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Medicaid

Local Planned Parenthood joins lawsuit against the video fraudsters

Good.

Right there with them

Right there with them

A Texas-based Planned Parenthood affiliate on Thursday moved to join a federal lawsuit filed in California against the anti-abortion group behind undercover videos of the organization’s clinics.

The lawsuit, filed in a San Francisco-based federal court in January, alleges the Center for Medical Progress engaged in conspiracy, fraud and other activities that violate organized crime law and other federal regulations in its pursuit of secretly recorded videos of Planned Parenthood. Citing recordings of staff at a Houston clinic, Planned Parenthood Gulf Coast filed to join the lawsuit as a plaintiff.

The recordings, released by the group last summer, depicted Planned Parenthood staff discussing the procurement of fetal tissue. The group alleged that Planned Parenthood was illegally profiting from the sale of tissue of aborted fetuses — an accusation the organization has vehemently denied.

The lawsuit against the group was first filed by Planned Parenthood Federation of America and seven California affiliates against the Center for Medical Progress, Biomax Procurement Services and several anti-abortion activists, including videographers David Daleiden and Sandra Susan Merritt.

See here for the background on the existing lawsuit, and here for a copy of the complaint. There’s another federal lawsuit against these clowns as well, plus a lawsuit by PP against the state over revocation of Medicaid funds. If these CMP idiots want to be martyrs for their cause, I hope the justice system helps them get there, one judgment (and conviction) at a time. The Chron and the Observer have more.

What’s next for Adrian Garcia?

We haven’t seen the last of him, I suspect.

Adrian Garcia

Adrian Garcia

In less than a year, former Harris County Sheriff Adrian Garcia has gone from being the top Democratic elected official in Harris County to an also-ran in back-to-back elections.

Garcia’s resounding primary loss to U.S. Rep. Gene Green on Tuesday leaves him politically precarious, having alienated several onetime allies by resigning the sheriff’s post last May to run for Houston mayor and later challenging an incumbent in a safe Democratic seat.

“When you take an oath, you run and take an oath to hold an office, it’s supposed to mean something,” said state Sen. John Whitmire, who backed Green. “And to leave in the middle and look like an opportunist and want to run for mayor, and then you don’t make that, and then you run against a congressman that most people felt was doing a very good job, a congressman that actually endorsed you for mayor … I think Adrian’s got real problems.”

Garcia’s campaign said he was unavailable for comment Wednesday, but he said at his election watch party Tuesday night the race was not personal and that he planned to rest before assessing future options.

“Will this be my last campaign? I doubt it,” he said to applause. “I lost two campaigns, but I jumped in always with the idea of doing more. I took a chance. My heart was in the right place.”

[…]

Many of the former sheriff’s attacks were biting. “Gene Green perpetuates the cradle to prison pipeline,” read a news release from late February. Another, from January, declared, “Gene Green protects polluters, not Pasadena.”

Facing limited financial resources, as well as opposition from many Democratic officeholders and area unions, however, Garcia was unable to outmaneuver Green, who outspent him $585,000 to $171,000 during the first six weeks of the year.

Those affiliated with Garcia’s campaign framed that financial shortfall as critical.

“We had a lot of factors working against us. We were in an extremely short two-month race against a 23-year incumbent who’d accumulated significant financial resources, and, yet, we made significant strides and held Congressman Green to 58 points,” Garcia campaign spokesman Sergio Cantu said in an email. “The message and the messenger were not the problems. We are proud of what we achieved, and we hope this opens the door to see change on the issues in this district.”

Several of the former sheriff’s supporters remained optimistic about Garcia’s political future.

“Will he run again? He might if it’s the right place for him to serve,” Garcia consultant Mustafa Tameez said. “That’s the nature of politics. You win some and you lose some. But he’s demonstrated his ability to raise money. He’s demonstrated his ability to get the votes.”

It’s true that after leaving the Sheriff’s office and having it handed to a Republican as well as running what were basically two contested Democratic primaries in the space of five months, Garcia has a few bridges to rebuild with past allies. But let’s not forget, he won five November elections before this, plus two contested primaries, so there’s no reason to believe he’s finished just because those last two elections did not go his way. There’s a very simple way for Garcia to get back into the good graces of his fellow Democrats, and that’s by working, vigorously and visibly, to help elect Democrats up and down the ballot this fall. Hold fundraisers, donate to candidates, attend as many campaign events for the party and for candidates as possible. Continue working on engaging with and boosting turnout in the Latino community. Keep talking about the issues that drove those two campaigns, and the good work that was done as Sheriff. Do those things, and I guarantee, bygones will be bygones.

Assuming we get to that point, then what office might Garcia reasonably seek in the near future? Before he resigned as Sheriff, when his Mayoral campaign was still in the rumor-has-it stage, I suggested Garcia stay in office, declare he wasn’t running for re-election in 2016, then at his first opportunity declare his candidacy for County Judge in 2018. He could still do that, but as we know there are some other people – Annise Parker, for one – who have expressed interest in that office as well. Now, there’s no reason why Garcia couldn’t declare for County Judge. No one is entitled to anything, and he’s be as strong a candidate as anyone we could put forth. But if we’re looking to maintain some harmony, if we’re trying to ensure that the reservoir of goodwill that he just finished refilling doesn’t get immediately drained, then we should at least consider a Plan B.

Which is why my suggestion is: County Commissioner, Precinct 2, the seat formerly held by Sen. Sylvia Garcia. It’s still a county office, which given Garcia’s tenure as Sheriff is a good fit, he’d be extremely likely to have a clear path to the nomination, and if we also have a strong candidate for County Judge it would put thoughts of having a Democratic majority on Commissioners Court in people’s heads, which is sure to get folks fired up. When I say this seat is a good fit for Garcia because of his time as Sheriff, I’m particularly thinking of all the crap he had to endure as Sheriff from the rest of the Court, which was generally hostile to him and got even more so after Jack Morman knocked off Sylvia Garcia in 2010. As a former Sheriff and a candidate for Commissioners Court, Garcia could turn a lot of the criticism they gave him back on them, in terms of budgeting, putting pressure on the criminal court judges to use Pretrial Services and set reasonable bail, and screaming from the rooftops in favor of Medicaid expansion and the much-needed boost for mental health funding and treatment it would bring. I can’t think of anyone better positioned to make these arguments in a Commissioners Court race, or anyone who could pose a bigger threat to a sitting Commissioner. We know Garcia can raise money, and the people who are grumbling about his Mayoral and Congressional races now would surely be willing to pitch in and help him in a race like this. If I had the power to do so, I would absolutely make this happen.

I don’t have that power, of course, I’m just another schmoe in the cheap seats making noise. But this is my scenario for Adrian Garcia, for whatever it’s worth. The path I’m highlighting is easy this year and a lot harder after that, but it’s all doable. What he chooses to do is up to him, but if he wants to know what I think, here it is.

Why are some people more likely to smoke than others?

From the CDC:

American adults who are uninsured or on Medicaid smoke at rates more than double those for adults with private health insurance or Medicare, according to a study published by the Centers for Disease Control and Prevention in today’s Morbidity and Mortality Weekly Report (MMWR).

Data from the 2014 National Health Interview Survey (NHIS) show that 27.9 percent of uninsured adults and 29.1 percent of Medicaid recipients currently smoke. By contrast, 12.9 percent of adults with private insurance and 12.5 percent of those on Medicare currently smoke.

