survey show 26 percent of U.S. adults reported having problems paying medical bills in the past year.

“The fact that Texans had fewer problems paying their medical bills in 2015 is good news,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute and director of the institute’s Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “One reason fewer Texans are having problems paying medical bills is because more Texans now have health insurance. However, one in five Texans still has problems affording health care. And it’s no surprise our data show the uninsured and those with lower incomes continue to struggle paying those bills more than anyone else.”

The report found 30 percent of uninsured Texans reported problems paying their health care costs in 2015, down from 35 percent in 2013. Researchers found just 20 percent of those with health insurance said they had problems paying medical bills last year, down from 23 percent in 2013.

When it comes to skipping health care services because of cost, the report found uninsured Texans are more likely to skip all services (primary care, specialist care, prescription drugs, etc.) than those with insurance. However, researchers discovered fewer uninsured Texans said they skipped getting care in 2015 compared to 2013.

“On the whole, uninsured Texans reported fewer problems with affording health care in 2015,” said Elena Marks, EHF’s president and CEO, and a nonresident health policy fellow at the Baker Institute. “While our data doesn’t explain exactly why that is happening, the Texas economy improved during that time which might have helped the uninsured pay for care.”

In addition, Marks said because the number of insured patients increased across the state, more charitable care may have been available to the uninsured. New 1115 Medicaid waiver projects across Texas also may have enabled more uninsured adults to access affordable health services, Marks said.

The full report is here. Elena Marks and Vivian Ho are familiar names to anyone who’s been following health insurance news in Houston – they’ve been on this stuff since the beginning. Now just imagine how much better things could be if we’d only expand Medicaid, too.

Medicaid expansion: Still a good idea

I know, right?

It's constitutional - deal with it

It’s constitutional – deal with it

Fewer low-income residents of Kentucky and Arkansas, two poor states that expanded Medicaid in 2014, reported problems paying medical bills after the coverage expansions, especially compared with residents of Texas, which has rejected the health law.

And hospitals in Medicaid expansion states saw a marked decline in the share of patients without insurance, compared with hospitals in states that have not broadened access to Medicaid, a second study found.

“Our findings underscore the significant benefits of Medicaid expansion not only for low-income adults, but also for the hospitals that serve this population,” the authors of that study conclude.

The two studies, both published Tuesday in the journal Health Affairs, come as new states consider Medicaid expansion, a key pillar of the health law that President Obama signed in 2010.

[…]

GOP resistance to Obamacare is already affecting low-income residents of those state, the new studies suggest.

In Texas, for example, the percentage of residents reporting trouble paying medical bills, skipping prescriptions or delaying care because of cost barely moved between 2013 and 2014.

By comparison, Kentucky and Arkansas saw major declines in all three measures of access to medical care after the Medicaid expansion began in 2014.

The share of residents of the two states who reported skipping a medication due to cost fell more than 10 percentage points. And the percentage of Kentucky residents who said they had trouble paying medical bills dropped by more than 14 percentage points, from 42.7% to 28.4%.

Researchers also found major gains in the share of residents who said they had a check-up in the prior year, which increased more than eight percentage points in both Kentucky and Arkansas.

And they found sizable increases in the percentage of patients with chronic medical conditions who got regular care, which increased more than 6 percentage points in the two states.

Texas, by contrast, saw a decline in the percentage of chronically ill residents who got regular care between 2013 and 2014, according to the study, which was based on a telephone survey of 5,665 low-income, working-age adults in the three states.

But hey, we sure are pro-life around here, right? Just not pro-healthy life, or at least not pro-healthy life for non-rich people. I’m sure that’s in the bible somewhere. The Chron and Daily Kos have 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.

Health insurance exchange open enrollment, Year 3

The challenge, in a nutshell.

It's constitutional - deal with it

It’s constitutional – deal with it

In rural Borden County, 12 people signed up for Obamacare this year.

Livid over the government telling them they must buy something and loath to take anything that looks like a “handout,” the uninsured here are likely to stay that way. As Obamacare’s third open enrollment season began Sunday, this rock-solid conservative community of about 650 people offers a window into the challenges health law advocates face to expand coverage around the country.

“Health care is fine, if you can afford it,” said Brenda Copeland, a middle-aged woman who works at the Coyote Country Store and café, along with her two grown daughters, all of whom are uninsured. Copeland has had health insurance only once in her life, and opted to pay Obamacare’s tax penalty earlier this year rather than buy a plan.

“I hope Obamacare goes down the toilet,” she added.

[…]

Outreach workers who are supposed to educate people here and in other parts of west Texas must travel huge distances to find small pockets of the uninsured — people like Copeland and her daughters, Becky Justice and Rika Law, both married women with children. And all of them think the Affordable Care Act is anything but affordable.

Copeland said her income fluctuates but she made about $19,000 last year; she didn’t know that she would have qualified for significant subsidies to lower her monthly insurance premiums, as well as for lowered co-pays and out-of-pocket costs. A plan for the coming year in the mid-priced, most popular tier would cost about $200 a month, after subsidies are figured in.

When she did learn about the subsidies, she softened her stance slightly and said she might look into it. But she said she’s done just fine without health insurance most of her life and is still angry that the federal government can mandate she has to buy it.

“At this point, I don’t mind them penalizing me,” she said.

Law, her daughter, did take a look at the federal enrollment website HealthCare.gov, but said the plans cost too much for her family of four. She too was unaware that she might qualify for tax credits to lower her premiums.

Her family previously had job-based coverage that cost about $1,000 a month — her husband works in the oil fields, but when oil prices dropped, his hours were cut and the Laws decided they didn’t have the money to cover premiums. The plans she looked at on HealthCare.gov cost even more, about $1,350 a month.

“I understand the benefit of having it,” she says of health insurance. “When you’re trying to juggle everyday bills, that’s when it becomes a problem.”

Her sister Becky Justice, who owns this one-room store on the only road through town, said she had health insurance until mid-2014. She doesn’t agree with Obamacare and, unlike her sister, never even window-shopped for plans. If she needs to see a doctor, she says she’ll go to a community health clinic outside the county and figure out how to pay the bill.

On the one hand, it’s hard to feel sympathy for people who refuse to help themselves. On the other hand, when people’s heads get filled with poison for a long time, it’s hard to overcome that. Keep this in mind when you hear poison producers like the shills at the TPPF talk about the “failure” of Obamacare to cover as many people as it should, as if they had nothing to do with it.

But challenge or no, the work proceeds, and as we go forward I do expect the uninsured rate in Texas to continue to decline. Of course, what could make it take a huge step down remains off the table, at least for now.

The uninsured rate in Texas is 19 percent. There are multiple reasons: the number of low-wage jobs in Texas that don’t offer benefits, cultural and language barriers, and political opposition to health reform. Another reason is that Republican leaders have not expanded Medicaid to more poor people, as 30 other states have done. That part of the law is optional, but by declining the expansion, Texas loses out on billions of dollars in federal funds every year.

There is growing pressure for Texas to expand Medicaid, and supporters are now looking for the right political message that could bring the parties together.

For the moment, Republicans still consider the Affordable Care Act to be political kryptonite. Senator Ted Cruz continues to criticize it. Attorney General Ken Paxton just filed another lawsuit attacking part of it. Governor Greg Abbott has said he won’t consider the Medicaid expansion, because he considers Medicaid a dysfunctional entitlement program that should not be allowed to expand.

In Houston, local leaders want the expansion. Harris County Judge Ed Emmett, a moderate Republican, has supported it for years. The CEO of the taxpayer-supported Harris Health System, George Masi, says he needs the revenue that Medicaid expansion would bring. He’s had to lay off more than 100 employees, and cut back on charity care.

“What is even more profound is that money is going to other states that expanded Medicaid, like New York, California, Connecticut,” Masi said. “And so the taxpayer of Texas is being penalized, if you will, for not taking advantage of that option.”

By emphasizing the impact on taxpayers, Masi and others are framing the issue in terms of economics rather than humanitarian concerns.

“We call it a paradigm shift,” Masi added. “It’s a different way of thinking.”

[…]

In 2013, the Texas legislature took no action on Medicaid expansion. The same thing happened this year.

But more voices are starting to push for change, according to Ken Janda, who runs Community Health Choice, a not-for-profit insurance company in Houston.

Janda said the Texas Medical Association and the Texas Hospital Association are both being more vocal on the issue, as is the Texas Association of Business. The federal Medicaid funds would help the state budget, and inject revenue into the medical sector of the economy.

“Doctors’ offices are able to hire more people. Pharmacies are able to hire more people. That becomes an economic multiplier,” Janda said.

County budgets would benefit as well, because they support safety-net clinics and public hospitals such as Ben Taub, part of the Harris Health system.

“If Texas expanded Medicaid, we would be able to look at reducing local property taxes across the board in all counties, or use those dollars for something besides healthcare,” said Janda.

Janda says the new emphasis on economics could eventually bring the parties together.

“There is some interest now by some Republican state senators because of the potential to reduce local property taxes,” he added.

Janda isn’t naming names yet. He also says don’t expect to see any movement on this issue until after the 2016 presidential election. But he says he is “guardedly optimistic” that Republicans will be willing to discuss a possible Medicaid expansion after that.

Color me very skeptical of that. The Senate has gotten worse, from a problem-solving, get-things-done perspective, in the past couple of elections, and I’m hard-pressed to think of any Republican Senators that will be in the Lege in 2017 that I can imagine having interest in Medicaid expansion. I’d be delighted to be wrong about this, but I sure wouldn’t bet on it. I’ve said this about multiple issues, from things like equality to immigration and Medicaid expansion – things won’t change until someone loses an election over it. I’m sure Ken Janda knows that the Texas Medical Association and the Texas Hospital Association both endorsed Greg Abbott and Dan Patrick in 2014. I know why they did, and I know why the Texas Association of Business did as well, but this is as clear an example of the canonical definition of insanity you’ll ever see. Nothing will change until someone loses an election over this sort of thing. In the meantime, other states will continue to receive the money that we’re turning away in the name of ideology.

Yet another Obamacare lawsuit

Some things never get old.

It's constitutional - deal with it

It’s constitutional – deal with it

n Texas’ latest salvo against Obamacare, Attorney General Ken Paxton has filed suit over a fee states must help cover to pay for the sweeping federal health reform law.

Texas joins Louisiana and Kansas in suing the Obama administration over the Health Insurance Providers Fee, which Paxton says cost Texas $86 million in 2013 and about $120 million per year since. Texas feels the effect of the fee, levied on health insurers, because it reimburses the companies that operate with public funds in the state’s privatized Medicaid program.

“This threat to cut Medicaid funding to Texans unless the state continues to pay hundreds of millions in taxes to Washington amounts to the very ‘gun to the head’ the Supreme Court warned about in earlier rulings on Obamacare,” Paxton said in a statement Thursday.

[…]

State lawmakers debated the validity of the fee this year as they were crafting a new budget. A handful of Republican legislators briefly entertained the possibility of not reimbursing the private insurers who operate in Medicaid, the joint state-federal insurance program for the poor and disabled, for the health insurance providers fee. They ultimately voted to pay back the Medicaid managed care organizations — after taking the opportunity to lambast the Affordable Care Act, also known as Obamacare.

Now, Paxton says Texas should get its money back, arguing that the state should not have had to pay the “unconstitutional tax to Washington” in the first place.

The attorney general’s office alleges the wide-ranging federal health law is “silent” about whether states should have to pay the health insurance providers fee — under threat of losing federal funding to pay for Medicaid. That, Paxton says, violates a provision of the U.S. Constitution requiring state officials to “clearly understand” the conditions of accepting federal funds and amounts to “coercion.”

The lawsuit was filed in federal court in Wichita Falls. The states are asking for the fee to be ruled unconstitutional and to be reimbursed for the funding already paid to the federal government in previous years.

You can see a copy of the complaint here. A lot of other anti-Obamacare litigation has been telegraphed in advance, but I couldn’t find anything enlightening on the Health Insurance Providers Fee. You’d think all the obvious targets would have been aimed at already, but I suppose there could be a judge out there willing to buy into whatever Paxton et al are selling. Nice to know his self-recusal isn’t keeping him from his most solemn of duties. Gotta give his wife something to sing about, I guess. As for the merits of the claim that Texas is being unfairly deprived of this Medicaid money, I might have a big more sympathy for it if the state, with Paxton’s assistance and blessing, weren’t voluntarily depriving itself of a whole lot more Medicaid money. But hey, all’s fair in politics, right? Trail Blazers and KUHF have more.

2015 Texas Lyceum poll

Issues first, election stuff to come. From the press release:

The 2015 Texas Lyceum Poll Finds: 

  • Immigration remains the most important issue facing the state and Texans support lawmakers’ increased spending on border security.
  • Texans’ views on  gay marriage are changing. Forty nine percent of Texans support gay marriage – up from 29 percent in 2009.
  • Experience with  race-based discriminationshifts greatly depending on the racial or ethnic background of the person polled.
  • Footballrules in Texas. Despite national poll numbers revealing 40 percent of Americans would discourage their children from playing youth football72 percent of Texans would encourage children to play football.
  • A growing number of Texans, 46 percent, support legalizing the use of marijuana (up by 13 percent since 2011) and among those who oppose legalization, 57 percent support decriminalization.
  • Texans are not overly concerned about climate change, but a majority (67 percent) would support new regulations on private companies.

