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Texas Department of Insurance

Your auto insurance rates are about to go up

Another gift to us from Harvey.

Auto insurance companies have restricted options for Houston-area drivers looking to purchase new policies and replace cars flooded by Hurricane Harvey, and comprehensive rates are expected to rise after the loss of an estimated half-million vehicles.

Some carriers have imposed temporary limits on selling insurance to customers in Harvey’s path, hesitant to assume new risk even as floodwaters recede. Experts expect longer-term changes as carriers reassess their rates after a spate of intense storms across the state.

“Look at our most recent history,” said Mark Hanna, spokesman for the Insurance Council of Texas. “This the third flood you’ve had affecting tens of thousands of vehicles, and that’s had a huge impact on comprehensive coverage.”


The Texas Department of Insurance is working to determine the number of carriers that have taken similar approaches after the storm. Spokesman Jerry Hagins said most companies have in the past resumed normal operations within three days after a major storm, but Harvey’s magnitude appears to have changed their approach.

“It’s still a very fluid situation,” he said. “There are some things that aren’t typical about the industry response.”

Hard to argue with the proposition that the risks of car ownership are higher now than they were before. I wonder how much of this will filter down to the neighborhood level, or even the block level – that is, if your house hasn’t flooded, will your car insurance rates rise? Wouldn’t surprise me. This is the world we live in now.

SCOTUS could really screw Texas on Obamacare

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

It's constitutional - deal with it

It’s constitutional – deal with it

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


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

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

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


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

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

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

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

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

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

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

Just don’t call it “Medicaid expansion”

It’s the public policy that dare not have its name spoken, at least by Republican legislators.

It's constitutional - deal with it

It’s constitutional – deal with it

State lawmakers renewed efforts Thursday to find a “Texas solution” to expand health-insurance coverage for low-income residents without accepting the Medicaid expansion in President Barack Obama’s signature health care law.

Social-services advocates and local officials are among those pushing for a compromise measure that gives the state more flexibility than in the law to spend the money available from the federal government to cover more residents.

On Thursday, the state Senate Health and Human Services Committee met to “start a conversation that will give us an accurate picture of who the uninsured are, what services are available to them and what we can do to help them,” said chairman Charles Schwertner, R-Georgetown.

Katrina Daniel of the Texas Department of Insurance said about 6.5 million state residents do not have health insurance, although some of those can afford insurance and have chosen not to purchase it. An estimated 1.3 million uninsured Texans earn less than the federal poverty level, leaving them in the so-called “coverage gap.” The president’s law assumed all states would expand Medicaid, so it left those eligible for Medicaid out of its subsidies to help poor residents buy insurance.

Caring for those and other uninsured residents is costing counties billions of dollars a year, according to a letter sent to Schwertner on Wednesday by the judges in Harris, Bexar, Dallas, Tarrant, Travis and El Paso counties.

“We write not to complain about this fiscal burden or duty, but to urge your committee to use this interim to find a Texas way forward to fund and increase access to healthcare coverage for low-wage working Texans,” the judges wrote.

Two of those county judges are Republicans, of course, and frankly I think they have every right to complain. The cost of health care for those uninsured people comes out of their budgets, not the state’s. A lot of that cost includes treatment for folks with mental illness, who generally get that treatment in county jails. Medicaid expansion solves a whole world of problems, we just have to be smart enough to take it. If that means calling it something else, or coming up with something that’s almost but not quite exactly Medicaid expansion so we can claim it’s a “Texas solution”, then so be it. Either is better than what we’re doing now.

Checking in on Uber and Lyft in San Antonio

San Antonio City Council will soon be taking up with vehicles for hire issue, and so far things have gone about as smoothly as you’d expect.


A proposal from City staff to integrate rideshare companies into the existing Vehicle for Hire Ordinance, and therefore legalizing rideshare operations in San Antonio, was met with unanimous opposition from the Transportation Advisory Board (TAB) Monday evening. It seems arguments from all sides of the issue remain unresolved – and just as heated.

The TAB is made up of citizens, representatives from transportation, tourism, and hospitality industries. The board’s vote to reject the proposal that would legalize rideshare was not surprising.

The traditional vehicle for hire (taxi, limo, shuttle, carriage) industry claims that the transportation network companies are unfairly and unsafely circumventing regulation under the guise of mobile technology. The TNC’s, and San Antonio Police Department Assistant Director Steven Baum, claim that regulations need to be changed to accommodate for an evolving industry – including its technology.