“Smoking kills half a million Americans each year and costs more than $300 billion,” said CDC Director Tom Frieden, M.D., M.P.H. “This report shows real progress helping American smokers quit and that more progress is possible.”

The study reported that the prevalence of cigarette smoking among U.S. adults declined from 20.9 percent to 16.8 percent from 2005 to 2014, including a full percentage-point decline between 2013 and 2014 alone. The considerable drop in the overall adult smoking rate over time shows marked progress toward achieving the Healthy People 2020 goal of reducing the cigarette smoking rate to 12 percent or lower. Another major finding was that the average number of cigarettes smoked per day among daily smokers declined from 16.7 in 2005 to 13.8 in 2014 — driven by declines in the proportion of daily smokers who smoked 20 or more cigarettes per day.

At-risk populations

The study found other differences in smoking rates consistent with previous studies. In 2014, prevalence of cigarette smoking was higher among these groups:

  • Males (18.8 percent vs. 14.8 percent for females)
  • Adults ages 25-44 years (20.0 percent)
  • Multiracial (27.9 percent) or American Indian/Alaska Natives (29.2 percent)
  • People with a General Education Development certificate (43.0 percent)
  • People who live below the federal poverty level (26.3 percent)
  • People who live in the Midwest (20.7 percent)
  • People who have a disability/limitation (21.9 percent)
  • People who are lesbian, gay, or bisexual (23.9 percent)

“These findings underscore the importance of ensuring that proven strategies to prevent and reduce tobacco use reach the entire population, particularly vulnerable groups,”said Brian King, Ph.D., deputy director for research translation, CDC Office on Smoking and Health. Comprehensive smoke-free laws, higher prices for tobacco products, high-impact mass media campaigns, and barrier-free access to quitting help are all important. They work to reduce the enormous health and financial burden of tobacco use and secondhand smoke exposure among Americans.”

Changes in the U.S. health-care system continue to offer opportunities to improve the use of clinical preventive services among adults. The Patient Protection and Affordable Care Act of 2010 is increasing the number of Americans with health insurance and is expected to improve tobacco cessation coverage.

Currently, neither private insurers nor state Medicaid programs consistently provide comprehensive coverage of evidence-based cessation treatments. In 2015, although all 50 state Medicaid programs covered some tobacco cessation treatments for some Medicaid enrollees, only nine states covered individual and group counseling and all seven FDA-approved cessation medications for all Medicaid enrollees. Cessation coverage is used most when smokers and health-care providers know which cessation treatments are covered.

I find this fascinating. I’m old enough to remember when smoking was ubiquitous – I’ve experienced the smoking section of airplanes and restaurants – but nowadays not only do I hardly know any smokers, most of the people I know are militantly anti-smoking. The combination of government action and peer pressure has basically made my life, and the lives of most people I know, a non-smoking zone. Which, from my perspective, is awesome. But that yields a big question: Why is it that this effort has been so much more successful among some parts of society than others? What is it that we’ve been doing wrong, or doing inadequately? There’s a huge societal cost to smoking, so figuring this out would be a big deal. I hope the next study focuses on that question.

Steve Radack supports Medicaid expansion

I have three things to say about this.

It's constitutional - deal with it

It’s constitutional – deal with it

When Harris County commissioners were asked this week by a member of the public to lower the property tax burden, Steve Radack had a response prepared: tell Austin to let millions of Medicaid dollars flow to the county – then the commissioners might be able to lower taxes.

The comment may come as a surprise from the Precinct 3 commissioner, one of the most outspoken conservatives on the court who has been a vocal critic of Harris Health System, the county’s health care system for the poor.

But his comment adds to the number of local voices that have challenged state Republican leaders to accept the federal money at a time when the county’s population and medical needs continue to grow. Radack said he will keep up the drumbeat.

“So, let’s go after the state,” he said at the meeting Tuesday. “Let them just simply accept the money, send it to us, we’ll cut taxes.”

[…]

Last year, Harris Health System officials estimated there were 70,000 uninsured patients in the county public hospital system who would have benefited from the Medicaid expansion, translating into about $70.3 million.

That money, said CEO George Masi, is instead picked up by the Harris County taxpayer when uninsured patients can’t pay their bills.

“That’s what’s so compelling about this,” Masi said. “This is 70.3 million, that would accrue immediately to Harris County.”

Masi said the number was similar each year since Texas opted against expanding Medicaid.

1. This is very good to hear. I have plenty of disagreements with Commissioner Radack and plenty of reasons why I’d like to see someone else in that office, but he’s 100% dead on right here, and he deserves to be applauded for it.

2. That said, how long has he felt this way? Judge Emmett has been a supporter of Medicaid expansion for a few years now. If Radack has felt this way all along, he’s kept it pretty close to the vest. Be loud and proud, Commissioner!

3. I hate to be the one to bring up uncomfortable topics here, but the only way we’re going to get Medicaid expansion in Texas is to elect more people who support it. There are some Republicans in the Legislature who support Medicaid expansion – off the top of my head, I don’t know of any from Harris County, though that may just be because they’ve also been quiet about it – but the majority of them do not, and our Governor and Lt. Governor are especially antagonistic to it. As long as that is the case, the status quo will remain firmly in place. The words are nice and necessary, but without action to accompany them, that’s all they are.

More kids in Texas have health insurance now

Thanks, Obama!

It's constitutional - deal with it

It’s constitutional – deal with it

The number of uninsured children in Texas fell by almost 100,000 during the first year of full implementation of the Affordable Care Act, signalling a potential trend across all age groups, a new study by the Robert Wood Johnson Foundation finds.

The findings were welcomed in a place with stubbornly high uninsured rates, particularly among the poor and racial and ethnic minority groups.

“This is good news. Texas is a state with a comparably young population, so the more of them that are insured the bigger the impact for the entire population,” said Elena Marks, president and CEO of Houston’s Episcopal Health Foundation.

The thought is that as parents find coverage options for their children they are more likely to learn about coverage options for themselves, which will lead to higher overall coverage rates.

In 2013, as the health-care law took hold, 977,000 Texas children were without coverage, the new research shows. That equates to 13.2 percent of the state’s under-18 population. By 2014, that uninsured rate had fallen to 11.8 percent.

[…]

Typically children are insured in greater numbers than adults since states, including Texas, offer safety net coverage through the Children’s Health Insurance Program, also known as CHIP, which provides low-cost insurance for children whose parents earn too much to qualify for Medicaid or do not have other coverage.

“Despite the politicking around health policy lately, I think we can all agree that coverage for kids is essential for their healthy development and to get a healthy start in life,” Katherine Hempstead, who directs health insurance issues for the Robert Wood Johnson Foundation, said in an interview Monday.

Despite the gains, 880,000 Texas children – the highest number nationally – still have no coverage.

That includes 533,000 Hispanic children, Guerra-Cardus said. She added that 94 percent of those are U.S. citizens.

The Robert Wood Johnson study shows nearly half of the nation’s 5 million uninsured children live in Texas and five other states: California, Florida, Georgia, Arizona and New York.

The research provides a baseline to track future children’s coverage trends, Hempstead said, adding that the report will be duplicated next year.