 

2015 Texas Lyceum Poll Infographic

AUSTIN — An independent statewide poll conducted earlier this month (Sept. 8-21) by the Texas Lyceum, the state’s premier non-partisan, nonprofit statewide leadership group, suggests that Texans believe immigration is the state’s number one issue, continue to love their football, have moderated their opinion on the legalization of marijuana and gay marriage over the years, and support some regulation to reduce global warming.

“As the Texas Lyceum celebrates its 35th anniversary, we are proud to conduct this public service offering the media, policymakers, scholars and the general public an annual snapshot of Texans’ views on key issues,” said 2015 Texas Lyceum President Jane Cummins. “This year the Texas Lyceum held meetings focused on the Texas economy and the war on drugs, among other topics, and next year we will address the big business of football in Texas, showing our programs are on point with what Texans are talking about.”

Border Security / Immigration

Border security and/or immigration has remained one of the top three issues for Texans since the inception of the Lyceum Poll. This year the Lyceum Poll gauged Texans’ thoughts on two related policies – one state and the other federal. At the state level, a majority of Texans (62 percent) favor state lawmakers’ approval to spend $800 million on border security operations over the next two years.

Turning to federal policy, 65 percent of Texans approve of the federal government’s decision to halt deportations of undocumented immigrant youth who attend college or serve in the military while providing them with a work permit. Only 20 percent queried believe this policy did “a lot” to encourage illegal immigration.

Gay Marriage

Following the U.S. Supreme Court decision over the summer that legalized marriage for gay and lesbian couples in all 50 states, more Texans favor allowing same sex marriage than say they oppose it. Our survey shows 49 percent of Texans favor gay marriage, up from 33 percent when asked a similar question in 2011. However, 40 percent are opposed to allowing gay and lesbian couples the right to marry legally.

Racial Discrimination

In light of recent national and Texas race-related controversies, the Lyceum Poll asked respondents two related questions: First, was there ever “a specific instance in which you felt discriminated against by the police because of your racial or ethnic background?” Second, was there ever, “a specific instance in which you felt discriminated against by an employer or a potential employer because of your racial or ethnic background?” Reviewing the total sample with regard to police discrimination, only 17 percent of Texans believed they were discriminated against by police because of their racial or ethnic background. However, on closer inspection, these numbers shift significantly according to the race or ethnicity of the respondent. Four percent of whites, 24 percent of Hispanics and 45 percent of black respondents said they had felt discriminated against by the police. This pattern held with regard to Texans’ attitudes about employer discrimination as well. Only 11 percent of whites indicated they had been discriminated against by an employer, while 27 percent of Hispanics and 42 percent of black Texans felt they had experienced a form of workplace discrimination.

Football Reigns

Despite growing national concern that children who suffer repeated head injuries from tackle football can sustain long-term brain damage, Texans would not discourage their children from playing the contact sport. In fact, 72 percent of those polled said they would encourage children to play football while only 21 percent would discourage it. These numbers contrast with a national NBC/Wall Street Journal poll taken last year showing that 40 percent of Americans would steer their children away from playing football due to concerns over concussions.

Legalizing / Decriminalizing Marijuana

As more states either decriminalize or legalize marijuana – with Texas lawmakers passing limited medical marijuana use this past legislative session – a majority of Texans don’t support legalization outright. The survey shows 50 percent of Texans are opposed to legalization, while 46 percent of Texas adults said that they would support legalizing the use of marijuana. However, the numbers are breaking in favor of legalization as support has gone up by 13 points when compared with a question asked in the 2011 Lyceum Poll. Meanwhile, among those who oppose legalization, 57 percent said they would support decriminalization. Specifically, this group agrees on “reducing the maximum punishment for possessing small amounts of marijuana to a citation and a fine.”

Climate Change

Global warming is not a top concern for Texans. When asked if they personally worry about climate change, 50 percent say “only a little” or “not at all.” But when asked “would you support or oppose Congress passing new legislation that would regulate energy output from private companies in an attempt to reduce global warming,” 67 percent of Texans said they would support such regulation.

Daron Shaw, Ph.D., Professor at The University of Texas at Austin and a Texas Lyceum alumnus, oversaw the poll, which was conducted September 8-21, 2015, and queried 1,000 adult Texans. The poll has a margin of error of +/- 3.1 percentage points. Dr. Shaw and Texas Lyceum Research Director Joshua Blank, used the latest statistically-advisable polling techniques: live interviewers contacted respondents both by landline as well as cell phones (40 percent) and administered the survey in the respondent’s language of choice (English or Spanish).

The executive summary is here. A couple of points of interest:

On immigration: “The second policy that we queried asked respondents to evaluate the policy by which the Department of Justice stops the deportation of any undocumented immigrant youth who attends college or serves in the military and provides them with a legal work permit that is renewable. Despite the perception that Texans have particularly harsh attitudes on illegal immigration, 65% of Texas adults said that they supported this policy with only 28% expressing opposition. Majorities of Democrats (81%), Republicans (54%), and independents (62%) expressed support, as did majorities of Anglos (58%), blacks (63%), and Hispanics (75%).

On same sex marriage: “Majorities of Democrats (69%), Hispanics (53%), and Texans 18 to 29 years old (65%) and 30 to 44 years old (52%) said that they favored allowing gay marriage; pluralities of independents (46%) and Anglos (47%) also said that they favored allowing gay marriage. A majority of Republicans (58%) and a plurality of black respondents (45%) said that they oppose allowing gay marriage.” I would add that only the 65-and-over crowd was truly opposed (34% in favor to 53% against). The 45-64 group was barely in opposition, 43% yes and 44% no.

On marijuana: “A majority of Democrats support legalization (54% support; 42% oppose) while a majority of Republicans oppose legalization (37% support; 61% oppose). Fifty percent of whites support legalization while 51% of blacks and 56% of Hispanics stand in opposition. Eighteen to 29 year olds are the only age group in which a majority supports legalization (66%). Interestingly, when it comes to Democrats and Republicans in opposition to legalization, both groups favor decriminalization (60% of Democrats and 59% of Republicans). Majorities of whites (59%), blacks (52%), and Hispanics (56%) initially opposed to legalization are supportive of decriminalization, as are all age groups.”

On climate change: “Not surprisingly, given the partisan dimensions of this issue, 84% of Democrats said that they would support [new legislation that would regulate energy output from private companies in an attempt to reduce global warming] (60% said that they would strongly support them), while 45% of Republicans said that they would support such regulations, with 48% saying that they would be opposed. These results still display a rather surprising willingness among Texas Republicans to consider regulation to combat global climate change.”

On the Affordable Care Act: “Like in past polling, Democrats held a much more positive attitude toward the ACA than did Republicans. While 63% of the former hold a positive view of the ACA (up from 58% in 2014), 76% of the latter hold a negative opinion (down slightly from 80%). Whites continue to hold negative opinions towards the healthcare law with only 26% expressing a favorable opinion, while a majority of blacks hold a positive view (65%). Hispanics were evenly divided in their opinions of the ACA, with 42% holding a favorable opinion and 39% holding an unfavorable opinion.”

Basically, outside of that last issue, the survey respondents were a lot less in agreement with the Republicans that dominate state government than they were with Democrats. Needless to say, that discrepancy is a function of who actually votes, and increasingly when they vote; Republican primary voters are far more extreme than Republican non-primary voters. The question is when election results will more closely reflect this. Perhaps the higher turnout of a contested Presidential primary will draw some more moderate Republicans to the polls in March; that won’t have any statewide effect but it might make the Lege a pinch saner. Beyond that, all I know is that it won’t happen in its own.

The Lyceum will be releasing election poll data today. I’ll link to it later, and will have a separate post tomorrow.

We’re still #1!

In uninsured people.

It's constitutional - deal with it

It’s constitutional – deal with it

For the first time in more than a decade, Texas’ uninsured rate dipped below 20 percent, analysts said [recently] following the release of U.S. Census data.

Slightly more than 5 million Texans were uninsured in 2014 — a 700,000 decrease from the year before. That represented a 3-point dip in the percentage of Texans without health insurance, to 19 percent — the largest gain in health care coverage in Texas since 1999, according to the left-leaning Center for Public Policy Priorities.

The data released Wednesday marked the first government-provided snapshot of the uninsured rate since the rollout of Healthcare.gov, the health insurance marketplace created by President Obama’s signature health law.

Texas remains the state with the highest rate of uninsured people, according to the federal survey. Nationwide, the uninsured rate fell from about 15 percent to 12 percent.

And it’s not just in the rate where we lead, it’s also in sheer numbers.

Texas’ decrease was just 40 percent of the size of California’s shrinkage of its uninsured population. It reduced the number of uninsured by 1.73 million folks. That’s out of proportion to population. The bureau’s latest estimates show California has about 1.4 times as many people as Texas — 39 million versus 27 million. California has expanded Medicaid and runs its own online health insurance marketplace.

For many years, the Golden State has had the largest uninsured population. No longer. Texas does.

The Lone Star State has not just the highest percentage but the biggest raw number of uninsured — 5,047,000. In 2013, California had 6.5 million uninsured residents, while Texas had 5.75 million. But last year, California’s number dipped below 4.8 million.

“California has seen robust increases in both private insurance coverage under the [federal law’s] marketplace and public coverage through Medicaid coverage for working poor adults,” said Obamacare supporter Anne Dunkelberg, a veteran health-policy analyst at the center-left think tank the Center for Public Policy Priorities. She noted that California posted a nearly 5 percentage point decrease in its uninsured rate. It dropped from 17.2 to 12.4 percent, compared with only 3-point drop in Texas from 2013 to 2014.

But hey, at least we surpassed California in something, amirite? Woo hoo, high five!

All five of the states with the highest uninsurance rate have one thing in common: They failed to expand Medicaid. Well, two things in common, that and having Republican Governors and legislatures. But if you knew the first part, you could have guessed the second.

Harris Health wants more people to enroll in Obamacare

Who can blame them?

Harris County’s public health care agency, responding to a budget crisis, will eliminate more than 19,000 people next year from eligibility for free or nearly free services, hoping most of these patients will obtain coverage through the Affordable Care Act.

The board of the agency, Harris Health, voted Thursday to reduce its income threshold for subsidized care from 200 percent of the federal poverty level to 150 percent, saving the system a projected $21.3 million in fiscal year 2017.

Of those losing coverage, more than 15,000 would be eligible to purchase insurance plans through Healthcare.gov, the health insurance exchange created by the federal law widely known as Obamacare. Most would qualify for large subsidies that would lower the cost of their premiums, deductibles and co-payments.

“We know the seriousness of what is about to take place, but something is going to have to take place for us to survive” in the face of a $53 million budget deficit, board chairman Elvin Franklin said before the vote. “We have to make some hard decisions from time to time, and sometimes those decisions are not going to reflect what everybody wants.”

Under the revised guidelines, an individual making more than $17,655 annually or a family of four with income exceeding $36,375 would no longer be eligible for subsidized care. The change would affect an estimated 19,527 patients, about 6 percent of the 325,000 clients the agency serves.

[…]

Harris Health and local advocacy groups will have a major challenge in helping people, like Walker, understand their options and how health insurance works.

Plans sold through the exchange are arranged into four tiers – platinum, gold, silver and bronze. Platinum and gold plans generally have higher premiums but lower deductibles and copayments. Bronze plans have the lowest premiums but high deductibles and copayments.

Federal subsidies, provided through tax credits, and cost sharing help are only available through silver plans. Often, paying a higher monthly premium for a silver plan will be less expensive in the long run for an individual patient.

“We’re talking to people who have never had health insurance before,” said Tiffany Hogue, policy director for the Texas Organizing Project, an advocacy group for the poor that has been conducting enrollment outreach. “Unless they’re sick, this is not their top priority or concern. And it’s complicated to show them the value of why they need it now.”

The education effort may get a significant boost from the federal government. Health and Human Services Secretary Sylvia Burwell announced Tuesday that Houston was among the five areas the agency will target with expanded enrollment outreach because they have high levels of uninsured people.

“We’ve found that costs are still a big concern – about half of the people who are uninsured have less than $100 in savings,” Burwell said. “And people are worried about fitting premiums into their budgets. Almost 60 percent of people who are uninsured are either confused about how the tax credits work or don’t know that they are available.”

While their monthly costs may increase, patients who enroll in the exchanges will have other benefits of health insurance. For example, they can seek care from doctors and hospitals outside the Harris Health System. And their plans can provide coverage when they travel out of the area.

This has been under discussion for several weeks now, as Harris Health has tried to deal with its deficit. They could apply some of the savings they’ll get from 15,000 people signing up for Obamacare to help the 4,000 or so that don’t qualify for subsidies, and still come out way ahead. It’s going to be hard on a lot of people, and some will unfortunately fall through the cracks, but it doesn’t make sense for Harris Health to not do this. Let’s put the blame for any problems that arise – indeed, for the shortfalls that are forcing this in the first place – where it belongs: on the state, particularly Greg Abbott and Dan Patrick and the Legislature, for refusing to expand Medicaid. That would have provided coverage to a large number of the people that will still be serviced by Harris Health. Medicaid expansion would also provide coverage to many people who suffer from mental illness, including a significant portion of the homeless and the people who make frequent trips to the local jails. Our state leadership isn’t interested in any of that. They want to push those costs down to the local level, where they don’t have to take responsibility for it, and they want to arbitrarily cut costs despite the huge negative effects that has. That is the root cause of these problems, and it will remain so until we have different leadership. I hope I live long enough to see it. KUHF and the Chron editorial board have more.

Texas Pulse Poll

Hey look! Someone polled Texas.