“The (proposed) system’s a little different, the system for the transportation network companies puts responsibility on the companies to vet the drivers (and vehicles) according to city standards,” Baum said. Traditional companies go through a testing and verification process through the City.

“The way we validate (those standards) is we do random, unannounced inspections,” he said, compared to the regularly scheduled inspections granted to traditional vehicles for hire and their drivers. Baum assured TAB members that neither public safety nor the city’s economy would be put at risk.

“I can’t believe you’re shoving this ordinance down our throat,” said TAB member George Alva during one of the most heated exchanges between a board member and Baum. “From the very beginning your mind was made up.”

Three months ago Baum was tasked by the City Council Public Safety Committee to see if there was a way to integrate rideshare into the current ordinance (Chapter 33 of City Code) and present his findings at the committee’s Aug. 6 meeting. From there, the committee can decide if further research is required or if the proposal should proceed to a City Council vote.

See here and here for the background. The Council committee will have both the committee report and the TAB’s rejection of it to take into consideration. Good luck with that, y’all.

On a tangential note, Joshua Sanders, one of the people that has been representing Lyft in Houston, sent me this update to Lyft’s insurance policy. The point of this is that once a ride has been accepted, Lyft’s commercial policy is the primary policy in all instances now. As we know, there have been questions about how insurance works with TNCs like Uber and Lyft, and recent stories have indicated that representatives of Texas’ insurance industry see gaps in the coverage. I would be interested to know what they think about this.

Finally, there’s a provocative op-ed in the Chron from Michael Zoorob, who is an intern working as a research assistant at the Southwest ADA Center, a nonprofit disability organization in Houston. He takes Uber and Lyft to task for their lack of accessibility for disabled folks.

So why can’t the disabled community just use other modes of transportation? For one thing, the rapid entrance of Uber and Lyft – following a pattern of “break the rules and ask questions later” – has eroded the supply of accessible taxis, as seen in some cities. In San Francisco, a quarter of the wheelchair-accessible taxi fleet is unused as taxi drivers have flocked to ride-sharing companies.

For all the complaints about ride-share companies, you’d have a tough time finding a best-practices model among traditional taxi services. In Houston, there are only 50 accessible taxis on the market covering more than 600 square miles. They make up about one-fiftieth of all taxis. So if you use a wheelchair, good luck hailing a cab.

As a society, we have decided that people with disabilities deserve equal opportunity to participate in public life. This logic compelled Congress in 1990 to pass the Americans with Disabilities Act. In his signing remarks, analogizing the ADA with the fall of the Berlin Wall, President George H. W. Bush declared: “We will not accept, we will not excuse, we will not tolerate discrimination in America. … I now lift my pen to sign this Americans with Disabilities Act and say: Let the shameful wall of exclusion finally come tumbling down.”

It is precisely this “shameful wall of exclusion” that Uber, Lyft and other transportation providers seek, however unwittingly, to maintain with their standards of service to the disabled community. And it is wrong.

It is wrong to relegate citizens with disabilities to a separate, segregated system of transportation, just as it is wrong to deny them access to City Hall or to a grocery store because accommodating them is costly. It is a fact of American history that when marginalized groups are allowed access only to segregated services, these services tend to be inferior. This is the reality for many people with disabilities who must rely on state-provided paratransit services.

Uber and Lyft must play by the same rules as everyone else in the taxi marketplace, including providing service to everyone – a standard that also bears improving among taxi companies. Being innovative does not excuse trampling on the rights of people with disabilities.

As Zoorob notes, there was a lawsuit filed recently against Uber and Lyft by disability rights activists. I’ve said before that I’m not sure how their business model, which relies on the personal vehicles of their drivers, can handle making these accommodations. Zoorob makes a compelling case that they need to figure it out, or else.

UPDATE: Meanwhile, the Chron opines again in favor of Uber and Lyft, while CM Stephen Costello and Texpatriate’s Noah Horwitz, who is working for Cindy Clifford’s firm, have dueling op-eds in TribTalk about it.

Will we finally get a vote on vehicles for hire this week?