I couldn’t find a copy of the study when I looked, but there was a lot of news coverage of it out there when I googled around. It goes without saying that having healthy children is one of the best investments that a society can make, but then our state government threw 250,000 kids off of CHIP in 2003 in the name of “fiscal conservatism”, so I guess it doesn’t go without saying. There’s a reason why the reforms of the Affordable Care Act have had such a profound impact in Texas – there was so, so much that needed to be done. And as long as the current crew is in charge, there’s still so much more left to do.

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.

The easily predicted results of de-funding Planned Parenthood have resulted as predicted

Who’d a thunk it?

Right there with them

Right there with them

A new study released Wednesday reports that after anti-abortion Texas lawmakers blocked Planned Parenthood from participating in the Texas Women’s Health Program (TWHP) in 2013, fewer low-income women received the most effective kinds of contraception. The study, published in the New England Journal of Medicine, is also the first to analyze the subsequent significant rise in some Medicaid-covered deliveries after the provider’s ouster.

Comparing quarterly medical and pharmaceutical claims from 2011 to 2014, researchers with the Texas Policy Evaluation Project (TxPEP) found that 35 percent fewer patients received highly effective intrauterine devices (IUDs) and implants — known as long-acting, reversible contraception (LARC) — over the four-year period. Claims for the injectable Depo shot, which requires follow up every three months, decreased by 31 percent. Researchers found that the rate of Medicaid-covered deliveries among women in the Depo group then increased by 27 percent.

The reduction in claims, said lead author Amanda Stevenson, highlights the fact that despite recent state efforts to recruit more providers, and claims of successwithout Planned Parenthood, patients have lost services.

“The reproductive health safety net cannot just absorb all of the demand for highly effective contraception when you remove Planned Parenthood from the network,” Stevenson told the Observer. TxPEP’s findings, she said, “directly contradict” claims “that Planned Parenthood can be removed from federally-funded healthcare programs and other providers will just step up to pick up the slack.”

[…]

For this study, TxPEP focused on patient claims that reflect the eligibility criteria for enrollees in the TWHP: legal Texas residents between the ages of 18 and 44 and who live at or below 185 percent of the federal poverty line (an annual income of approximately $44,000 for a family of four). They also compared services in counties with and without a Planned Parenthood health center.

The study found that contraceptive claims decreased most dramatically in counties with Planned Parenthood clinics, while counties without a Planned Parenthood clinic were largely unaffected.

The percentage of women who returned for their birth control shot every three months illustrates the long-term impact of losing Planned Parenthood as a program provider. Before the exclusion, 56.9 percent of patients living in counties with a Planned Parenthood clinic received their follow-up injections. After the exclusion, just 37.7 percent of patients got their subsequent shots.

In addition to cutting family planning funding by more than $70 million, the 2011 Legislature also funneled what remained of the state’s available family planning dollars away from specialty reproductive health providers, including Planned Parenthood. That, compounded by the cuts, led to the closure of 82 family planning clinics statewide; about one third of those were Planned Parenthood health centers.

I don’t even know what else to say, so I’m just going to let this speak for itself. Just repeat after me: Nothing will change until our electoral results change.

State of the county 2016

This year’s theme is cooperation and meeting challenges.

Judge Ed Emmett

Judge Ed Emmett

In his ongoing effort to revive the Astrodome, Harris County Judge Ed Emmett on Tuesday proposed using the aging landmark for an outdoor light show when Houston hosts the Super Bowl next February.

Emmett discussed the future of the Ddome and touched on the challenges the county faces in health care during his ninth “State of the County” address before 1,100 business leaders at NRG Center.

He floated the idea of a projected light show on the exterior of the Astrodome to coincide with the Super Bowl. Emmett also laid out a long-term plan to convert the nine-acre interior into an indoor park with underground parking or storage and retail facilities above.

[…]

He also touched on another of his key themes, the county’s duty to meet fundamental health care needs of residents while it grapples with the cost of providing services without help from expanded Medicaid funds that state leaders refuse to pursue.

“So long as the county property taxpayer has to bear the cost of health care, we will have trouble meeting the challenge. Refusing to accept federal dollars available for indigent health care makes no more sense than turning down federal highway funds,” Emmett said. “Those who now reject federal dollars for health care are not only punishing individuals and families who need access to better care, they are increasing property taxes for all taxpayers.”

Emmett ended by pleading with business leaders to “push back against those who want to play politics with county government.” People vilify government, he said, but then they expect high-quality emergency services, flood control and a smooth commute.

The full speech is here. In his discussion of how senseless it is to reject federal dollars for indigent health care, he recalled his time in the Legislature when some of his colleagues wanted to turn down federal highway dollars because they didn’t want to mandate seat belt usage. It took a visit from Dr. Red Duke to convince them to come to their senses. “We need another Red Duke to bring reason to the issue of indigent health care,” he said. I love the parallel Emmett draws, but I respectfully disagree with his prescription. What we really need is fewer Republicans in Austin, beginning with the Governor and Lt. Governor, who would refuse to listen to what Dr. Red Duke would be telling them. It’s not like we don’t have plenty of other respected authorities – doctors, business folk, economists – who have been saying the same thing. The problem is the hammerheaded and entirely partisan unwillingness to listen.

Anyway. As always, the full speech is worth your time; background on the Dome stuff is here. Judge Emmett was introduced by Mayor Turner, which again bodes well for city/county cooperation going forward. Your Houston News and Swamplot have more.

Grand jury indicts Planned Parenthood video fraudsters

Sweet.

Right there with them

Right there with them

A Harris County grand jury investigating allegations that a Planned Parenthood clinic in Houston illegally sold the tissue of aborted fetuses has cleared the organization of wrongdoing and instead indicted two anti-abortion activists behind the undercover videos that sparked the probe.

Secret videographers David Daleiden and Sandra Merritt were both indicted on charges of tampering with a governmental record, a second-degree felony that carries a punishment of up to 20 years in prison. Daleiden received an additional misdemeanor indictment under the law prohibiting the purchase and sale of human organs.

Harris County District Attorney Devon Anderson announced the surprising indictments Monday after a two-month investigation.

“We were called upon to investigate allegations of criminal conduct by Planned Parenthood Gulf Coast,” said Anderson, a Republican. “As I stated at the outset of this investigation, we must go where the evidence leads us. All the evidence uncovered in the course of this investigation was presented to the grand jury. I respect their decision on this difficult case.”

The probe began after the Center for Medical Progress, an anti-abortion group run by Daleiden, released footage of the Houston clinic as part of a series of videos showing Planned Parenthood officials casually discussing the methods and costs of preserving fetal tissue for scientific research. That prompted allegations that the organization was profiting off of tissue — an allegation that was never proven — and sparked calls for an investigation from Gov. Greg Abbott, Attorney General Ken Paxton and others.

[…]

A spokeswoman for the Houston branch of Planned Parenthood said the news made the organization feel “vindicated.”

“It’s great news because it demonstrates what we have said from the very beginning, which is that Planned Parenthood is following every rule and regulation, and that these people came into our buildings under the guise of health when their true intentions were to spread lies,” said the spokeswoman, Rochelle Tafolla. “We’re glad that these extremists have been indicted for breaking the law.”