A statewide poll of Texas likely voters finds that immigration and the economy are the top issues of concern for residents of the Lone Star State. The poll also found that Donald Trump and Hillary Clinton lead the Republican and Democratic primaries. Barack Obama is viewed unfavorably by a majority of Texans. Gov. Greg Abbott is seen favorably, and Sen. Ted Cruz has a more mixed favorability rating.

The Texas Pulse, a periodic survey of Texans’ opinions on a variety of cultural, economic and political issues, was conducted by Crosswind Media & Public Relations from Sep. 11-14, using a survey of 1,000 Texans. The margin of error is +/- 3 percentage points. A 2014 Texas Pulse survey was recognized by the Houston Chronicle as the most accurate poll in the governor’s race.

In a survey of 452 likely Democratic voters, Clinton leads Democrat Bernie Sanders 53 percent to 21 percent, with Sen. Joe Biden, who has not announced for president, in third with 14 percent in a hypothetical matchup.

“Despite some challenges, the Clinton name is still gold among Texas Democrats,” said Thomas Graham, Crosswind president and CEO. “Hillary’s support remains solid, particularly among minorities and women. While Sanders fares well among white and younger voters relative to his overall numbers, Hillary Clinton still beats him 2-1 in even these categories.”

Clinton even beats Sanders 52 percent to 31 percent among voters identifying themselves as liberal. The former secretary of state does best among African-Americans, with almost two thirds (65%) supporting her. Sanders’ only lead in any category is among voters identifying their ethnicity as “other.” This is a relatively small sample, however.

On the Republican side, as Crosswind announced last week, Donald Trump leads the field with 26 percent, followed by Ben Carson at 19 percent. Texas’ own Senator Ted Cruz is third with 15 percent, and Jeb Bush is fourth with 9 percent.

You can go here to add yourself to their mailing list enter your information to see the full poll information. Honestly, it doesn’t have that much – you will be shocked to know that Republicans like Greg Abbott and Ted Cruz but hate President Obama and Obamacare, while Democrats love the President and Obamacare but can’t stand Abbott or Cruz. There’s a bit more nuance than that, so go get yourself the full poll if you want to know the full details plus some other things. On the GOP primary side, that link above in this paragraph has a pie chart of the full field. Pre-dropout Rick Perry got 3% and Scott Walker got 2%, while pre-CNN debate Carly Fiorina was at 3%. Such are the perils of waiting to release poll data. I would have loved to have seen some potential November matchups, but no dice. There’s also some issues polling – Republicans continue to be obsessed with immigration and “border security” (a full 50% had it as their top issue), while Dems are interested in a broader range of things. The press release linked at the top has some of those numbers, though oddly they disagree with what’s on the full poll page – the release says “Among Republicans, the economy is second (18%) and taxes and spending third (15%)”, but the chart on the poll page shows “economy and jobs” at 15% and “taxes and spending” at 11%. Go figure.

Anyway, much of this is for entertainment value only at this stage. You can be sure it will be different in February, even if neither field is much smaller. The Texas Lyceum will be releasing the results of its 2015 Issues and Elections poll next Wednesday the 30th, so we’ll see how these two compare.

Paxton files amicus brief in HBU contraception lawsuit

Of course he does.

Female employees of religious nonprofits should not be given insurance coverage for birth control if their employers object to certain contraceptives on religious grounds, according to a brief filed at the U.S. Supreme Court by Texas Attorney General Ken Paxton.

Paxton’s “friend of the court” brief was filed Monday in support of a lawsuit brought by East Texas Baptist University and Houston Baptist University against the federal government over a provision of the Affordable Care Act requiring some employers to offer health plans that include contraceptive coverage.

The religious universities oppose emergency contraceptives, including the so-called morning-after pill, and intrauterine devices, which they liken to abortifacients. (Health experts and scientists have disputed that claim.)

[…]

In the brief filed by Paxton’s office, state attorneys wrote that the “supposed ‘accommodation’” will still “coerce employers to proceed with a course of action despite a belief in its religious impermissibility.”

“Many employers around the country feel driven by their faith to care for their employees by providing them health insurance,” the brief reads. “But some employers find it incompatible with their religious convictions to provide that health insurance when it means contracting with a company that then, by virtue of that very relationship, becomes obligated to pay for drugs regarded as abortifacients.”

A federal district court previously sided with the universities, blocking the requirement from going into effect. The U.S. Department of Health and Human Services appealed the case to the New Orleans-based U.S. 5th Circuit Court of Appeals — considered the most conservative appellate court in the country — which reversed that decision, saying the universities had “not shown and are not likely to show that the requirement substantially burdens their religious exercise under established law.”

In its ruling, the panel of the appellate court sided with the federal government in its argument that the universities’ religious exemption from providing contraception coverage did not extend to third parties left to administer insurance plans if a religious organization is exempted.

See here, here, and here for the background. While HBU and ETBU won in district court, no plaintiffs have prevailed at the appellate level yet. As such, there isn’t a district split yet for SCOTUS, though as we saw with the Obamacare subsidies case they don’t need to have one to take up an appeal. I’ll be surprised if it’s not on their docket by next year.

The demography of the uninsured in Texas

Another look at those who have been helped by Obamacare in Texas, and those who would be helped if the state wasn’t actively resisting.

It's constitutional - deal with it

It’s constitutional – deal with it

The states’s uninsured continue to be most likely Hispanic, middle-aged, with low incomes and without a college degree, according to a continuing study tracking the implementation of the health care law in Texas by Rice University’s Baker Institute and the Episcopal Health Foundation.

But even as Hispanics still represent the majority of those without insurance in Texas, theirs was the ethnic group that also showed the biggest gains.

Between the opening of the marketplace in September 2013 and the close of the second enrollment period in March 2015, the uninsured rate among Hispanic adults in Texas dropped to 57.1 percent from 61.2 percent – a bigger drop than any other ethnicity.

“It is not really surprising since they had the farthest to go, and still do,” said Elena Marks, president and CEO of the Episcopal Health Foundation and co-author of the study. She added: “We’re very encouraged,” crediting the improvement among Hispanics to vigorous outreach efforts to enroll people in marketplace plans.

[…]

Still, Thursday’s report also showed the percentage of the lowest income uninsured Texans continues to climb. The percentage of the poor in the state without insurance has grown to 66.9 percent from 63.2 percent in September 2013.

The report’s co-author Vivian Ho, the Baker Institute’s chair in health economics, has said the number of uninsured among the state’s poorest residents is not likely to change or could even grow in coming years. Under the law, the poor who were not eligible for subsidies were to be covered under a widening net of Medicaid. But Texas is one of 20 states that chose not to participate.

It is estimated about 1.5 million in the state would be eligible for coverage under an expanded Medicaid.

The report is here, and more information including previous reports in this vein is here. None of this is going to change the minds of those that can do something about this, but I have to hope that some day, with enough of this information and enough people visibly being helped by it, the voters may eventually do something about it. I hope I live long enough to see it happen.

Woodfill is still pursuing his anti-same-sex benefits lawsuit

From the inbox and the febrile mind of Jared Woodfill:

RedEquality

Last year Houston Judge Lisa Millard granted a temporary injunction and ordered Houston Mayor Annise Parker and the City of Houston to immediately stop recognizing same-sex ‘marriages’ and stop providing benefits to the same-sex couples married in other states. Judge Millard stated, “This court does not legislate from the bench” and ordered the injunction to stay in place until a trial date of December 2015. I filed the lawsuit on behalf of Larry Hicks and Pastor Jack Pidgeon. The City of Houston has appealed Judge Millard’s opinion. Mayor Parker is arguing that the United States Supreme Court’s recent decision regarding same-sex marriage justifies her unilateral decision to use your tax dollars to fund same-sex benefits. I believe the City of Houston and Mayor Parker are wrong. The recent marriage decisions addressed a new right for same-sex marriage, but did not establish an entitlement for financial support at taxpayer expense. Consistent with the same dichotomy that resulted in the abortion decisions, which established an individual right to abortion but an equally strong right by the States to deny public funding for abortion. Accordingly, we have responded to Mayor Parker’s unlawful use of your tax dollars and filed a responsive brief. The brief can be accessed by clicking here. I am hopeful that the Houston Fourteenth Court of Appeals, like Judge Millard, will once again make it clear that Mayor Parker’s executive actions to force the funding of same-sex benefits on the people of Houston are illegal. It is time for Mayor Parker to stop wasting tax dollars on issues that have already been resolved by Texas voters and Texas state courts. I will keep you posted on the progress of this litigation.

Read Judge Millard’s order here.

To review the situation: In November of 2013, after SCOTUS knocked down the federal Defense of Marriage Act (DOMA), Mayor Parker issued an executive order declaring that spousal benefits for city employees extended to legally married (i.e., in other states) same-sex spouses. This was both in response to the deletion of DOMA and in recognition of the fact that the 2001 charter amendment limited benefits to “employees, their legal spouses and dependent children”. Pidgeon and Hicks, abetted by Woodfill, then filed a lawsuit challenging this, and got an initial injunction against it from Family Court Judge Lisa Millard. A second lawsuit was then filed by three City employees who would have benefited from Mayor Parker’s order, to force the action that she took. Both suits were then moved to federal court in December, where Judge Lee Rosenthal dropped the injunction against the city. The second plaintiffs, represented by Lambda Legal, moved to combine the two suits, which were eventually moved back to state court last August. Woodfill and pals filed another lawsuit in state court in November; I have no idea what happened to that one.

As far as I know, that was the last update until after the Obergfell decision, at which time the Lambda Legal lawsuit was formally dismissed for being moot. I would have assumed the same would have happened to the Pidgeon/Hicks lawsuit, but I have not seen anything to confirm or deny that. As for this current action, I have no idea what legal basis Woodfill thinks he has to draw a distinction between same-sex marriage and opposite-sex marriage – silly me, I thought the SCOTUS ruling was pretty clear on that point – but after what we’ve seen in the past few weeks, who knows what a Texas court might do. Any legal types out there who can explain any or all of this better than I can, by all means please do. I’ll keep my eyes open for any further developments.

We wouldn’t be having these problems if we had just expanded Medicaid

The chickens, they are roosting.

It's constitutional - deal with it

It’s constitutional – deal with it

Hospitals that serve large uninsured populations in Texas stand to lose critical funding if the state can’t convince the federal government to continue helping with the cost, doctors and health advocates told the state health department Thursday.

With the expiration date of a five-year, $29 billion program approaching, the Health and Human Services Commission will attempt to negotiate a renewal of federal funds to help reimburse hospitals caring for the uninsured.

Rural Texas hospitals serve large uninsured populations and rely on the money to keep from closing, Grace Chimene, a pediatric nurse practitioner, told a panel of HHSC administrators taking public testimony on the need for an extension.

“When a rural hospital closes, lives are lost due to the lack of emergency services,” the Austin resident said. “If you have an emergency like a heart attack in rural Texas, you better hope that local community has enough insured population to support a community hospital.”

The money was originally intended to help Texas transition over five years to an expanded Medicaid program under the Affordable Care Act. But Texas officials decided not to expand Medicaid, the state-federal insurance program for the poor and disabled, leaving uninsured nearly one million residents who would have been eligible for coverage under the expanded program.

That was a rebuke of the Obama administration, which is now considering whether — or to what extent — it will renew the matching funds. Federal officials told HHSC in April they would consider Texas’ refusal to expand Medicaid when determining whether to renew the federal matching funds that supplement local dollars.

[…]

The month-long public comment period for HHSC’s proposal to have the funding extended another five years will end August 5. The deadline to reach a deal with the federal government is September 30.

However, many who testified said Medicaid coverage expansion itself is more important than extending the five-year program, and urged the HHSC to pressure the government to expand coverage.

“Coverage expansion must be part of the solution,” said Laura Guerra-Cardus, an Austin doctor who serves as associate director of the Children’s Defense Fund in Texas. “Without coverage, individuals do not have adequate access to preventative, chronic and ongoing care that makes the concept of health care meaningful.”

HHSC must submit its request for extending the waiver by the end of September. If it fails, the money would run out in September 2016.

See here and here for the background. I’ll say again, I hope the feds stand firm and make it clear to Texas that this money is contingent on Medicaid expansion, no ifs ands or buts about it. Ideology is the only reason for the opposition to expanding Medicaid. Let’s make it perfectly clear to the hospitals and the communities they serve that stand to get screwed by this who and why it is happening. As they say, elections have consequences.

HBU appeals contraceptive case to SCOTUS

Here we go.

Houston Baptist University on Wednesday turned to the U.S. Supreme Court in its battle to avoid providing employees with forms of contraception it finds morally objectionable.

The appeal of a 5th U.S. Circuit Court of Appeals ruling was filed on behalf of the Houston university, East Texas Baptist University and the Westminster Theological Seminary in Pennsylvania by lawyers with the Becket Fund for Religious Liberty.

The Press fills in some important details.

HBU’s is just one of many cases challenging the Affordable Care Act’s birth control mandate. Under the law, religious employers who object to some or all forms of birth control (HBU, for example, takes issue with some emergency contraception that it wrongly likens to abortion) can seek an exemption from the feds. Typically this just means filling out a form letting the feds know of your objection to birth control and naming the company that administers your employee health plan. The government then works separately with the insurance company to make sure workers can get birth control coverage on another health plan if they want it.

East Texas Baptist University and Westminster Theological Seminary joined HBU in challenging the mandate. The schools have argued that by simply informing the feds of their objection – either by filling out a form or by some other means – they’re triggering or facilitating birth control coverage in violation of their religious beliefs. In their challenge, they’ve cited the federal Religious Freedom Restoration Act (RFRA), which says the federal government can’t, except in limited circumstances, “substantially burden a person’s exercise of religion.”