Remember last month when Council was supposed to vote on a vehicles for hire ordinance change to allow Uber and Lyft to operate here in some fashion? It was put off till July 30 to allow for some form of “consensus” to emerge among the stakeholders. How’s that going? Slowly, it would seem.


At least 2 percent of vehicles for hire in Houston would be capable of serving disabled passengers who require special treatment under revised rules proposed by city officials.

The changes, part of the debate about new companies barging into the Houston paid ride market, would meet what officials said is the anticipated demand for cabs and other vehicles in Houston by those who are in a wheelchair or who require a lift to get into a car.

Far more than 2 percent of Houston cabs and limousines are accessible to disabled passengers now.

Service to the disabled was one of the chief concerns expressed by City Council members as they debated regulatory changes that would open the local market to new companies such as Lyft and Uber. The companies pair drivers using their own vehicles with customers interested in hitching a ride. Lyft and Uber use smartphone applications to pair drivers and riders, then take a cut of what the rider pays.



Other than the provisions for the disabled, little of the 140-page Chapter 46 of the city code changed since council members delayed a decision last month. Beyond the 2 percent standard, the regulations would require city officials to periodically gauge the demand and progress of disabled for-hire vehicle availability.

Yellow Cab alone already meets the 2 percent threshold for the entire city, in part because the agency is a provider of disabled rides for the Metropolitan Transit Authority, which pays for rides for some clients. According to a 2013 study, Yellow Cab has more than 200 vehicles compliant with the Americans With Disabilities Act and equipped with wheelchair lifts.

Currently the city has fewer than 2,500 taxi permits and fewer than 1,900 limo permits issued. It would take more than 5,000 new vehicles entering the paid ride business before the industry would risk having too few vehicles to meet the 2 percent standard.

You’d think we could have arrived at this point in less than 45 days, but whatever. Cab companies were reviewing the revised rules as of last report. I’m going to step out on a limb here and guess that they still won’t be happy about them. On the one hand, it’s not clear to me that just because there will be an increase in the total number of vehicles for hire in Houston that there will also be an increase in demand for rides by folks that need vehicles that are accessible to the disabled. But that doesn’t mean that the newcomers shouldn’t need to carry some of that load as well. How you ensure that Uber and Lyft have some number of cars that can give rides to people with disabilities is still an open question. You could require them to have a certain number of such vehicles available and make their app have an option to request one, which means in effect that they’d be operating like traditional cab companies in this respect. Or I suppose you could require them to have some number of drivers who own such vehicles among their troupe of available drivers for at least some set number of hours per day. I have no idea if that could work.

Perhaps it would be useful to see how other cities are handling this issue. The city of Minneapolis just voted to allow Uber and Lyft to operate. The question of rides for folks with disabilities came up there as well.

The new ordinance distinguishes the companies from taxicabs, creates a process for them to become licensed and specifies what insurance they must carry. Insurance is a particularly complicated issue for the services, since they typically use hybrid plans that complement a driver’s personal policy.

But taxi industry representatives weren’t happy with a two-tier fee structure that will charge major taxi companies significantly more than transportation network companies. Others have concerns that changes to the wheelchair-accessible vehicle requirements could backfire.

Minneapolis follows California, Colorado, Seattle, Chicago and Baton Rouge in passing legislation to specifically regulate the services; St. Paul is crafting its own version, while other cities have interim agreements.


Another point of contention related to how a proposed incentive program for wheelchair-accessible vehicles will work. The city will fund it using a $10,000 surcharge, which replaces an existing requirement on companies to provide the vehicles themselves (which never acheived compliance).

“I dont think there’s a taxicab company that will do it,” said Waleed Sonbol, owner of Blue and White Taxi, following the vote. That concern that no one will bid on the program was reflected in a letter earlier this week from disability advocates.

[Ordinance sponsor Jacob] Frey said the new system will actually work better, however. “If you’re an individual with disabilities and you need transportation, you call one number and you will get service that is fully ADA accessible,” Frey said. “And we aready have four or five different companies that are chomping at the bit” to provide that service.

Council Member Cam Gordon, who expressed concerns Thursday with the disability provisions, said the entire process convinced him that the Twin Cities should be tackling transportation regulations as a region.

“This whole process has only reaffirmed for me my conclusion that having the city regulate this industry is no longer necessarily appropriate,” Gordon said.