See here for the background. The irony in this is so thick one might choke on it. Greg Abbott made a feeble statement noting that the state was still investigating Planned Parenthood to find some pretext for justifying its decision to completely boot it off Medicaid, but that’s all been a load of hot air. The national office of Planned Parenthood has filed a federal lawsuit against these CMP idiots and their fraudulent shenanigans, and a separate federal lawsuit against the state of Texas for acting on their lies. I’m thinking both of those cases just got a solid boost. A statement from Sen. Sylvia Garcia on the indictments is here – it sure would be nice to hear from the idiot Texas Monthly columnist who fell for the CMP video hook, line, and sinker as well – and TPM, the Trib, Daily Kos, Think Progress, Trail Blazers, the Current, Juanita, Newsdesk, and the Press have 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.

Selecting a successor for El Franco Lee: What I’m looking for

El Franco Lee

Building on what we discussed last time, what am I, as one of maybe 100 people who has the privilege of selecting a Democratic nominee to take El Franco Lee’s place on the November ballot – and most likely, on Commissioners Court for the foreseeable future – looking for? What qualities do I want that person to have?

I’ve already noted my preference for someone who will take an active role in assisting good candidates and getting out the vote locally. Beyond that, I have three main criteria.

1. I will only support candidates who supported HERO this past November. This is non-negotiable. I have no intention of rewarding someone who was on the same team as Jared Woodfill and Steve Hotze.

2. I want a progressive. Look, I get that we’re picking one person to be on a governing body that has no other Democrats. Commissioners Court works on back-scratching consensus, and there’s not going to be a progressive consensus, at least not until there are two other Democrats on board. But because the Court operates on consensus, having a progressive voice in there means that some part of that consensus will contain that voice. The effect may be small and incremental, but it will be there if that voice is present. Thus, my preferred candidate for Commissioner has to have it in the first place.

3. I want leadership on these issues. Some things for which there is already a consensus could use a push from a progressive perspective. I’m specifically thinking of criminal justice reform, for which there’s also a fiscal motivation to get it right, but it’s not the only possibility. The single best thing that could happen to Harris County and its budget right now would be Medicaid expansion. We know Judge Emmett supports this, and we can expect the next Commissioner in Precinct 1 to support it as well. It would be great if the next Commissioner in Precinct 1 could try to get one more colleague on board, then push to get a resolution passed that calls on the Legislature to expand Medicaid already.

Beyond that, the main point to understand here is that being a County Commissioner in Precinct 1 is a pretty damn sweet gig. The next Commissioner will have a large budget, considerable discretion, and basically no worries about the next election. It also comes with a fairly sizable platform, if one chooses to use it. On that matter of criminal justice reform, what is to stop a Commissioner from, say, calling out the judges who contribute to the jail overcrowding problem by refusing to use Pretrial Services, or the judges who help line the pockets of a few preferred assembly-line attorneys who hoover up appointments as indigent defense counsel – in return for not rocking the boat and contributing to those judges’ campaign coffers – instead of using the public defender’s office? Or from calling out Greg Abbott and Dan Patrick and the Legislature for things like refusing to expand Medicaid or reform how property tax appraisals are done, both of which put a significant burden on local taxpayers? One can do that as a State Rep or State Senator, but I’d argue that the microphone a Harris County Commissioner has would be louder. But you have to want to use it. You have to want to pick the fights that need to be picked, and not worry about making a few enemies. Those enemies were never your friend anyway. You have the power. Do some good with it.

Planned Parenthood sues over those anti-abortion sting videos

Game on, indeed.

Right there with them

Right there with them

Planned Parenthood is suing the people behind the Center for Medical Progress (CMP), the anti-abortion group that released a series of misleading videos this summer claiming that the women’s health organization sells fetal tissue for profit.

“The people behind this fraud lied and broke the law in order to spread malicious lies about Planned Parenthood,” Dawn Laguens, executive vice president of Planned Parenthood Federation of America, said in a statement. “This lawsuit exposes the elaborate, illegal conspiracy designed to block women’s access to safe and legal abortion, and we filed the case to hold them accountable.”

The lawsuit, announced to reporters Thursday afternoon, might seem a little late, given that the first tapes were released about six months ago and the provider has taken a lot of heat since then. But it took time to do a full investigation into the “complex conspiracy” behind the videos, Laguens told reporters. “We wanted to make sure we had every bit of it right.”

Planned Parenthood isn’t pulling any punches with this lawsuit. The organization is calling CMP a “criminal enterprise” and is suing under federal racketeering law (which has been used once before against anti-abortion protesters but ultimately failed at the Supreme Court). Planned Parenthood is also suing for other damages and bringing a civil action for CMP’s alleged violations of state criminal codes about secret recordings.

The organization says that CMP and its officers engaged in an elaborate three-year criminal conspiracy to mislead Planned Parenthood and public officials, breaking both federal and state laws (in Maryland, Florida, and California, where the suit was filed) in the process.

[…]

It’s worth noting that no state or federal investigations thus far, even those led by anti-abortion officials like Ohio Attorney General Mike DeWine, have found evidence that Daleiden’s claims about “profit” are true.

Yes, that is worth noting. It’s also worth noting that the state of Texas used the pretext that these videos were truthful to kick Planned Parenthood out of Medicaid – to be more accurate, it blustered about it without ever producing any evidence of malfeasance on Planned Parenthood’s part. There’s another lawsuit related to that, and a separate federal lawsuit filed against the CMP last year, which was narrower in scope. Somebody’s been lying all along, and one way or another the courts will sort that out. You can see a copy of the lawsuit here, and ThinkProgress, RH Reality Check, and the Current have more.

UPDATE: More from the Press.

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.

State cuts off funds to Planned Parenthood for HIV testing

Seriously?

Right there with them

Right there with them

Amid an ongoing battle over Planned Parenthood’s participation in the state Medicaid program, Texas health officials are cutting off funding to a Planned Parenthood affiliate for an HIV prevention program.

In a notice received by Planned Parenthood Gulf Coast late Monday, an official with the Department of State Health Services informed the Houston-based provider that it would not renew its contract for HIV prevention services.

The long-standing grant, which funds HIV testing and prevention services, was set to expire on Dec. 31, according to the notice which was obtained by the Texas Tribune.

“There will be no further renewals of this contract,” a DSHS official wrote in the notice to Planned Parenthood.

The contract is federally funded through the Centers for Disease Control and Prevention but managed by the state. A spokeswoman for the CDC said she was unaware of the state’s notice and did not immediately provide comment.

By ending Planned Parenthood’s contract, the state is cutting off almost $600,000 in annual funding, which the health care provider used for HIV testing and counseling, condom distribution and referral consultations.

Incredible. At least with the cutoff of Women’s Health Program funds, the state made some arrangements for alternate options. It was half-assed and still caused a huge unnecessary upheaval for thousands of women, but there was at least a token gesture towards maintaining the service. That doesn’t appear to be the case here, or at least the flunkies at the HHSC had no comment at the time the story was published. Unless PPGC decides to continue this on its own dime, this service just goes away. Because why would Greg Abbott care about people who might have HIV? And remember, the root of all this is a pack of lies that the state is hoping you’ll all forget.

The Chron story on this is here. I don’t know if this action can be wrapped into the ongoing litigation over the state cutting off Medicaid funds for Planned Parenthood, but regardless perhaps some political pressure can be applied.

Texas Democrats in Congress sent a letter to the Centers for Medicaid and Medicare Services this month asking that they “explore all options available at the federal level” to stop the State of Texas from blocking Planned Parenthood from receiving Medicaid funding for health services.