That the Fifth Circuit didn’t buy that argument is notable for a couple of reasons. First, every single federal appeals court that’s so far considered the issue has ruled that religious nonprofits can’t block their workers from getting coverage for birth control. Secondly, the Fifth Circuit, as we’ve written before, is perhaps the most conservative federal appeals court in the country. If anyone was going to buck the trend in favor of religious institutions, you’d have thought it would be the Fifth.

See here and here for some background. Basically, this is about employers attempting to control how their employees are spending their money, based on their belief in a demonstrable falsehood than none of them even gave a thought about as recently as a couple of years ago. But hey, religious freedom! Obamacare oppression! We’ll move to Irion County if we have to! You get the idea.

On to the benefits

Now that same sex marriage is the law of the land, Texas employers need to make sure that the spousal benefits they offer apply to all spouses.

RedEquality

“If an employer provides benefits to anyone who is currently married, they must now treat gay and lesbian employees the same and offer them the exact same benefits,” said Neel Lane, a San Antonio lawyer at corporate law firm Akin Gump Strauss Hauer & Feld.

“The ruling has an enormous impact on employers and employees in Texas,” said Lane, who represents on a pro bono basis a gay couple in Texas who have challenged the state’s ban on same-sex marriages.

[…]

Lawyers said they have been inundated with calls – mainly from small- and medium-sized business owners – seeking legal advice on updating employment and benefits forms but also asking if there are ways under Texas law to avoid having to make changes.

James Griffin, an expert on employment benefits and federal tax law at Jackson Walker in Dallas, said the legal advice he is giving his business clients is simple.

“Don’t waste your time looking for ways to defeat this,” Griffin said. “The Supreme Court decision is very broad. This issue is done. Make the changes and move on.”

Griffin and other lawyers say most large corporations implemented policies years ago that extend benefits to same-sex couples.

But they say some Texas-based companies that operate exclusively within the state have not addressed the issue because they have never had employees come forward and say they are gay and want benefits for their partners. Lawyers say that because Texas political leaders have been adamantly anti-same-sex marriage and benefits, many workers were afraid to step forward.

“Now, because of the Supreme Court ruling, a lot of people who have been reluctant are going to raise their hand for the benefits and the companies have to address it,” said Mark Shank, an employment law partner at Gruber Hurst Elrod Johansen Hail Shank in Dallas.

Among the employers who have already taken action is the state of Texas.

The state’s bureaucracy is moving forward to comply with the U.S. Supreme Court’s gay-marriage decision, even as state elected officials – including Gov. Greg Abbott – have lambasted the landmark ruling.

Starting Wednesday – less than a week after the decision – the Employees Retirement System of Texas, the University of Texas System and the Texas A&M System will extend benefits to spouses of gay and lesbian employees.

That means the state’s largest employer, the State of Texas, will join the list of those providing equal benefits to same-sex partners.

The decision is latest sign that state government is accepting the ruling, which struck down gay marriage bans in Texas and other states. And that bureaucratic churn provides a notable counterbalance to the saber-rattling by Abbott and other top Republicans.

“This is all kind of new for us,” said Catherine Terrell, a spokeswoman for the Employees Retirement System of Texas. “We’re just looking at what other employers have seen.”

The state employees some 311,000 people, according to the state auditor’s office. Terrell said ERS, which handles benefits for most state employees, was anticipating that about 1,500 spouses of gay employees would now enroll for benefits.

A “notable counterbalance to the saber-rattling”. I like that. When you consider all the county clerks who ignored Ken Paxton’s legal “advice”, it’s quite clear who’s really out of touch here. That doesn’t mean they’re going to acknowledge it any time soon.

The Teacher Retirement System of Texas is also providing these benefits now; they weren’t included in the Trail Blazers post. Regarding the UT and A&M systems, I like the quote in this Trib story about that:

Professors at Texas’ public universities celebrated the extension of benefits, saying the policy change will offer relief for many gay and lesbian employees and reduce the rate at which they leave Texas institutions in search of schools that accommodate same-sex couples.

Patrick Burkart, a communications professor at Texas A&M University, said extending benefits for same-sex couples will put the university on the “same competitive footing” as other research universities across the country because it will help retain and recruit top faculty and staffers.

“What we’re going to find out is how expensive it’s been to keep a discriminatory policy on the books as we have,” said Burkart, the secretary and treasurer of the A&M chapter of the American Association of University Professors, which has pushed for the benefits for years.

Burkart, who has served on several faculty search committees, indicated that the previous policy denying benefits to same-sex spouses or partners kept potential candidates from applying for posts at the school.

Hundreds of colleges across the country offer benefits to same-sex spouses or same-sex domestic partners.

”I think our university has suffered for it, and now is a great time to catch up and gather our strengths,” Burkart said.

I’m willing to bet none of our “saber-rattling” state leaders ever considered that, and if any of them did, I seriously doubt they cared. It is of course one big reason why so many private employers have been doing this for so long – you’ve got to keep up with the competition. Burying your head in the sand never works.

Let’s go back to the first story for a minute to see an example of another place where they can demonstrate that:

Legal experts also say the first major domino likely to fall will occur in federal court in Wichita Falls, where a federal judge in March, at the request of Gov. Greg Abbott and Attorney General Paxton, issued an injunction that prevented the federal Family and Medical Leave Act from applying to same-sex couples in Texas.

Because of the ruling, Texas was one of four states in the U.S. where FMLA benefits have been denied to gay couples involved in civil unions.

“That decision will almost certainly be reversed right away,” said David Coale, a partner at Lynn Tillotson Pinker & Cox. “State political leaders may try to fight it, but they are going to lose, and then they are going to have to pay a lot of money to lawyers for pursuing frivolous legal claims.”

See here and here for the background. The lawsuit involved federal employees in Texas, who were covered by an Obama executive order extending employment benefits to same-sex spouses. In the face of Obergfell v. Hodges, the injunction that was granted is clearly out of order. I presume a motion to lift the injunction will be filed shortly, and will be granted right away. Any other outcome is unfathomable.

Moving on, all the newly-married couples in Texas can now sign up for health insurance if they need to.

Same-sex couples who marry have had what the Affordable Care Act considers a “qualifying life event.” And that triggers a special 60-day enrollment period to purchase health insurance from Texas’ federally run, online marketplace, a group promoting enrollment said Tuesday.

Enroll America, a nonprofit supporting Obamacare, said in a release that under the health law, marriage is one of the unusual phenomena that allow consumers a mid-year bite at the apple. The others are having a baby, moving to a different coverage area, getting divorced and experiencing certain changes of income that would affect tax credits and cost-sharing subsidies.

“People don’t know that the special enrollment period exists,” Enroll America spokeswoman Annette Raveneau said in an interview.

[…]

Newly married same-sex couples and others with qualifying life events can sign up all by themselves, using HealthCare.gov.

Raveneau, though, strongly recommends that shoppers meet in person with a certified assistance counselor or Obamacare navigator. They can schedule appointments using Enroll America’s “Get Covered Connector.”

“The people who use an in-person assister, which are free, are twice as likely to finish the enrollment process and actually get a plan,” she said.

How many people might be able to do this? We can only guess, in part because the state has no plans to count how many same-sex couples get hitched.

Though Texas collects detailed data on marriages by county and age, getting better information on same-sex marriage rates in Texas could take years since the state has no plans to separately track those unions. Following Friday’s ruling, the Department of State Health Services released a new gender-neutral marriage application for counties to use. The application does not ask for the sex of either of the applicants.

“We are not specifically tracking those at this time,” said Carrie Williams, a spokeswoman for the department. “The application asks for Applicant One and Applicant Two and currently does not ask for gender.”

States in which same-sex marriage was legal before Friday have taken different record-keeping approaches. Oregon, Vermont and Washington track marriage licenses specifically issued to same-sex couples. California and Florida simply track all marriages, and do not differentiate between same-sex and opposite-sex unions.

The U.S. Census Bureau’s American Community Survey estimated in 2013 that there were 252,000 married same-sex couples in the country, but later said that was likely an overestimate, citing flawed data. A recent paper from a census researcher put the figure at closer to 170,000.

The patchwork of data collection means reliable numbers on how many same-sex couples are getting married in different states may not be available until the next census in 2020, said Drew DeSilver, a senior writer with the Pew Research Center who has researched the issue.

I guess I’m not too bothered by this, since there doesn’t seem to be a single standard practice nationwide. It would be nice to know, but given the way the updated form is worded, I understand the reasoning. I’m sure there will be a million ways to come up with reasonably accurate estimates – new Obamacare enrollments will be one data point – and we’ll have Census data soon enough.

HBU contraceptive coverage decision overturned

Good.

The U.S. Court of Appeals for the Fifth Circuit has turned back a challenge brought by several Texas religious organizations that oppose offering insurance contraceptive coverage to their employees, concluding that the plaintiffs have no right to challenge the conduct of third parties.

The recent decision also found that U.S. Supreme Court’s controversial 2014 Hobby Lobby decision was of “no help” to the plaintiffs, which included East Texas Baptist University and the Catholic Diocese of Beaumont, among others. That 5-4 high court decision held that corporations opposed to offering contraceptive coverage to their employees are exempt under the Religious Freedom Restoration Act [RFRA].

[…]

In his decision, Judge Jerry Smith wrote that the Fifth Circuit was joining several other circuit courts in finding that the ACA’s contraception coverage mandate doesn’t present a substantial burden to the plaintiffs’ religious freedom.

“Although the plaintiffs have identified several acts that offend their religious beliefs, the acts they are required to perform do not include providing access to contraceptives. Instead, the acts that violate their faith are those of third parties,” Smith wrote, reversing the trial court decisions in the cases.

“Because RFRA confers no right to challenge the independent conduct of third parties, we join our sister circuits in concluding that the plaintiffs have not shown a substantial burden on their religious exercise,” Smith wrote.

While the plaintiffs complain that sending in a notion of opposition will authorize or trigger payments for contraceptives, that is “not so,” wrote Smith, who explained that “the ACA already requires contraceptive coverage.”

Smith also noted that the Hobby Lobby decision mentions that certain religious organizations have already been “effectively exempted” through the ACA’s accommodation.

“Thus, Hobby Lobby is of no help to the plaintiffs’ position, and the requirement to offer a group health plan does not burden their religious exercise,” Smith wrote.

See here for some background, and here for a copy of the opinion. As Think Progress reminds us, Judge Smith is a very conservative Reagan appointee who is a reliable vote against abortion rights, so it’s not a case of getting lucky with the three-judge panel. The full circuit may be asked to review this, and it will certainly go to SCOTUS, though as RH Reality Check notes, every appeals court so far has sided with the feds on this. So there’s some hope that the dreadful Hobby Lobby decision will not expand any farther in scope. Hair Balls has more.

Ambulances and ERs

Very interesting story about the overuse of ambulances in Houston and how the city is trying to deal with it.

But in truth little works in a system that has been broken for years. Over the past generation, patients began to see emergency rooms as doctor’s offices, taking ambulances to get there.

It’s the most expensive ride to the most expensive kind of medical care in the world.

An ambulance trip costs at least $1,000. Just walking through the ER doors adds another grand and a half.

More troubling is a recent study by the University of Texas’ School of Public Health that showed 40 percent of patients streaming into Harris County’s overburdened ERs don’t need to be there; either their condition is not urgent or they are using the ER for something that can be or should have already been handled by a primary-care doctor or clinic.

The reasons behind this shift are not fully understood, buried somewhere in a tangle of public misperceptions, lack of access to primary care and habit.

[…]

Last year in Houston, 318,630 calls to 911 got routed to the fire department, with medical calls outstripping fires by nearly seven times. About 80 percent resulted in trips to the hospital. It is not known how many were true emergencies, but one indicator is how often lights and sirens were used en route to the hospital. The best guess is more than half are not urgent, fire officials say.

The result has created a crisis, especially for public hospitals. At Harris Health System, there were 144,891 ER cases between March 2014 and February. Of those, 61.5 percent of patients were indigent or uninsured.

“It’s unsustainable,” says Dr. David Persse.

He has seen all sides. In the 1980s, he worked as an EMT and paramedic in Buffalo, N.Y. He then went to Georgetown University to study emergency medicine. He came to Houston in 1996 and is now physician director of Emergency Medical Services for the Houston Fire Department and head of Houston’s Public Health Authority.

Six months ago, he helped launch a first-of-its kind project that had been percolating for years. It is called ETHAN, for Emergency Tele-Health and Navigation, a common-sense concept that mashes EMT tradition with emergency-room triage and wraps it in modern technology.

When a fire truck or ambulance arrives on a 911 call, a quick assessment is done. If the patient appears critical, he or she is transported. But if the complaint does not seem to rise to an emergency, a doctor trained in emergency medicine is called to talk to the patient by video chat on a specialized tablet.

The doctor searches troubled voices, inconsistent stories and the grainy images for clues. If the condition could be handled by a primary care physician or at a clinic, the doctor makes the appointment on the spot and arranges city-paid transportation by cab – a sliver of the cost of an ambulance. If the patient still wants to go to the ER, the ETHAN doctor has the power to insist they go by cab or find another ride.

Not only does this cut costs, it gets ambulance crews back into service faster.

Since the December launch, there have been about 1,000 ETHAN calls. By some estimates, it has already saved the city $1 million.