Cabs got several breaks in the new law. New regulations spearheaded by council member Abdi Warsame allow non-city facilities to inspect vehicles, extends the maximum age of vehicles by five years and gives drivers more parking privileges.

“What we have in front of you is the wish list of the taxi companies,” Warsame said.

Some possibilities there for Houston, perhaps. I certainly hope someone has at least placed a call to the cities with existing ordinances to see how they handled some of the concerns that have arisen.

There’s also the insurance question.

It’s a transportation company that’s growing at record speeds, but some are saying slow down and put on the brakes because when it comes to insurance coverage you may not be safe.

“It does concern us,” said Mark Hanna with the Insurance Council of Texas as he spoke of Uber. “We have 20 different states looking at this and no one really has come up with a solution.”

Uber connects a passenger to a driver via an app on a cell phone. That’s the only way the driver and passenger are supposed to communicate. All fare transactions go through a credit card already on file.

But rivals of Uber, such as local cab companies, say that isn’t always happening and that can put everyone in danger. And that has the insurance industry concerned.

“You’ve got gaps,” said Hanna. “In fact, there may not be any insurance coverage whatsoever.”

According to Uber, unless you go through the app and abide by Uber’s platform, Uber’s insurance policy does not apply.

And according to Hanna most personal insurance policies don’t cover drivers if they charge a fare. And that could leave people exposed.


And it’s concerns like that that have the Texas insurance industry asking Uber to put on the brakes.

“We’re just asking them to slow down,” said Hanna, “Let us put some mechanism in place that lets us provide coverage for everybody, so everybody is safe.”

Uber declined and on-camera interview, but in a written statement said if a driver is accepting trips through other means that the Uber platform, Uber’s insurance policy does not apply.

Here’s another story about how the insurers in Texas are saying that there’s a gap.

Mark Hanna, a spokesman for the industry group the Insurance Council of Texas, said insurance companies across the U.S. are looking to state regulators and legislatures for guidance as they prepare to offer expanded policies.

“Everyone is trying to come up with a solution,” Hanna said.

California might be the place where model legislation or regulation will be crafted.

Pete Moraga, spokesman for the Insurance Information Network of California, said lawmakers in the California Assembly and state Senate are working on bills, and state insurance regulators are pondering new regulations.

In Texas, insurance regulators haven’t made much progress in dealing with ride-sharing companies.

Texas Department of Insurance spokesman Jerry Hagins said that state law requires auto liability coverage, but it doesn’t distinguish between personal and commercial coverage, and local municipalities must set requirements for insurance for taxis and livery operations.

So far, Austin city officials have deemed Lyft and Uber to be operating as illegal and unpermitted taxis. Officials have gone so far as to impound vehicles and ticket drivers.

Hagins also said that most insurers offering personal auto policies do not rate their policies for commercial uses.

Patti Kelly, a State Farm spokeswoman, confirmed that Uber and Lyft drivers in Texas generally wouldn’t be covered by their personal policies while earning extra money shuttling people around.

Both Uber and Lyft have liability policies that insure drivers who take on passengers under their name. But they are supposed to pick up where personal polices leave off, the companies have said.

Advice from the Texas Department of Insurance echoed the guidance from the Insurance Information Institute: Call your insurance company to confirm you’re covered.

Again, you’d think some progress would have been made on this by now. At the very least, can we get a definitive answer on whether those Uber and Lyft liability policies do in fact pick up where the personal policies leave off? Perhaps the Legislature needs to get involved here.

In any event, that’s the lay of the land as Council prepares to maybe vote on this on Wednesday. Assuming it doesn’t get tagged for a week – I’m not sure if that’s still in play after the current delay – or any further delays are proposed.

Texas insurance enrollment update

Enrollments are up and the number of uninsured are down, though both could have been a lot better.

It's constitutional - deal with it

It’s constitutional – deal with it

The sky-high rate of Texans without health insurance has dropped only slightly since the launch of the federal Affordable Care Act’s online health insurance marketplace, according to a new report from Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

During the open enrollment period from September through March, the rate of uninsured adults in Texas fell to 23.5 percent from 24.8. And most of that change was attributable to an increase in employer-sponsored health coverage, the report found, rather than new signups in the federal marketplace.