[…]

“Members of the delegation understand that there is a precedent for intervention, and several options available for the federal government to bring Texas into compliance with federal law,” said Congressman Marc Veasey, D-Fort Worth. “In the past, CMS has decreased or removed federal funding from Texas, which we do not want to happen again as doing so would decrease access to care instead of expanding it.”

Click over to see the letter, which was signed by ten members of the Texas Congressional delegation. The Observer and the Press have more.

The state was full of it all along on Planned Parenthood

Shocked, shocked I am.

Right there with them

Right there with them

Almost two months after Texas Republican leaders announced they would kick Planned Parenthood out of Medicaid, it hasn’t happened.

The organization is still receiving federal and state funds to provide health care for about 13,500 low-income women a year, and the state officials who called for a cutoff, including Gov. Greg Abbott, have fallen silent on why the funding continues.

But the state’s hesitance to pull the trigger reflects a recent pattern in its dealings with an organization that is a lightning rod for any political debate that even remotely touches on abortion. Repeatedly, raising claims of fraud or wrongdoing, conservative Texas politicians have vowed to fine or punish the organization.

And repeatedly, when the smoke cleared there was no fire.

[…]

On Oct. 21, Planned Parenthood affiliates in Texas received a “notice of termination” from the state Health and Human Services Commission announcing it was axing the organization’s Medicaid contract, citing the videos and unspecified allegations of Medicaid fraud.

The agency’s inspector general, the letter said, had “reliable information indicating a pattern of illegal billing practices” that would disqualify Planned Parenthood from participating in Medicaid.

The commission’s chief fraud investigator, Stuart Bowen, gave Planned Parenthood 30 days to respond and request an “informal resolution meeting” with health commission attorneys. If it didn’t, the state said it would issue a “final notice of termination” formally booting Planned Parenthood from Medicaid — an order that would go into effect 15 days after the organization received it.

Worried they would be cut from the Medicaid program as early as Dec. 8, Planned Parenthood affiliates in November filed a federal lawsuit seeking to block Texas’ efforts. In it, Planned Parenthood argued that terminating its Medicaid contract would prevent low-income women, including 10 unnamed patients that signed on to the case, from obtaining services from a “qualified, willing provider” as required by law.

But when U.S. District Judge Sam Sparks considered the organization’s request for a restraining order on Dec. 8, a curious fact emerged. Despite its claims that it had proof of misconduct, state health officials never delivered the final legal notice to defund the organization.

Lacking a final notice of termination, Sparks canceled the hearing.

“Planned Parenthood has not received official notice from the state for termination of our health centers’ continued participation in Medicaid so our court case is delayed,” said Sarah Wheat, a vice president for Planned Parenthood of Greater Texas.

The state’s efforts to nix the Medicaid dollars have been “political from the start,” Wheat said.

[…]

In a previous interview with the Tribune, Bowen emphasized that the “notice of termination” sent to Planned Parenthood in October was the start of a civil enforcement process — not a final determination of the organization’s status as a Medicaid provider.

“We did not terminate them,” he said. “We began a process … inclusive of the development of evidence.”

Bowen’s explanation appeared at odds with the wording of the notice sent to Planned Parenthood and public statements made by Abbott and other top state officials indicating that Planned Parenthood would indeed be ousted from the program.

It remains unclear why Planned Parenthood has yet to receive the final notice, and the Office of Inspector General has declined to provide any details about its investigation into the organization.

It’s not unclear at all. Sarah Wheat explained it quite succinctly and sufficiently. But Abbott and his ilk got what they wanted, even if they won’t get what they promised. The people they were really speaking to, including a few shamefully gullible “journalists”, heard what they wanted to hear. Truthfulness wasn’t a factor, all they wanted was the rah rah. It’s up to the rest of us to remember that.

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.

Feds warn Texas about Planned Parenthood

We’ll see what happens.

Right there with them

Right there with them

The Obama administration has warned state officials that pushing Planned Parenthood out of the state’s Medicaid program could put Texas at odds with federal law.

Officials with the federal Centers for Medicare & Medicaid Services contacted the state Medicaid director on Tuesday to give notice that removing Planned Parenthood from the program “may be in conflict with federal law” because poor women who obtain family planning services through Medicaid would be limited from receiving health care from the qualified provider of their choice.

“Longstanding Medicaid law prohibits states from restricting individuals with Medicaid coverage from receiving their care from any qualified provider,” a U.S. Department of Health and Human Services representative said in a statement. “Every year, millions of women benefit from critical preventive services, such as cancer screenings, that Planned Parenthood provides. State efforts to restrict women from using qualified providers puts these important health care services at risk.”

The feds’ intervention comes a week after Texas health officials announced they were working to boot Planned Parenthood from Medicaid, the joint state-federal insurer of the very poor and disabled. This would cut off taxpayer dollars to Planned Parenthood clinics that provide well-woman care, like cancer screenings, birth control and pregnancy tests. Planned Parenthood clinics that accept Medicaid dollars are already barred from performing abortions.

A spokesman for the Texas Office of Inspector General, which is handling the Planned Parenthood investigation, said state officials on Tuesday “had a very productive call” with the feds about the Medicaid announcement.

“Some concerns were voiced, and the state was able to responsively address them,” said OIG spokesman Chris Cutrone.

See here and here for some background. Hard to know what to make of this. Stuart Bowen recently dropped hints about a whistleblower being the basis of the state’s actions, which could be something or could be more smoke. At the same time this was happening, US Health and Human Services Secretary Sylvia Burwell was taking a conciliatory tone about the state expanding Medicaid, which may have played into that “very productive call” or may be completely separate. I personally think the feds should continue to play on this, but I suppose someone has to be the good cop. Meanwhile, another state that has tried to follow the same path that Texas is taking lost in court, as a federal judge blocked efforts in Alabama to kick Planned Parenthood affiliates out of the state Medicaid program. Until the state puts its cards on the table, who can say what if any actual evidence they’ve got?

What you can say is this.

“Everyone is entitled to due process under the law. As a former judge, I recognize this is the first step in a lengthy process and will respect that process as it moves forward.”

—Gov. Greg Abbott

The quote is Abbott’s response to the criminal indictment accusing Attorney General Ken Paxton of having deceived investors, some of whom lost tens of thousands of dollars they risked because they trusted him. Abbott of all people should know about due process, having served as attorney general for 13 years in addition to having been a Texas Supreme Court justice.

But Abbott had no qualms about abandoning his ethical-lawyer respect for due process when it came to the current case the state has trumped up against Planned Parenthood. The state moved last week to end Planned Parenthood’s Medicaid funding based on the propagandic video snippets that have been making the rounds nationwide from anti-Planned Parenthood zealots purporting to show illegal deal-making for aborted fetal tissue.

Abbott declared Planned Parenthood guilty without benefit of an investigation, much less a trial. “The gruesome harvesting of baby body parts by Planned Parenthood will not be allowed in Texas and the barbaric practice must be brought to an end,” he said in a statement from his office issued under the headline “Texas eliminates taxpayer funding to Planned Parenthood providers.” See how the sentencing in this case appears to precede all else?

[…]

This foray against Planned Parenthood is a staged event to disrupt an organization whose Medicaid reimbursements primarily are for basic health services to low-income patients, including cancer screenings and testing for socially transmitted diseases. That is a wrong thing to interrupt just to make a political show of opposing abortion.