Once patients are in the ETHAN system, they are contacted by a public health nurse or counselor for a follow-up home visit to make sure they have a doctor and keep their appointments. Living conditions are assessed to see if other types of assistance are needed. The goal is to keep people from returning to the ER.

There’s more, so read the whole thing. I suspect a big portion of this is lack of access to primary care, which is undoubtedly related to lack of insurance for many people. Cities and counties are left picking up the tab for that, which can be laid at the feet of our Governor and Legislature. Still, even in a context where we had Medicaid expansion and broader insurance coverage, there would be a need for this. It’s a smart idea, and I hope it continues to pay off.

Abbott would like to restore the uninsured rate

It’s what he does.

It's constitutional - deal with it

It’s constitutional – deal with it

Greg Abbott on Monday urged his fellow Republicans not to “rescue” President Barack Obama’s signature health care law if it is torpedoed by the U.S. Supreme Court, an unusually public stance that could make the first-term Texas governor a leading voice on a national issue dividing the GOP.

Abbott’s position, announced in an opinion article published on the conservative National Review magazine’s website ahead of an expected high court decision, puts him in a group, including U.S. Sen. Ted Cruz, that hopes a ruling against the Affordable Care Act’s subsidies to help poor residents buy health insurance ultimately would undo the entire law. Others, including U.S. Sen. John Cornyn and former Texas Gov. Rick Perry, say the government should patch the problem by replacing the subsidies for the nearly 1 million Texans and 5 million other Americans now receiving them, at least temporarily and with some changes to the law.

Abbott’s piece also suggested what he intends to do if the justices throw out the subsidies and Congress fails to replace them: nothing.

“Now is not the time to throw Obamacare a lifeline,” Abbott wrote, “it is time to sound its death knell.”

Now is apparently the time to make sure that everyone who didn’t have insurance before the passage of the Affordable Care Act goes back to not having insurance if the Supreme Court strikes down the subsidies. Because that’s how we keep score in this state. Abbott’s article was typically full of the usual lies and distortions about Obamacare, which the Chron story to its credit points out. It also includes the same warmed-over Republican proposals for increasing health care access that Abbott would totally push for if only his party had any control in Texas. Oh, wait.

This is usually the place where liberal/Democratic types like me bemoan low turnout and lost opportunities and the like. I am instead going to point out that groups like the Texas Association of Business and the Texas Medical Association, both of which support the full implementation of Obamacare via Medicaid expansion and also supported Greg Abbott’s gubernatorial campaign, have a role in this as well. Yes, yes, I know – Wendy Davis was a lousy candidate, the Democratic Party in this state is feckless and impotent, there’s no point for these groups in supporting someone who can’t win, blah blah blah. These things may be true, but they’re also self-fulfilling. TAB and TMA supported Abbott for their own reasons – tax cuts and tort “reform”, to be specific – but there are plenty of other things they support that they aren’t ever going to get from him or his partymates. At some point they need to decide when doing the same thing and hoping for a different result starts to become more crazy than it’s worth to them.

UPDATE: Sorry (not sorry), Greg.

Lots of people will lose insurance if SCOTUS takes it away from them

Just a reminder.

It's constitutional - deal with it

It’s constitutional – deal with it

With a U.S. Supreme Court decision looming this month on a point of law that could dismantle the Affordable Care Act, a series of new reports offer a grim glimpse at the toll on Texas should the court decide against the Obama administration.

An estimated 1 million in Texas could lose their health insurance if the high court strikes down a provision in the Affordable Care Act that allows people to get tax subsidies that make their premiums more affordable through the federal insurance exchange, according to a study commissioned by the Texas Association of Community Health Centers and the Texas Academy of Family Physicians.

Those people could soon rejoin the millions in Texas who are already without health care coverage. Texas leads the nation in the number of uninsured with a rate of about 17 percent. Before the implementation of the health care law, the rate was 24.6 percent.

The pain is especially acute in Texas, the report says, because state leaders chose not to expand Medicaid, which left another 1.5 million people who were eligible without coverage.

“This is unconscionable. … What do you tell the million people in Texas who about to lose their coverage? That they didn’t deserve it in the first place?” said Ken Jandra, president and CEO of Community Health Choice, a HMO with 300,000 members is Houston.

[…]

In Texas, 85 percent of those insured through the federal marketplace receive an average tax credit of $247 a month. Without the subsidy, premiums could climb 305 percent, according to a study released last week by the Kaiser Family Foundation.

The most recent figure I saw for Texas was 1.2 million enrollments on the exchange; eighty-five percent of that – the share of folks who have subsidized coverage – yields the one million at risk number. The number of uninsured Texans dropped by eight percentage points this year versus what it was pre-Obamacare. We’re still at twice the national rate because our shortsighted and pound-foolish Republican leadership stubbornly refuses to expand Medicaid, but it’s still big progress. Which can be taken away by the whim of five Supreme Court justices, if they decide to do that. Anyone who thinks either Congress or those same state Republicans will do anything to fix this in that event probably thinks swimming in the bayou during a heavy rain is a good idea. For now at least, all we can do is hope for the best. Kevin Drum, Daily Kos, Better Texas Blog, and KUHF has more.

House chubfest kills several bad bills

Some good news, though as always at the end of a session, the outcome isn’t clean and the details are very murky.

Squalius cephalus, the official mascot of talking bills to death

As the clock struck midnight, the failure of an anti-abortion initiative — dear to the hearts of the far right — marked the end of a tumultuous day on the floor of the Texas House that saw the passage of sweeping ethics reform and a version of legislation allowing concealed carrying of handguns on college campuses.

On the last day that it could approve major legislation that began in the Senate, the lower chamber embarked on an all-day procedural waltz, with Democrats attempting to kill bills by delaying them past midnight, and Republicans looking for openings to move their legislation.

Early in the day, Democrats narrowly shot down an attempt to essentially change the order of the calendar, moving big-ticket items up for faster consideration. They then used every parliamentary trick in the book to slow the pace, delaying consideration of mostly uncontroversial bills.

But after huddling in a secret meeting in a room adjacent to the House floor, Democrats let the action get moving again.

For hours, the House debated an ethics reform bill, dissolving into angry tirades and raunchy debate about the reach of a drug-testing provision for lawmakers.

The passionate debate pitted Republicans against each other — over lifting the veil on “dark money” and restricting people from recording or videotaping politicians without their permission.

With the clock ticking, a few Republicans at one point even sought to postpone debate over ethics legislation — deemed a priority by Republican Gov. Greg Abbott — so the House could take up campus carry and an abortion bill that would have prohibited coverage of the procedure on certain health insurance plans.

Republican state Rep. Matt Schaefer of Tyler asked state Rep. Byron Cook, R-Corsicana, the House sponsor of the ethics legislation, to temporarily pull down the measure so that it did not chew up the time left on the clock.

After Cook declined, Democrats took to the mic to reiterate that ethics reform was declared an emergency item by the governor and was supposed to be prioritized over the rest of the calendar.

The House eventually passed the ethics bill, including the dark money provision, then went back to an innocuous agency-review bill, also known as a Sunset bill, to reform the Department of Family and Protective Services.

[…]

The biggest victim of the midnight deadline was Senate Bill 575 by Republican Sen. Larry Taylor, which would have banned abortion coverage on plans sold on the federal Affordable Care Act’s marketplace.

Originally, SB 575 would have banned abortion coverage on both ACA plans and private health insurance plans. But the House State Affairs Committee amended the bill to mirror a measure filed in the House by state Rep. Marsha Farney, R-Georgetown, and approved by the committee this month before dying on a House bill deadline.

Republicans had said they intended to amend it on the floor to bring back the private insurance ban.

The bill — passed in the Senate earlier this month — died in the House after a turbulent ride in the lower chamber.

It was cleared by the State Affairs Committee on Saturday in a last-minute vote on the last day the committee could clear Senate proposals.

Killing SB575 was a big one, and one of the Democrats’ main goals for deadline day. They also succeeded in preventing an amendment allowing child welfare agencies to discriminate against LGBT families to a sunset bill for the Department of Family and Protective Services, another main goal. What did get passed was a somewhat watered-down version of campus carry that will allow university trustees to designate certain “gun-free zones” as long as there isn’t a blanket ban on carrying firearms by those with concealed handgun licenses. The campus carry bill could possibly have been stopped, though (this is where we get into the messy and murky stuff) that could have had effects that would make the victory a lot more pyhrric. The Morning News hints at some of what might have happened.

Late Tuesday, the House was debating the gun measure, though it was unclear if it would pass.

Several Republicans said that after the initial slowdown, Speaker Joe Straus intervened in the early afternoon, to get things moving. There were conflicting accounts, though, of precisely how Straus, a San Antonio Republican, did so.

House Republican Caucus Chairman Tan Parker of Flower Mound said that in conversations with individual Democrats, “the speaker was firm that he would use everything,” meaning parliamentary “nuclear options,” to shut down debate and force votes.

Straus, though, was coy.

“I didn’t talk to Democrats,” Straus told a reporter. “But I intend to get through this,” he added, referring to the House’s agenda.

One consideration may have been that the campus carry bill is part of a grand bargain on tax cuts, border security, guns and ethics. The deal may allow lawmakers to finish their work Monday, as scheduled, instead of having a special session.

As passed by the Senate, the campus carry measure would allow the licensed concealed carrying of handguns in most public university buildings. There were rumblings the House might restore a campus-by-campus opt-in provision, as it did two years ago, or let the measure die when the clock struck midnight.

Whether Lt. Gov. Dan Patrick and his GOP allies in the Senate would consider that a breach of the grand bargain remained unclear.

[…]

Rep. Terry Canales, D-Edinburg, said he was upset that some senior Democrats relented.

“We’ve given away too much leverage,” he said.

There was talk that Martinez Fischer and other long-serving Democrats were worried the minority might be asking for too much, especially after gaining key House GOP leaders’ cooperation in squelching bills aimed at unions and stopping hailstorm damage lawsuits.

[Rep. Trey] Martinez Fischer, though, called that too facile.

“You can’t view everything as a quid pro quo,” he said. “It’s not personal. It’s all about business.”

Martinez-Fischer had a point of order that could have killed the campus carry bill, but he pulled it down after some intense discussion, and thus it went to a vote. How you feel about all this likely correlates directly to your opinion of his dealmaking ability and trustworthiness in making such deals. It’s also the case that this isn’t the end of the story, as the Statesman notes.

Cutting off debate ended a daylong Democratic effort to avoid a floor vote on the campus carry legislation before a drop-dead midnight deadline to have an initial vote on Senate bills.

After the vote, Rep. Trey Martinez Fischer, D-San Antonio, said Democrats voluntarily pulled down their amendments after winning a key concession with an approved amendment allowing colleges and universities to have limited authority on banning guns in certain campus areas.

In addition, he said, Republicans were prepared to employ a rarely used maneuver to cut off debate with a motion that had already lined up agreement from the required 25 House members.

[…]

The bill-killing tactics appeared headed for success late Tuesday, until Speaker Joe Straus abruptly called for a vote on SB 11 about 20 minutes before the deadline.

The move avoided a bitter blow for Lt. Gov. Dan Patrick and state Sen. Brian Birdwell, R-Granbury.

Based on assurances from House leaders that campus carry would get a floor vote in their chamber, Patrick and Birdwell declined last week to add the school gun bill as an amendment to House Bill 910, a measure to allow openly carried holstered handguns that is now one small step away from Gov. Greg Abbott’s desk.

Before approving SB11, the House voted overwhelmingly to allow each college and university to regulate where guns may be excluded, as long as firearms are not banned campus-wide. Each plan would have to be approved by two-thirds of the board of regents under the amendment by Rep. John Zerwas, R-Richmond, that was approved 119-29.

The House also adopted an amendment by Rep. Sarah Davis, R-Houston, to exempt health care-related institutions and the Texas Medical Center from campus carry.

“Never assume the Democrats gave up on campus carry. Democrats did not give up on campus carry,” said Rep. Sylvester Turner, D-Houston. “The Zerwas amendment waters it down. The bill will go to conference and we will continue to have our input in the process.”

Here’s a separate Trib story on the campus carry bill, an Observer story about the ethics reform bill that was a main vehicle for Democratic stalling tactics, and a Chron story on the overall chubbing strategy as it was happening. Newsdesk, RG Ratcliffe, and Hair Balls have more on the day overall, and for the last word (via PDiddie), here’s Glen Maxey:

LGBT people are finally, FINALLY free from all types of mischief and evilness. The Senate gets to debate the Cecil Bell amendment by Sen. Lucio put on a friggin’ Garnet Coleman bill tomorrow. It’s all for show. Garnet Coleman is one of the strongest allies of the LGBTQ community. They could amend all the anti-gay stuff they want on it and he’ll strip it off in conference or just outright kill the bill before allowing it to pass with that crap on it. This is for record votes to say they did “something” about teh gays to their nutso base.

And lots of high stakes trading to make sure that other stuff didn’t get amended onto bills today (labor dues, TWIA, etc.) and making sure an Ethics Bill of some sort passed. We didn’t want that to die and give Abbot a reason to call a special session.

Campus carry got watered down… no clue what happens in conference. And the delaying tactics kept us from reaching the abortion insurance ban.

Four good Elections bills passed today. Three on Consent in the House, three in the Senate all will be done by noon Wednesday.

And Lastly: Pigs have flown and landed. HB 1096 the bad voter registration bill is NOT on the Calendar for tomorrow and is therefore DEAD. I am one proud lobbyist on that one. With it’s demise, no major voter suppression bills passed (well, except for Interstate Crosscheck which is only bad if implemented badly, and we have to stay on top of it to make sure it’s not), and over forty good ones survived.