An objective review of the state’s actions and Abbott’s utterances against Planned Parenthood by a high-ranking law school would be interesting to see. We fear that Texas wouldn’t come off any better than the government of Iran. We wish that weren’t hyperbole.

Well, at some point we’ll get an objective review by a judge, and that will tell us a lot. The Chron and BOR have more.

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.

State goes fishing against Planned Parenthood

Here we go.

Right there with them

Right there with them

Days after Texas health officials announced they want to kick Planned Parenthood out of the state Medicaid program, state investigators on Thursday visited Planned Parenthood facilities in San Antonio, Houston and Dallas.

Investigators with the Texas Health and Human Services Commission’s investigative arm delivered requests to Planned Parenthood facilities in all three cities asking for Medicaid records, billing information and personnel information, according to Planned Parenthood officials. A request delivered to a Dallas facility included request for files from clinics in Austin and Waco.

State health officials would not confirm details about investigators’ visits. A spokesman for the health commission’s Office of Inspector General said he could not “provide comment on any oversight or investigative activities.”

[…]

Planned Parenthood officials said in a statement that Thursday’s visits by state investigators were “political grandstanding” by the state’s Republican leadership, particularly Gov. Greg Abbott, who had previously called for cutting off all taxpayer dollars the organization received.

“Representatives from the Texas Office of Inspector General showed up at Planned Parenthood health centers in Houston, Dallas and San Antonio looking for an excuse to take health care away from thousands of women and men who rely on Planned Parenthood for preventive care,” said Yvonne Gutierrez, executive director of the organization’s state political arm Planned Parenthood Texas Votes. “But what they will see is professional, compassionate and quality health care. Despite their efforts to distort the truth, health care — no matter what — is what happens at Planned Parenthood.”

In a statement earlier this week praising the move to cut off the funding for Planned Parenthood, Abbott said, “Texas has stepped forward and shown its unyielding commitment to both protecting life and providing women’s health services.”

Among the documents investigators are requesting are Medicaid records dating back to 2010. At Planned Parenthood’s facility in Spring, Texas, which does not perform abortions, state investigators are requesting records related to specific services provided to Medicaid patients, employee information and appointment books, according to a letter obtained by the Texas Tribune.

See here for the background and here for a copy of the letters. I’m going to let Dave Mann, who goes through the details of the latest attack on Planned Parenthood point by point, sum this up:

4. Based on what we know, the state’s case seems a little thin.

This one comes with a major caveat: We don’t know exactly what evidence the state possesses. The letters reference “reliable information indicating a pattern of illegal billing practices by Planned Parenthood affiliates across the State.” And that may well be. If state officials have uncovered evidence of widespread Medicaid fraud at Planned Parenthood clinics, then Texas may well succeed in cutting the organizations out of the program—and deservedly so.

But the specifics offered by the state so far don’t exactly blow you away. In their letters to Planned Parenthood, Texas officials contend that the organization is “no longer capable of performing medical services in a professionally competent, safe, legal, and ethical manner.”

The allegations center on Planned Parenthood Gulf Coast (PPGC), based in Houston, just one of the major Planned Parenthood affiliates in the state. (There are no specific allegations in the letters against other groups, such as Planned Parenthood of Greater Texas, which serves D-FW, Austin and Waco, or Planned Parenthood South Texas. They’re apparently guilty by association.)

The state contends that PPGC has engaged in Medicaid fraud. These allegations largely stem from a 2009 whistleblower suit by a former clinic worker who accused PPGC of fraudulent billing. PPGC settled the case in 2013, though admitted no wrongdoing. The Texas Attorney General’s office—headed at the time by one Greg Abbott—announced that the case was closed.

So the state’s argument—at least as laid out in the letters of termination—is based on six-year-old allegations against one Planned Parenthood affiliate—a case the Texas AG’s office closed more than two years ago. That seems kind of thin.

Is that enough to convince federal health officials or a federal court that a major provider of health services to thousands of Texas women should be booted from Medicaid? State officials seemingly will have a tough time winning that argument— unless they’ve obtained some new, damning evidence of widespread fraud by Planned Parenthood. In other words, the fate of Planned Parenthood in Medicaid will be decided on the merits, not the politics.

So the question is, are they looking for corroboration of evidence they already have or reliably believe they will find, or is this an example of “we know there are weapons of mass destruction in there somewhere and we’ll find them if we just look hard enough”? I have a hard time believing it’s not the latter, but we’ll find out soon enough when the state is forced to put up or shut up. The Statesman, the Observer, Juanita, the Current, Wonkblog, and Trail Blazers have more.

Texas vs Planned Parenthood, part one million

This was going to happen sooner or later.

Right there with them

Right there with them

Texas health officials say they are kicking Planned Parenthood out of the state Medicaid program entirely over what they called “acts of misconduct” revealed in undercover videos filmed earlier this year.

Republican state leaders, who vehemently oppose abortion, have worked for years to curb taxpayer funding of Planned Parenthood — despite the fact that its clinics may not receive such funding if they perform the procedure.

Monday’s decision means even Planned Parenthood clinics that only provide well-woman care, like cancer screenings, pregnancy tests and birth control, will also be cut out of receiving dollars from Medicaid, the joint state-federal insurer of the poor.

The vast majority of Medicaid funding for Planned Parenthood clinics in Texas comes from the federal government. Texas spent just $310,000 from its own coffers on the women’s health organization in 2015, but it also dispersed $2.8 million in federal dollars to those clinics. A spokesman for the federal Centers for Medicare and Medicaid Services did not immediately respond to a request for comment.

[…]

On Monday, the Texas Health and Human Services Commission’s inspector general, Stuart Bowen, wrote to Planned Parenthood Gulf Coast that the women’s health provider had violated state Medicaid rules and put Texans at risk of infection. Citing the sting videos, Bowen said Planned Parenthood officials disregarded federal law by agreeing to change the timing or method of abortions in order to procure fetal tissue for medical research.

As a result, the state will no longer allow any Planned Parenthood clinics in Texas to receive Medicaid funding. Last year, Planned Parenthood clinics in Texas received $3.05 million in federal funds through Medicaid for family planning services like birth control and pregnancy tests.

Planned Parenthood Gulf Coast spokeswoman Rochelle Tafolla described the state’s efforts to block Medicaid patients from receiving care from any of the organization’s clinics as “politically motivated.” Planned Parenthood Gulf Coast does not currently participate in fetal tissue donation, the organization says, but did in 2010, in conjunction with a University of Texas Medical Branch study on miscarriage.

“Tens of thousands of women are already going without care after years of policies aimed at blocking access to care at Planned Parenthood,” Tafolla said. “Now Texas politicians are using a thoroughly discredited, bogus attack against Planned Parenthood as a shameful excuse to attack Texas women’s health yet again.”

This has been the end goal for Texas Republicans for several years now, so like I said, no surprise, and one excuse is as good as another. I would point out that multiple states have investigated these videos and found nothing – Texas, as well as Harris County, is doing its own investigation, and one presumes they have nothing worthwhile to show for it as yet. As such, this may be their consolation prize, since coming away empty-handed was not an option. What comes next is almost certainly a lawsuit, since Texas doesn’t exactly have the authority to do this. If they could have, they would have done this much earlier than this. In the meantime, still more women will lose their access to healthcare. That’s the reality we unfortunately live in, and much as I hate to say it, nothing will change until our state leadership does. BOR, Newsdesk, and the Observer have more.