Just a few technical concurrences, and we’re done. Thank the goddess and well, some bipartisanship for once.

As someone once said, for every action there is an equal and opposite reaction. See the next post for more on that.

There’s still time for bad bills to be passed

Bad bill #1:

Never again

Never again

After four hours of debate and more than a dozen failed amendments offered by Democrats, the Senate on Monday gave preliminary approval to far-reaching restrictions on minors seeking abortions in Texas without parental consent.

On a 21-10 vote, the upper chamber signed off on House Bill 3994 by Republican state Rep. Geanie Morrison of Victoria to tighten the requirements on “judicial bypass,” the legal process that allows minors to get court approval for an abortion if seeking permission from their parents could endanger them.

The vote was along party lines with one Democrat, Sen. Eddie Lucio Jr. of Brownsville, joining Republicans to pass the measure.

[…]

After it reached the Senate, [Sen. Charles] Perry did some rewriting on HB 3994 to address two of the bill’s most controversial provisions on which both Democrats and some conservatives had raised concerns.

As expected, he gutted a provision that would have required all doctors to presume a pregnant woman seeking an abortion was a minor unless she could present a “valid government record of identification” to prove she was 18 or older.

The ID requirement — dubbed “abortion ID” by opponents — raised red flags because it would apply to all women in the state even though the bill focused on minors.

Under Perry’s new language, a physician must use “due diligence” to determine a woman’s identity and age, but could still perform the abortion if a woman could not provide an ID. Doctors would also have to report to the state how many abortions were performed annually without “proof of identity and age.”

Perry said the revised language “gives physician more latitude” to determine a woman’s age.

But Democratic state Sen. Kirk Watson of Austin, who spoke in opposition to the bill and questioned Perry for almost an hour, questioned the ID requirement altogether.

“I can’t think of another instance where we presume women are children,” Watson said. “I certainly can’t think of any situation where we presume a man is a child.”

Perry also changed course on a provision that would have reversed current law such that if a judge does not rule on the bypass request within five days, the request is considered denied. Under current law, the bypass is presumed approved if a judge does not rule.

Perry cut that denial provision from the bill, saying it is now “silent” on the issue. But that did little to appease opponents who pointed out a judge’s failure to rule effectively denies the minor an abortion.

“In essence, the judge can bypass the judicial bypass by simply not ruling,” Watson said, adding that the appeals process is derailed without a denial by a judge.

HB 3994 also extends the time in which judges can rule on a judicial bypass case from two business days to five. Perry said this was meant to give judges more time and “clarity” to consider these cases.

But Democratic state Sen. Sylvia Garcia of Houston, who also offered several unsuccessful amendments, questioned whether Perry’s intentions were rooted in a distrust of women and judges.

“I’m not really sure who it is you don’t trust — the girls, the judges or the entire judicial system?” Garcia asked.

See here for the background. The Senate version is not quite as bad as the original House version that passed, but as Nonsequiteuse notes, it’s still a farce that does nothing but infantilize women. It’s a cliched analogy, but can anyone imagine a similar set of hoops for a man to jump through to get a vasectomy or a prescription for Viagra? The only people who will benefit from this bill are the lawyers that will be involved in the litigation over it. Oh, and Eddie Lucio sucks. Good Lord, he needs to be retired. TrailBlazers, the Observer, and Newsdesk have more.

Bad bill #2:

In a dramatic turn of events, the House Calendars Committee on Sunday night reversed course and sent a controversial bill prohibiting health insurance plans sold on the Affordable Care Act’s marketplace from covering abortions to the full chamber for a vote.

Earlier in the night, the committee voted not to place Senate Bill 575 by Republican Sen. Larry Taylor on the lower chamber’s calendar for Tuesday — the last day a Senate bill can be passed by the House. After fireworks on the House floor instigated by a lawmaker who believed he had entered into an agreement to get the bill to the full chamber, the committee reconvened and reconsidered its vote.

Under SB 575, women seeking coverage for what Taylor has called “elective” abortions would have been required to purchase supplemental health insurance plans.

On Saturday, state Rep. Jonathan Stickland, R-Bedford, had threatened to force a House vote to prohibit abortions on the basis of fetal abnormalities by filing an amendment to an innocuous agency review bill. But Stickland later withdrew the amendment, telling the Austin American-Statesman that he had agreed to pull it down in exchange of a vow from House leadership that they would move SB 575 forward.

The bill did make it out of the House State Affairs Committee, chaired by state Rep. Byron Cook, R-Corsicana. But when it got to Calendars, that committee voted it down, leading Stickland to go after Cook on the House floor. Stickland had to be separated from Cook, and House sergeants immediately ran over to prevent a lengthier tussle.

Again, infantilizing women. And speaking of infants, what more can be said about Jonathan Stickland? I know there’s a minimum age requirement to run for office. Maybe there needs to be a minimum maturity requirement as well. Hey, if we can force doctors to assume that women seeking abortions are children, we can assume that any first-time filer for office is a callow jerk. We sure wouldn’t have been wrong in this case.

Bad bill #3:

Senate Republicans on Monday voted to move the state’s Public Integrity Unit out of the Travis County District Attorney’s Office. The action was spurred in part by last year’s indictment of former Gov. Rick Perry.

The legislation by Sen. Joan Huffman, R-Houston, would move key decisions about investigating public officials to the Texas Rangers and away from the Democratic-controlled Travis County District Attorney.

The bill was approved in a 20-11 vote, with Democrats casting all the no votes.

[…]

Under the proposed law, any district attorney looking at suspicious activity by a state official would refer the matter to new Public Integrity Unit within the Texas Rangers. That office would then use a Texas Ranger to further investigate the allegation, with expenses handled by the Texas Department of Public Safety.

If confirmed, the recommendation for further action would be sent to the district attorney in the home county of the public official. That district attorney could pursue or drop the investigation.

See here for the background. As I said before, I don’t think this is the worst bill ever, but I do think it’s a guarantee that some future scandal will result from this. And as others have pointed out, it sets up legislators to be treated differently than every other Texan in this sort of situation. That’s never a good precedent to set.

And finally, bad bill #4:

Gays and same-sex couples could be turned away from adopting children or serving as foster parents under an amendment filed by a social conservative House member and expected to be heard Tuesday.

The measure also would allow child welfare providers to deny teenagers in foster care access to contraception or an abortion under a wide umbrella of religious protections for the state contractor.

Rep. Scott Sanford, R-McKinney, has filed the measure that gives state contractors for child welfare services the right to sue the state if they are punished for making decisions based on their religious beliefs.

The state could not force contractors to follow policies providing for contraception or allowing same-sex couples to adopt, for instance. If the state tried to terminate a contract or suspend licensing for the state contractors’ failure to abide by such polices, the contractor could sue, win compensatory damages, relief from the policy and attorneys fees against the state, according to the proposal.

Sanford tried to pass as separate bill earlier in the session, but it failed. The proposal now has resurfaced as an amendment to the sunset bill that would reconstitute the Department of Family and Protective Services.

I’m just going to hand this one off to Equality Texas:

TUESDAY, MAY 26TH, Rep. Scott Sanford will try again to pass an amendment allowing child welfare agencies to discriminate against LGBT families

Tell your State Representative to oppose the Sanford amendment permitting discrimination in Texas’ child welfare system.

Rep. Scott Sanford has pre-filed an amendment that he will seek to add to SB 206 on Tuesday, May 26th. This cynical “religious refusal” amendment would authorize all child welfare organizations to refuse to place a child with a qualified family just because that family doesn’t meet the organization’s religious or moral criteria.

If enacted into law, the Sanford Amendment would allow child welfare providers to discriminate against not just gay and transgender families, but also against people of other faiths, interfaith couples and anyone else to whom a provider objects for religious reasons.

The only consideration of a child welfare agency should be the best interest of the child – not proselytizing for a single, narrow religious interpretation.

SB 206 is not objectionable. However, adding the Sanford Amendment to SB 206 must be prevented.

Urge your State Representative to OPPOSE the Sanford Amendment to SB 206.

Amen to that.

Texas’ uninsured rate drops dramatically

Amazing what can happen when a government actually tries to solve a problem, isn’t it?

It's constitutional - deal with it

It’s constitutional – deal with it

The rate of Texans without health insurance has fallen 8 percentage points since enrollment in the federal Affordable Care Act began, according to a new study.

Texas’ sky-high rate of adults without health coverage — previously about 25 percent, the highest rate in the nation — was down to 17 percent in March, according to a report from the Episcopal Health Foundation and Rice University’s Baker Institute for Public Policy.

But Texas remains the state with the highest percentage of uninsured people, the study found, and for the first time, the state has the largest raw number of uninsured residents in the country.

The amount of change was unequal among income levels. The poorest Texans saw a less dramatic improvement — the uninsured rate for people earning less than $16,000 fell by 20 percent, while the uninsured rate for people earning more income fell by 45 percent.

In a statement, Vivian Ho, one of the study’s authors, said the survey showed a widening “coverage gap” among poor and middle-income Texans. Texas leaders have declined to expand the state’s Medicaid program to provide health insurance to impoverished adults — a central tenet of President Obama’s signature health care law — criticizing the public program as “inefficient.”

“Unless Texas participates in an expanded Medicaid program or develops some other mechanism for covering the lowest income Texans, the number who remain uninsured is not likely to change,” Ho said. “Right now, those at the lowest incomes must rely on health care that is highly subsidized by county and state tax dollars, or get by without needed health care.”

The 31 percent decrease in the rate of uninsured Texans was similar to drops in other states that did not expand Medicaid coverage. For expansion states, the average decrease in the rate of uninsured was 53 percent, according to the study.

We know how that goes. I’ve skipped the typically dishonest quote from the TPPF’s designated hack, who always manages to get quoted uncritically in this kind of story despite the fact that all he does is spread misinformation. The numbers are out there if you want to look. We also know that people like having health insurance, for reasons that should be obvious to anyone who isn’t a professional liar. It will really suck if it all gets taken away by the Supreme Court, won’t it? The Chron has more.

Texans like having health insurance

Who knew?

It's constitutional - deal with it

It’s constitutional – deal with it

A first-of-its-kind survey asking Texans if health insurance is necessary found an overwhelming majority believe having coverage is critical for them and their families, with 50 percent calling it “absolutely essential.”

The Texas Medical Center commissioned Nielsen to survey attitudes surrounding health insurance ranging from its importance, what you would give up to pay for insurance, and whether people with bad health habits should be required to pay more.

The Houston Chronicle obtained advance results from the online poll posed to 1,000 Texans over 18 between Jan. 27 and March 3. The complete results will be unveiled Monday at the Medical World Americas 2015 conference in Houston.

Most striking was that 83 percent of those surveyed – a rate that held steady across age, race, income, education and insurance status categories – said having health insurance was either “very important” or “absolutely essential.” Only 5 percent said it was “not important at all.”

“That includes the all-important 25-to-35 demographic. It flies in the face of those groups who have been saying that young people don’t need or want health insurance,” said Dr. Arthur “Tim” Garson, director of the Health Policy Institute at Texas Medical Center.

[…]

Currently, Texas leads the nation in the number of uninsured with roughly 22 percent, or about 5.7 million people. And while it is not unusual for people living on the edge to experience periods without insurance, in Texas more than half of uninsured adults have been uninsured for five years or more, including 31 percent of the uninsured who have never had coverage in their lifetime, according to a 2014 Henry J. Kaiser Family Foundation analysis of the state’s uninsured.

I can’t find a copy of the study anywhere – a description of it is here – so you’ll just have to take the story’s word for it. Not really sure what there is to say other than I don’t know why anyone would be surprised by this. And in case you’re wondering, people who bought plans via the Obamacare exchanges are pretty happy with them, too. So yeah, health insurance good. Film at 11.

A different push for health care expansion

This ought to spark some interesting conversations.

It's constitutional - deal with it

It’s constitutional – deal with it

Two Democratic lawmakers called Wednesday for Texas leaders to explore a new type of Medicaid waiver that they say could provide health coverage to many of the state’s millions of uninsured.

The waiver, characterized by the legislators as the kind of block grant that Republicans favor, is not predicated on a Medicaid expansion and would allow Texas to avoid many provisions of the Affordable Care Act unpopular with the leadership in the Legislature – including the individual and employer mandates. The waiver, known as 1332, takes effect in 2017.

“Based on where we are now in this state, (the waiver) probably is the best chance or possibility of an agreement… toward coverage expansion,” Rep. Garnet Coleman, D-Houston, said at a news briefing with Sen. Jose Rodriguez, D-El Paso.

In a letter sent to colleagues earlier this week, Coleman added that the waiver must not reduce access to care, increase costs to the federal government, or make insurance more expensive than under the current law. The waiver effectively tells states that “if they know a better, more efficient way to provide health care, then have at it,” Coleman wrote.

[…]

Arlene Wohlgemuth, executive director of the Texas Public Policy Foundation, a conservative Austin think tank, said she had spoken to Coleman Wednesday morning about developing a 1332 waiver aligned with the principles laid out by the foundation.

“Of course, we are interested in reform of the program that truly gives flexibility to the states to provide for better health outcomes in a way that is affordable for the taxpayer,” Wohlgemuth said. “Thus far, the federal government has been unwilling to give exception to the requirements in the Social Security Act (the law that embodies Medicare) that have hamstrung true reform. We are interested to see what Representative Coleman has in mind through a 1332 waiver.”