More jail troubles

It’s ugly, both in content and in timing for Adrian Garcia.

Adrian Garcia

Adrian Garcia

Over the past nine months, the Houston Chronicle has reviewed more than 1,000 disciplinary reports provided by the Harris County Sheriff’s Office. Nearly half of those internal affairs investigations from 2010 through May 2015 resulted in discipline against jail staff who often brutalize inmates and attempt to cover up wrongdoing but rarely lose their jobs. Court records show jailers seldom faced criminal charges even in cases where they used excessive force.

“It was like an animal shelter,” said Jamarcus Hill, who was jailed in 2013 as a 19-year-old on an auto theft charge. “You do anything – you get punished, you get pepper sprayed. You got to fight for your food, you even have to fight for your shoes.”

In June 2009, the Justice Department concluded after its own yearlong investigation that inmates’ constitutional protections had been violated by excessive violence and by substandard medical care that led to an “alarming” number of prisoner deaths. The Justice Department has taken no public action since then despite what records show are similar instances of unreported beatings, inmate deaths and medical neglect. Officials provided a letter indicating that the Civil Rights Division has an “ongoing law enforcement proceeding,” but provided no specifics.

Adrian Garcia took over management of the jail in January 2009 as Harris County sheriff and promised reforms. He resigned in May to run for mayor of Houston. In a recent interview, he said that hundreds of disciplinary cases reviewed by the Chronicle resulted from his “commitment to transparency and accountability.” He said he put systems in place that addressed Justice Department findings and notes that the average number of annual deaths dropped from about 16 per year from 2001-2006 to roughly 11 during his administration. Still, the jail has become more violent in recent years, with fights, assaults and attacks on staff escalating, the Chronicle’s investigation has found, based on the sheriff’s own statistics as well as custodial death reports, autopsies, lawsuits and interviews with current and former jail officials, former inmates and attorneys.

Among the findings:

Harris County jailers were disciplined more than 120 times for misconduct involving abuse of authority or misuse of force, including beating, kicking and choking inmates. At least 15 were handcuffed at the time. In 84 of those 120 cases, jailers or supervisors failed to file required reports, lied or falsified documents. Stephen LaBoy, 25, was beaten by six jailers in his cell after flashing a mirror at a guard station. Drissa Pickens, 28, was assaulted by an accused murderer after a jailer unlocked a cell door and allowed the attack.

At least 70 inmates have died in custody since 2009. Three, including Hicks, died after guards used force. Other elderly or ill inmates were unable to make bond and died while awaiting trial. Latoshia Clark, 36, died pre-trial, of AIDS, after six weeks in jail for drug possession. Ten who died committed suicide, including Alex Guzman, 28, who hanged himself while two jailers ate a Domino’s pizza and missed required cell checks. Guzman’s case was among 35 documented instances where jailers skipped required cell checks, or faked records to hide skipping them.

Most jailers disciplined for abuse of authority or unnecessary force received only short suspensions. Since 2010, 33 of those jailers were fired for use of excessive force, unprofessional conduct, neglect of duties and lying or falsifying reports. Criminal charges were pursued against guards in only six of those cases.

[…]

Civil rights attorneys and other critics of the Harris County criminal justice system say jail violence and chronic overcrowding are symptoms of the deeper problem of local judges’ strict bond practices Few accused offenders get released unless they can pay a non-refundable 10 percent commission charged by a Harris County-approved bondsman – a group that collectively makes millions from the county’s tough lockup policies.

Hundreds of others are serving sentences of less than a year for minor crimes.

Let’s be clear that some of these problems would not exist if the jail were less crowded. That would require Harris County judges to use pretrial services and be more reasonable in setting bail – no one should be in jail because they are too poor to post bond – it would require the District Attorney to prosecute fewer low-level drug offenses, and it would require the state of Texas to expand Medicaid so that the many inmates with mental illness could get proper treatment when they are not in the clink. Until these things change, they will be a problem for the past Sheriff, the current Sheriff, and the next Sheriff. Even granting all that, there were some serious shortcomings with the way the jail was being run, and with the discipline system for the jailers. Adrian Garcia inherited a jail that was in complete disarray, and I do believe he improved things, but there was a lot of work left to be done, and a number of issues that don’t appear to have made much progress. He owns that, and it’s on him to explain it to the voters. Grits has more.

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.

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.

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.

Outsourcing inmates again

We’ve been down this road before.

go_to_jail

For the first time in three years, the Harris County sheriff began transferring busloads of inmates this week to other correctional facilities to avoid overcrowding at the state’s largest jail.

The jail population is currently at 93 percent of its 9,434-bed capacity, Harris County Sheriff Ron Hickman said Monday. He said part of the problem may stem from two recent back-to-back storms with flooding that delayed magistrate courts and consequently stalled the release of some low-level offenders.

Hickman also indicated that judges who set monetary bail for inmates have influenced the rising numbers because 62 percent of the jail’s occupants are awaiting trial.

The fluctuating jail population, he said, is out of his control. “In large part, the jail population is controlled by the courts, who determine which offenders will be released pending adjudication and which will be detained until trial,” Hickman said.

[…]

Hickman said another round of storms and flooding could cause the jail population to climb again.

“A singular event, like another bad rain and floodwaters, would cause us to shut courts down which would back prisoners up on the capacity side of our storage, and we’d be in violation of jail standards again,” he said.

The sheriff said he had very few options for dealing with the high numbers.

See here for previous blogging on this topic. This may be a temporary situation exacerbated by all the damn rain we’ve been having, but we wouldn’t be in this position if the overall jail population hadn’t been trending up. If we want to avoid being vulnerable to the vicissitudes of the TDCJ and the weather gods, there are three things we can do.

1. Bail reform. There are too many people sitting in jail awaiting trial. Some of them belong there, but some of them don’t. Less onerous bail amounts, and more personal recognizance bonds, would solve this problem.

2. Expand Medicaid. OK, I know, there’s nothing Harris County can do about this, and our state leaders are a bunch of deranged lunatics on the subject. Be that as it may, as we well know the Harris County Jail is the country’s largest mental health hospital. Many of the people in the jail getting treatment for mental illness can only get that treatment when they are in jail. You know what would change that? If they had health insurance. How could they get that insurance? If they were eligible for Medicaid. We’ve been over this before, too. The state of Texas and it’s Republican-fueled refusal to expand Medicaid are a big cause of Harris County’s jail overcrowding. Every taxpayer in the county is paying for that.

3. Review and possibly expand the existing early release and ankle monitor programs that were put in place by then-Sheriff Garcia and the courts. Direct deputies to issue citations instead of making arrests for minor violations. None of these would likely be very big, but every little bit helps, and they are options that Sheriff Hickman himself has some control over. Surely that’s worth consideration. 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.

Texas plans to sue over EPA’s latest clean air plan

So what else is new?

ERCOT

Attorney General Ken Paxton said Tuesday that he plans to sue the Obama administration over the proposed “Clean Power Plan,” its plan to combat climate change by slashing carbon emissions from power plants.

“Texas has proven we can improve air quality without damaging our economy or Texans’ pocketbooks,” the Republican said in a statement, claiming the rules would threaten the power grid and increase electric prices. “I will fight this ill-conceived effort that threatens the livelihood and quality of life of all Texans.”