Vivian Ho, a health care economist at Rice University’s Baker Institute for Public Policy, said there are so many unknowns about the waiver that it’s hard to know what to conclude.

“I can’t believe any waiver is the answer unless the state agrees to some sort of Medicaid expansion, and I don’t see how 1332 is going to help that,” said Ho. “It’s unclear how much money it would actually supply and whether it would provide access to tax credits for people below 100 percent of the federal poverty level.”

Ho added that block grants are a questionable idea unless the amount of money increases with population growth, given Texas’ continual migration and growing uninsured pool.

But Ken Janda, CEO of Community Health Choice, a nonprofit health care organization, called the suggestion “a very good idea” and said it “definitely seems worth talking about.” He said it answers a lot of concerns raised about Medicaid expansion and presents a possible solution to the health-care crisis that’s caused the closure of some private hospitals and threatens the existence of safety-net hospitals.

Rep. Coleman and Sen. Rodriguez filed bills this session to pursue this waiver and the reforms that it would allow. Here’s the letter they sent to fellow legislators outlining what this waiver would mean. Here’s the key bit:

However, there is a catch – the waiver must not reduce access to care, increase costs to the federal government, or make insurance more expensive than it is under the current law. The 1332 Waiver effectively tells states that if they know a better, more efficient way to provide healthcare, then have at it. Texas should take the federal government’s offer and consider ways to reform both Medicaid and private marketplace coverage in this state.

Basically, this is a put-up-or-shut-up challenge to Greg Abbott and the Republicans that have dug their heels in so fiercely against Medicaid expansion, the insurance exchanges, and every other aspect of the Affordable Care Act. You think you can do better? Prove it. My guess is that this will be roundly ignored, since Abbott and Rick Perry before him have shown zero interest in doing anything about the millions of uninsured Texans. Abbott appears to be perfectly willing to set fire to billions more dollars in his continued quest to not do anything about health care. But who knows, maybe someone will rise to the challenge. I agree that it’s at least worth exploring to see what might be possible.

Let the budgetary games begin

The House takes up the budget today, with over 300 amendments and riders queued up for votes. A couple of things to watch for as the debate goes on:

Killing vouchers.

BagOfMoney

Lawmakers in the Texas House will have a chance to draw a line in the sand over private school vouchers during the upcoming battle over the budget Tuesday.

An amendment filed by state Rep. Abel Herrero, D-Corpus Christi, would ban the use of state dollars to fund private education for students in elementary through high schools, including through so-called tax credit scholarships.

If passed, the measure — one of more than 350 budget amendments covering topics from border security to abortion up for House consideration — would deliver a blow to Lt. Gov. Dan Patrick.

[…]

If Herrero’s amendment fails, it would represent a dramatic change in sentiment for the chamber, which overwhelmingly passed a similar budget amendment during the 2013 legislative session. Patrick, a Houston Republican who served as state senator before taking office as lieutenant governor in January, led that chamber’s education panel at the time.

Rep. Herrero’s amendment from 2013 passed by a 103-43 vote. Neither Speaker Straus nor Public Ed Chair Rep. Jimmie Don Aycock is any more pro-voucher than they were last year, and neither is Dan Patrick any more beloved, so you have to feel pretty good about the chances this time, though it’s best not to count your amendments till they pass. If it does, that won’t fully drive a stake through vouchers’ cold, greedy heart for the session, but it’ll be a solid blow against them.

“Alternatives To Abortion”

As the Texas House prepares for a floor fight Tuesday over its budget, a flurry of amendments filed by Democrats seeks to defund the state’s Alternatives to Abortion program.

A group of Democratic lawmakers filed more than a dozen amendments to either reduce or eliminate funding for the program, which provides “pregnancy and parenting information” to low-income women. Under the program, the state contracts with the Texas Pregnancy Care Network, a nonprofit charity organization with a network of crisis pregnancy resource centers that provide counseling and adoption assistance.

Since September 2006, the program has served roughly 110,000 clients. The network features 60 provider locations, including crisis pregnancy centers, maternity homes and adoption agencies.

State Rep. Jessica Farrar, D-Houston, said she filed an amendment to defund the entire program because the state is giving more money to “coerce women” into a “political ideology instead of providing information and services” at a time when Texas women’s access to health services is being reduced.

The proposed House budget allocates $9.15 million a year to the program in 2016 and 2017 — up from $5.15 million in the last budget.

“I think it’s troublesome that here we are going to almost double funding for a program that has not proven to be successful in any way,” said Farrar, chairwoman of the Women’s Health Caucus in the House. An additional amendment by Farrar would require an audit of the program.

Several House Democrats filed similar amendments, including Borris Miles of Houston, Celia Israel of Austin and Chris Turner of Grand Prairie, whose amendments would transfer more than $8 million from the Alternatives to Abortion program to family planning services and programs for people with disabilities.

“These facilities have very little regulation, no accountability and no requirement to offer actual medical services,” Turner said, adding that funding could be used for other medical programs. “My amendments are an attempt to address our state’s real priorities and needs.”

Two Republicans, meanwhile, filed measures to boost the program’s funding.

I don’t expect Dems to win this fight, but it’s a fight worth having.

Other women’s health funding issues

The state currently administers three similar women’s health programs that cover things like annual well woman exams, birth control and cancer screenings for low-income women.

The newest program, the Expanded Primary Health Care Program, created in 2013, is slated to get the funding bump, bringing the total for women’s health services in the House version of the budget to about $130 million per year.

Here is the breakdown of funding for each program:

  • Texas Women’s Health Program: $34.9 million in 2016, $35.1 million in 2017
  • Expanded Primary Health Care Program: $73.4 million in 2016, $73.4 million in 2017
  • Family planning program administered by Department of State Health Services: $21.4 million in 2016, $21.4 million in 2017

In 2011, motivated by a never-ending quest to defund Planned Parenthood, the Texas Legislature slashed family planning funding by nearly $70 million, leaving about $40 million for preventive and contraceptive services for low-income women. A recent study by the University of Texas at Austin’s Texas Policy Evaluation Project, a research group that studies the effects of family planning budget cuts, found that more than 100,000 women lost services after the 2011 cuts and 82 family planning clinics closed. In 2013, the Legislature restored the $70 million and put it into the newly created Expanded Primary Health Care Program, which became a separate item in the state budget. Still, advocates and providers have consistently fought for more money, arguing that the state is only serving one-third of women eligible to receive services.

[…]

Here is a list of other women’s health amendments and riders to watch for:

  • State Rep. Mary Gonzalez (D-Clint) filed an amendment that would allow teenagers who are 15 to 17 years old and already mothers to get contraception without their parents’ consent. Right now, state law requires that all teenagers under the age of 18 get their parent’s permission for birth control. The amendment mirrors Gonzalez’s House Bill 468, which she presented to the House State Affairs Committee in mid-March.
  • State Rep. Chris Turner (D-Arlington) has proposed a rider that would ensure sex education programs teach “medically accurate” information to public school students.
  • State Rep. Bryan Hughes (R-Mineola) proposes adding even more money to the Alternatives to Abortion program by taking almost $7 million from the Commission on Environmental Quality.
  • A House budget rider by state Rep. Sarah Davis (R-Houston) protects the state’s Breast and Cervical Cancer Services program that provides breast and cervical cancer screenings for uninsured women, under attack this session by conservative lawmakers hell bent on, you guessed it, defunding Planned Parenthood.

Some possible winners in there – in a decent world, Rep. Gonzalez’s bill would be a no-brainer – but again, fights worth having. Rep. Sarah Davis has received some liberal adulation this session for trying to do good on women’s health issues. That budget rider will be a test of whether she can actually move some of her colleagues or not.

Public education

An amendment by the House’s lead budget writer, Appropriations Committee Chairman John Otto would allocate $800 million more to certain public schools as part of a plan announced last week to diminish the inequities that exist among districts under the current funding scheme.

[…]

At the news conference Monday, Austin state Rep. Donna Howard said at least 20 percent of public schools still will receive less per-student funding than they did in 2011 under the proposal. That year, state lawmakers cut $5.4 billion from public education, restoring about $3.4 billion two years later.

“We aren’t keeping up as it is,” Howard said.

She also noted the plan also does not include the $130 million that had been earmarked for a bill containing Gov. Greg Abbott’s plan to bolster pre-K programs — an amount she described as insufficient considering it does fully restore funding to a pre-K grant program gutted in 2011.

Howard has filed a budget amendment that would allocate $300 million for pre-K.

Pre-K is one of Greg Abbott’s priorities this session, but his proposal is small ball. Rep. Howard’s amendment has a chance, but we’ll see if Abbott’s office gets involved.

And finally, same sex benefits, because of course there is.

Rep. Drew Springer (R-Muenster) is again trying to bar Texas school districts from offering benefits to the same-sex partners of employees.

Springer has introduced a budget amendment that would eliminate state funding for districts that violate the Texas Constitution, which prohibits recognition of same-sex partnerships.

The amendment is similar to a bill Springer authored two years ago, which cleared committee but was never considered on the floor. Under Springer’s budget amendment, the education commissioner, in consultation with the attorney general, would decide whether districts have violated the Constitution. Districts would have 60 days to correct the problem.

According to Equality Texas, Springer’s amendment is aimed at the Austin, Pflugerville and San Antonio school districts, which offer “plus-one” benefits that are inclusive of same-sex partners. But the group says those benefits are in line with a 2013 opinion from former Attorney General Greg Abbott, which found that such programs are only illegal if they create or recognize a status similar to marriage.

Yes, as noted, Rep. Springer has tried to meddle in this area before. I admit, I’m more worried about a budget amendment this year than a bill in 2013. Keep a close eye on that one.

Diabetes

What happens when you expand access to health care in America? More people with previously undiagnosed illnesses can get the diagnosis and treatment that they need.

It's constitutional - deal with it

It’s constitutional – deal with it

Putting off visits to the doctor because you don’t have insurance is common, says Dr. Vivian Fonseca, a professor of medicine and endocrinology at Tulane University, in New Orleans. And that’s particularly a problem for people with diabetes, he says.

“We’ve known for a long, long time that a lot of people with Type II diabetes go unrecognized for many years because they don’t get screened,” Fonseca says. And one of the main reasons they don’t get screened, he says, is that they don’t have health insurance.

Fonseca and his colleagues wondered whether Medicaid expansion under the Affordable Care Act, which became law five years ago Monday, has improved the detection of diabetes. That possibility seemed likely because more poor people now have insurance.

In 2012, the Supreme Court ruled that states could choose whether to expand their Medicaid programs under the ACA. In January 2014, about half the states, including Ohio, expanded and about half did not. This created what Fonseca calls a natural experiment — an opportunity to compare the impact of Medicaid programs on diabetes care.

Using data collected by the clinical laboratory Quest Diagnostics, Fonseca and his colleagues first looked at states that did not expand Medicaid. They saw a very small percentage increase (compared to the previous year) in diabetes diagnoses.

Then they looked at states that expanded Medicaid, and saw, among Medicaid patients, a much bigger increase — 23 percent. That translated into thousands of people with previously undiagnosed Type II diabetes being discovered because of Medicaid’s expansion, Fonseca says. He and his colleagues have published the study online this week in Diabetes Care, the journal of the American Diabetes Association.

Dr. Robert Ratner, the chief medical officer for the American Diabetes Association, says the study is important because early diagnosis and treatment are particularly crucial with diabetes. Left untreated, the disease can lead to blindness, heart attack, kidney failure or complications that require amputation of the foot or leg.

“Early and aggressive therapy of diabetes has a major impact on long-term complications and on quality of life,” Ratner says.

Early intervention may also reduce long-term costs, which account for a large percentage of overall health care spending.

But Ratner points out an irony of the study: Many of the states that did not expand Medicaid are in what he calls the “diabetes belt.” It’s a region stretching from Louisiana to North Carolina.

“Those states that did not expand Medicaid missed that opportunity and they still have large percentages of people, perhaps as high as 20 percent, living with diabetes who don’t know it,” he says.

The study is here. Not everyone buys into the conclusions – this NYT story quotes one skeptic of the result and one who cautioned that the cost effect of early diagnosis has not been established – but it’s easy enough to see how early diagnosis and treatment could have a large benefit for the people who receive it. In Texas, nearly ten percent of adults have been diagnosed with diabetes, with the prevalence among blacks and Hispanics being about double what it is for whites. I don’t know how many have it but don’t have not been diagnosed, but I’d guess it’s a lot. As you might imagine, folks who have diabetes but don’t have health insurance visit the emergency room a lot. And yet we’re supposed to believe that expanding Medicaid is something we can’t afford. It makes no sense at all. Daily Kos has more.

Rural hospitals

If this story was meant to evoke my sympathy, I’m afraid it failed.

It's constitutional - deal with it

It’s constitutional – deal with it

Since the hospital closed in Paducah, a town 30 miles to the north, patients in Guthrie have 60 long miles to travel to Childress for care. It’s a feeling of isolation that has crept up on other rural corners of the state following a spate of 10 hospital closures in the past two years. And financial data collected by the state and federal government shows revenue is falling for other rural hospitals, suggesting more may be on the brink.

Policymakers, operating on tight budgets, must decide whether they are willing to spend more money on small hospitals serving a limited number of patients, hospitals that in most cases could not keep their doors open without government assistance. But without them, people, inevitably, will die.

“We’ve all seen the crash that’s coming in the next five years,” said Kell Mercer, an Austin-based lawyer who has worked on hospital bankruptcy cases. “The Legislature’s more interested in cutting revenue and cutting services than providing the basic services for these rural communities. This is a perfect storm of events that’s going to hit the state, hard.”