Using those arguments over the past year, the state’s Republican leadership has loudly panned the proposal, which would require the state to cut close to 200 billion pounds of carbon dioxide in the next two decades however it sees fit.

Environmental and health advocates say limiting the greenhouse gas would help fight climate change, bolster public health and conserve water in parched Texas, and they suggest that opponents are exaggerating the economic burdens.

The federal Environmental Protection Agency suggests that Texas could meet its goal through a combination of actions: making coal plants more efficient, switching to cleaner-burning natural gas, adding more renewable resources and bolstering energy efficiency. Under the proposal, Texas could also adopt a “cap and trade” program – a scheme in which companies bid on the right to pollute.

The federal proposal is scheduled to become final in June, and Texas would have one year to submit its plan. But some watching the debate expect the EPA to push back the deadline amid pressure from states and other critics.

If Texas ignores the rules, the EPA will construct its own plan for Texas, though the agency has not said what that might look like. Democrats and others call that approach risky and suggest it would beckon more stringent requirements.

Bills that would direct Texas regulators to adopt a plan are nearing their death in the Legislature.

Fossil fuel interests and 15 U.S. states – not including Texas – have sued the EPA over the proposed rules in a case heard last week in federal court. Judges appeared skeptical of a challenge to rules that haven’t been finalized.

See here, here, and here for the background. I have to say, if Paxton managed to deliver that line about Texas improving its air quality on its own with a straight face, it will be the most impressive thing he ever does in office. Texas has fought the EPA multiple times in recent years with little to show for it, with another fight currently before the Supreme Court. Doesn’t mean they’ll lose this time, but it does give one some hope. It would of course be cheaper and easier and better for everyone if they would give up this fight and adopt rules that the state is already most of the way towards meeting anyway, but like most things in life that comes down to winning elections, and we know how that has gone around here.

Meanwhile, if you don’t like the idea of the EPA wielding power over Texas, you won’t like this, either.

Texas appears poised to enact environmental legislation that could trigger an unintended consequence: more federal oversight.

Fast-moving bills that would curb opportunities for public protest so state environmental permits can be issued more quickly have drawn the attention of the federal Environmental Protection Agency, long the state’s political punching bag.

The agency says it has concerns about the legislation, and may need to review whether it jeopardizes permitting authority the EPA has granted Texas.

Senate Bill 709 would scale back contested case hearings, a process that allows the public to challenge industrial applications for permits at the Texas Commission on Environmental Quality (TCEQ) — such as those allowing wastewater discharges or air pollution.

Similar versions of the bill pushed by Sen. Troy Fraser, R-Horseshoe Bay, and Rep. Geanie Morrison, R-Victoria, have sailed through the House and Senate, rankling consumer and environmental groups.

[…]

The EPA says it shares concerns about the bill, which would overhaul the hearings process in a variety of ways. It would give the agency sole discretion to determine who is an “affected person” who could ask for a hearing; set an 180-day time limit for the proceedings (with potential exceptions); narrow the issues the public could argue; and arguably shift the burden of proof from the company to the public.

“EPA is concerned that as currently drafted, [the legislation] could be read to impact the applicability of federal requirements to federal permitting programs being implemented by the TCEQ,” David Gray, director of external affairs for the EPA’s Dallas-based regional office, recently wrote to Rep. Eddie Rodriguez, D-Austin, who had asked for input.

Gray called the shift in the “burden of proof” as particularly problematic, adding that the EPA should review the legislation to ensure that it doesn’t “interfere with federal requirements or alter the basis for one or more program requirements.”

See here for the background. It’s like we can’t help ourselves sometimes, isn’t it?

And finally, on a related note:

Kansas and Texas will file amicus briefs supporting Florida in its lawsuit against the federal government over Medicaid expansion, Gov. Rick Scott announced Monday.

Scott filed suit last week, alleging that the federal government is “coercing” the state into accepting Medicaid expansion by witholding the extension of a different Medicaid program. The Low Income Pool brings $1.3 billion in federal funds to the state to pay hospitals for care for the poor and uninsured and is set to expire June 30.

“I am glad Kansas and Texas are joining our fight against the Obama Administration for attempting to coerce Florida into Obamacare expansion by ending an existing federal healthcare program and telling us to expand Medicaid instead. The US Supreme Court has already called this sort of coercion tactic illegal,” Scott said in a released statement.

In granting a one-year extension last year, federal officials stated they would not extend it again without significant changes. A recent letter from federal officials to the state clearly suggested the fate of LIP was tied to Medicaid expansion but officials with the Center for Medicare and Medicaid Services have also said Florida is free to expand Medicaid or not as it wishes.

See here for the background. Daily Kos has characterized the Florida lawsuit as being about refusing federal Obamacare dollars while demanding federal non-Obamacare dollars, which strikes me as apt. Easy to see why it was irresistible to Texas to join in. Ed Kilgore has more.

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.

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.

No, seriously, expand Medicaid or else

Bring. It. On.

It's constitutional - deal with it

It’s constitutional – deal with it

The federal government is officially holding state leaders’ feet to the fire, hoping to get Texas to expand its Medicaid program to provide health insurance to more low-income Texans.

Federal officials called the state’s health agency this week to say that Texas’ reluctance to expand Medicaid — a key tenet of President Obama’s signature health law — will play into whether his administration extends a waiver that helps the state’s hospitals cover uninsured patients.

The development follows news from Florida, where a similar tug-of-war is playing out between the federal government and a Republican-controlled statehouse that opposes Obamacare but hopes to renew billions of dollars in hospital funding. This week, federal officials sent a letter to Florida lawmakers that said Medicaid expansion “would reduce uncompensated care in the state,” making it “an important consideration in our approach regarding extending” the state’s hospital waiver.

Linda Edwards Gockel, a spokeswoman with the Texas Health and Human Services Commission, confirmed Friday that federal health officials called the Texas agency Thursday afternoon to relay a similar message.

Officials from the federal Centers for Medicare and Medicaid Services “said they recognize each state is different, but they intend to use the same three principles outlined in their letter to Florida as they evaluate uncompensated care funding pools in all states,” Edwards Gockel said in an email. “We don’t have more details than that at this point.”

Tom Banning, chief executive of the Texas Academy of Family Physicians and an advocate for Medicaid expansion, said in an email that the call “should be a wake up.” Annually, Texas hospitals receive billions of dollars combined by way of the federal “transformation waiver.” Losing that money “will have a crippling effect throughout Texas,” Banning added.

The Texas hospitals waiver runs through September 2016, but the 2015 legislative session is the last chance for state lawmakers to negotiate a renewal before then. The current session is slated to wrap up on June 1, barring a governor-called special session.

Estimates for the value of that waiver vary. The Texas Hospital Association, which supports some form of Medicaid coverage expansion under the Affordable Care Act, estimates the waiver’s five-year value at $29 billion.

See here for the background. As noted in the story, the feds are similarly putting the screws to Florida. There’s basically zero chance that anything will get passed this session – Sen. Rodney Ellis tried to get a Medicaid expansion amendment through during the budget debate and failed, while Greg Abbott is holding firm and whining about how mean the feds are being to him – so it’s just a matter of whether the feds follow through in 2016 and if enough pressure can be brought to change things in 2017. Anyone want to place a bet on that? The only semi-retired Burka has more.