Texas’ rural hospitals have long struggled to stay afloat, but new threats to their survival have mounted in recent years. Undelivered promises of federal health reform, payment cuts by both government programs and private insurers, falling patient volumes and a declining rural population overall have been tough on business — a phenomenon one health care executive called “death by a thousand paper cuts.” Add to that Texas’ distinction as the state with the highest percentage of people without health insurance and you get a financially hostile landscape for rural hospital operators.

“Hospital operating margins, and this is probably true of the big guys and the small guys, too, are very small, if not negative,” said John Henderson, chief executive of the Childress Regional Medical Center. “In a way, Texas rural hospitals are kind of in a worst-case scenario situation, because we lead the nation in uninsured, and we took Medicare cuts hoping that we could cover more people.”

[…]

The sum of all these changes has people like Don McBeath, who lobbies for rural hospitals, warning of a repeat of the widespread hospital closures Texas experienced three decades ago. In 1983, the federal government restructured the way Medicare made payments to hospitals, meant to reward efficient care. Those changes proved untenable for small hospitals with low patient volume, heralding decades of closures that claimed more than 200 small Texas hospitals as casualties, McBeath said.

Some counties can afford to raise taxes to keep their hospitals open; others cannot, or find that raising taxes is politically impossible.

And when a small county hospital closes, often the hospital in the next county over must shoulder a bigger burden of uninsured patients. Even patients with insurance face higher deductibles and often can’t pay their bills.

“When it closes, you’re forced to make other decisions, other plans,” said Becky Wilbanks, a judge in East Texas’ Cass County, which saw a hospital closure last year. “That’s an economic hit that we took.”

Rural hospitals are often one of the biggest and highest-paying employers in a community, Wilbanks said.

And when they close, it can have a domino effect on other local businesses, said Hall County Judge Ray Powell. When his county’s hospital closed in 2002, it prompted the local farm equipment dealership to close its doors and move to Childress.

“It was a big loss,” he said. “It was devastating.”

Across Texas, rural counties are seeing their populations dwindle. King County, home to Guthrie, is one of Texas’ 46 rural counties that are projected to lose population over the next four decades — at a time when the rest of the state’s population is expected to double.

Maybe I’m just a jerk, but my first reaction to stories like this is to check the most recent election results in the counties named.

In Cass County, Greg Abbott got 74.64% of the vote.
In Hall County, Greg Abbott got 85.09% of the vote.
In King County, Greg Abbott got 96.77% of the vote. Ninety-three people voted in total, and 90 of them went for Abbott.

In other words, the voters in these counties have gotten what they voted for. Perhaps someone should point that out to them if and when more of these rural hospitals close.

This isn’t entirely fair. Declining population in these counties is nobody’s fault. A change in Medicare payments in 2002 caused a lot of upheaval. But the problems they’re facing now are entirely the result of Republican intransigence on Obamacare and hostility to Medicaid. It’s abundantly clear by now that Medicaid expansion has been a boon for the states that have done it, while states like Texas are feeling the downside good and hard. If you want to blame Wendy Davis for not adequately communicating the issue to these voters, you have to equally blame Greg Abbott for continually lying about the need for “freedom” from the “tyranny” of Obamacare. Elections have consequences. This is one of them.

Cruz may go on Obamacare

Go ahead, laugh it up. You know you want to.

Not Ted Cruz

Not Ted Cruz

Ted Cruz, one of the loudest critics of Obamacare, will soon be using it for health insurance coverage.

“We will presumably go on the exchange and sign up for health care and we’re in the process of transitioning over to do that,” Cruz, a Republican candidate for president, told The Des Moines Register Tuesday.

Cruz’s wife, Heidi, is going on an unpaid leave of up absence from her job at Goldman Sachs to join Cruz full time on the campaign trail, Cruz told the Register.

Bloomberg was first to report that Heidi Cruz has taken the leave. CNN noted that Cruz, who has boasted about not needing to receive government health care benefits, would no longer be covered under his wife’s health insurance plan.

[…]

Cruz, as an employee of the government, will use the exchange to choose his employer-provided insurance. Iowa U.S. Sen. Chuck Grassley pushed through an amendment on the Affordable Care Act that requires members of Congress to obtain their coverage via the exchanges. Congress pays most of the premium. But Cruz won’t be getting any extra benefit under the Affordable Care Act that a member of Congress wouldn’t have gotten before the ACA became law.

Asked if it chafes at all to have to rely on Obamacare, Cruz told the Register: “Well, it is written in the law that members will be on the exchanges without subsidies just like millions of Americans so that’s – I think the same rules should apply to all of us. Members of Congress should not be exempt.”

But, Cruz added, he’d still like to see Obamacare repealed in its entirety.

Wonkblog notes that Cruz will not be taking any of the contribution money that legislators and their staffers are entitled to, so in that sense he’s sticking to his principle. I say if he really wants to be true to his vision, he should make like Louie Gohmert and forgo health insurance altogether. That’s the kind of freedom from tyranny he wants all those newly-insured people (and lots of not-so-newly-insured people, I expect) to have once he becomes President and repeals the Affordable Care Act, right? Well, then now is not the time for half-Measures. Now is the time to show us what you’re really made of and boldly go uninsured, Ted. Hell, just the opportunity to do a little civil disobedience by refusing to pay the tax penalty should have you licking your lips and twirling your mustache, if you had one to twirl. If Louie can do it, Ted, so can you. Anything less would be a sellout.

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.

From the “Be careful who you vote for” department

Because you never know when the consequences of your voting actions will directly affect you.

It's constitutional - deal with it

It’s constitutional – deal with it

Erin Meredith, a fifth-generation Republican who lives in Austin, was no fan of President Obama’s Affordable Care Act, which she considered just another wasteful government handout. She didn’t sign up for a health plan until late last year, when she felt she had no other choice.

By then, Meredith, who is 37 and has two children, had gotten divorced and lost the insurance provided through her husband. Her new job, as an office manager for a roofing company, didn’t offer benefits. About the same time, she learned that her headaches and fatigue were the result of a rare condition that affects the oxygen level in her blood. She couldn’t afford to spend thousands of dollars on doctor’s visits, and her desperation slowly turned to panic.

In November, at a friend’s urging, Meredith looked for a health plan on the federal online marketplace. With an income of about $30,000 a year, she discovered she qualified for a government subsidy of $132 a month. Her premium would be $89 a month.

Now that she has coverage, she doesn’t want to lose it. “I can still feed my kids and put gas in my car,” she said. “I’m not trying to go to Cancun or carry a Michael Kors bag. I drive a 2009 Mazda, and I’m just trying to make it in my little apartment and not be on government assistance.”

Meredith is one of about 6 million people whose subsidized insurance hangs in the balance as the Supreme Court takes up a case that poses the most serious challenge to the Affordable Care Act since the court found the law constitutional more than two years ago.

[…]

“If they’re not going to participate in Obamacare and I’m not going to have these financial benefits, which will force me to pay $220 a month for coverage, do you know if Greg Abbott, our governor, has any plan to offer something comparable?” Meredith asked in an e-mail. “I understand and support his efforts to put Washington back in its place. I just don’t want that to come at the cost of hard-working Texans and their ability to maintain medical coverage.”

Dear Erin Meredith,

The answer is no, he does not. Although this is the rare lawsuit against the Obama administration for which Greg Abbott is not among the plaintiffs, it is his fondest wish for Obamacare to die a bloody death, and if this lawsuit helps make that happen, then nothing will make him happier. If that means that you and your family will suffer as a result, well, that’s just too bad. Greg Abbott doesn’t care, and doesn’t have any intention of helping you. You’re on your own, as far as he’s concerned. Neither do Dan Patrick or Ken Paxton, and neither did Rick Perry while he was Governor. In fact, Rick Perry recently claimed that the reason people like you didn’t have health insurance before now is because that the way you wanted it. It’s his justification for why he never pushed to provide anything like the subsidies for insurance you now receive. Greg Abbott feels the same way. It’s your fault, and you don’t deserve any assistance for it. Hope this answers your question. Daily Kos has more.

(There are more stories about Texans who wold be very badly affected by an adverse SCOTUS ruling on subsidies, in Vox and the Sunday Houston Chronicle. Greg Abbott doesn’t care about any of these people, either, though those stories don’t say if any of them were foolish enough to have voted for him in November.)

One point two million Obamacare signups in Texas

Not too shabby.

It's constitutional - deal with it

It’s constitutional – deal with it

McCarter was one of nearly 1.2 million Texans who signed up or were re-enrolled in health coverage before open enrollment ended Sunday. The newly released numbers show Texas ranking behind only Florida in the number of people it signed up or re-enrolled in coverage among the 37 states that rely on the federal health insurance marketplace to sell insurance plans, federal officials said Wednesday. Florida signed up or re-enrolled about 1.6 million people.

“When was the last time this many people became insured?” asked Elena Marks, president and CEO of Houston’s Episcopal Health Foundation and a nonresident health policy fellow at Rice University’s Baker Institute. “It is almost double the number who signed up last year.”

[…]

About 150,000 consumers who were waiting to buy marketplace coverage and those who had technical problems while completing their applications as open enrollment ended Sunday will have until Monday to finish enrolling. Burwell said she hasn’t decided whether to open a special enrollment period for consumers who realize they face a penalty for being uninsured as they file their 2014 federal income taxes.

Texas’ enrollment figure indicates about 500,000 residents might have bought marketplace insurance for the first time. Last year, nearly 734,000 Texans bought coverage during the marketplace’s inaugural open enrollment period.

According to the national insurance advocacy group Get Covered America, more than 317,000 Houston-area residents bought or were re-enrolled in 2015 marketplace insurance coverage.

“The fact that more than 180,000 Texans enrolled in the final nine days of the open enrollment period shows that people want and need an affordable and quality health care plan,” Mimi Garcia, Get Covered America’s Texas director, said in a written statement.

That’s over 11 million nationally, or 19 million if you count Medicaid expansion. Not too shabby for a program that the hacks at the TPPF claims is broken, or for a population that Rick Perry swears wasn’t interested in getting coverage. Imagine what these numbers could be if everyone cared about doing something about the uninsured problem.

SCOTUS could really screw Texas on Obamacare

You know how all those Texans have been signing up for health insurance via the Healthcare.gov exchange? Every single one of them stands to lose if the Supreme Court decides to play politics.

It's constitutional - deal with it

It’s constitutional – deal with it

Nearly 1 million Texans have now signed up for health insurance on the federal marketplace, known as healthcare.gov. But Texas, and 33 other states that did not create their own exchanges, will be the most vulnerable if the U.S. Supreme Court rules against the Obama administration in the latest lawsuit challenging the Affordable Care Act, health policy experts say.

[…]

Oral arguments in the case are scheduled for March, and the high court’s decision could come as early as June. If the high court rules that subsidies are not allowed for Texans and others in states without their own exchanges, the ripple effects could be striking. One insurance industry group, in a court brief supporting the subsidies, said eliminating them would trigger a “death spiral” of premium increases and market destabilization.

Without assistance from the federal government, many young and healthy enrollees “are simply going to drop” their health plans, while the sickest people would remain in the market, said Nicholas Bagley, a professor at the University of Michigan Law School. That would expose insurers to greater risk, causing them to hike their rates for all customers, not just those who entered the system through Obamacare plans.

“Holy shit, that’s chaos,” said Robert Laszewski, a health policy consultant in D.C. “What’s ironic here is not only will the Republicans be screwing up the insurance for poor people on the Obamacare exchange, they’ll be screwing up health insurance for rich people in Texas who happen to be in the individual market.”

[…]

So far, state leaders have been tight-lipped about what, if anything, they are doing to prepare for a high court ruling. John Greeley, a spokesman for the Texas Department of Insurance, referred questions about King v. Burwell to “state leadership.”

“We’re not gonna weigh in,” he said. As for the state’s decision to create an insurance exchange, he said, “that has not been our call, from the very beginning.”

Representatives for Texas’ largest health insurers also declined to comment.

“Blue Cross and Blue Shield of Texas is waiting for further guidance from the federal government as this situation plays out,” company spokeswoman Margaret Jarvis said in a written statement, though a trade group representing the insurer has written to the Supreme Court in support of the subsidies.

Like I said, a whole lot of Texans are on the chopping block, with a state government that will be happy to let them get sick and die in the name of ideology. (Rep. Chris Turner has filed a bill to establish a state exchange, but – with all due respect – if Rep. John Zerwas couldn’t get anywhere with that, there’s no way a Dem like Turner will.) Having said all that, it’s possible that for all their bluster and BS, the state leadership is quietly hoping for a loss on this one.

States on both side of the issue have filed briefs with the Supreme Court. But only six red states—Oklahoma, Alabama, Georgia, Nebraska, South Carolina, and West Virginia—joined a brief on behalf of the petitioners. Conspicuously missing are deeply conservative states like Texas, with large beneficiary pools, or any swing states under GOP control. Republican senators from many of those states—including Wisconsin, Ohio, and Florida—are in cycle in 2016.

I’ll be honest, it hadn’t occurred to me that Texas hadn’t signed onto this effort. An opportunity to sue the federal government – over the hated Obamacare, no less – and we passed? Did Greg Abbott sleep in the day the other plaintiffs came around looking for amicus briefs? I’m stunned. True, this lawsuit is a steaming pile of baloney with little to no establishment support, but since when has that ever slowed Abbott down? We’ll see how this goes.

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.