Texas’ decline in the rate of its uninsured was commensurate with those in other Republican-led states that elected not to expand Medicaid to cover poor adults. But while the number of Texans applying for coverage in the online marketplace — about 746,000, according to the report — pales in comparison to the more than 5 million who lack insurance, ACA proponents may see reason for optimism, the authors wrote. The 746,000 figure represents a significant increase in Texas enrollments from the 295,000 reported by the federal government as of March 1.

“You look at the absolute numbers and say, ‘Wow! This is a good start,’” said Vivian Ho, a co-author.

The report, which draws its conclusions from survey data rather than figures that are gradually being released by the U.S. Department of Health and Human Services, offers new insight into what kinds of people are signing up for insurance under the ACA.

For example, only about 30.2 percent of those seeking coverage in the online marketplace were previously uninsured, researchers found. Employer-provided health insurance seemed to be responsible for the biggest drop in the uninsured.

“If I had to guess, a large portion of that is just the upswing in the economy,” Ho said. “There are more people getting jobs.” But she added that some businesses are also preparing to comply with the upcoming coverage mandate for their employees, offering low-cost insurance options for low-wage workers, a trend that may be reflected in the data.

We also now have some specific information about Houston enrollments.

Meanwhile, in an unrelated report, the Associated Press found more than 177,000 Houston residents signed up for health coverage, exceeding expectations and indicating a last-minute enrollment push just before the March 31 deadline might have helped Texas meet projected targets despite months of lagging.

The news service, citing an email by Marjorie McColl Petty, the Department of Health and Human Services’ Dallas regional director, and obtained by the Associated Press, reported that as of April 5, some 177,825 Houston residents signed up for coverage. A previous email by Petty said that as of March 29, 149,273 Houston residents had signed up for insurance, the AP said.

The expectation had been that 138,000 Houston residents would sign up.

You can see the Baker Institute report here. This answers some of the questions raised in my earlier post, though the Kaiser numbers have not yet been updated. As noted, there’s no official tally of who does or does not have health insurance in Texas. We’ll have the enrollment totals, and I presume HHSC has Medicaid and CHIP numbers, but beyond that it’s all estimates and speculation.

We all know how this has gone down in Texas, where the party line from the Republican leadership has been one of unrelenting hostility and obstacles. Not surprisingly, in states like Texas the ranks of the uninsured decreased at a lower rate than in states that are not run by heartless assholes. With the grace period for people who began but were unable to complete the enrollment process now over, the official tally for enrollees is eight million. That doesn’t count state exchanges, Medicaid expansions, the under-26 set that can be on their parents’ insurance, or people who will now have insurance through their employers; the grand total is at least 14 million, and counting. And it could have been so much more.

Opponents of the ACA said the report spelled bad news for President Obama’s signature health law. John Davidson, a policy analyst for the conservative Texas Public Policy Foundation, called the number of previously uninsured people who signed up for coverage on the exchange a “drop in the bucket” compared to Texas’ total uninsured population.

“I believe that cost is driving these numbers,” Davidson said. “Coverage on the exchange is very expensive, and it’s expensive even if you get a subsidy, in many cases.” He compared the report’s projection that 746,000 Texans had enrolled in the marketplace to a recent HHS brief that estimated that 2.2 million Texans could qualify for subsidies.

“Something’s going on there,” Davidson said. “Why so few?”

I’m going to be charitable and not assume that the oft-quoted token Davidson is sufficiently stupid as to be genuinely baffled. The organization for which he is employed is a malignant force in Texas, but they are quite clear-eyed about their goals. He knows what the truth is, and he knows what his role in relation to it is. The real question is why the Tribune, or any self-respecting news organization, thinks there is value in including his disinformation. Why do you think it’s a good idea to let someone lie to your readers, Evan Smith? I can’t think of a good reason for that. The LA Times has more.

What’s the health insurance enrollment status in Texas?

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

It's constitutional - deal with it

It’s constitutional – deal with it

Self-sufficiency. Distrust. Desire for flexibility.

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

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

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

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

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

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

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


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

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

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

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

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

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

Somewhat less onerous navigator rules published

They could have been worse, but they could still be better.

It's constitutional - deal with it

It’s constitutional – deal with it

The Texas Department of Insurance on Tuesday issued state regulations for health care “navigators,” the workers who assist people seeking health insurance in the federal marketplace created by the Affordable Care Act.

The rules take into account some of the criticism aired recently by Democrats and health care advocates at public hearings, while also broadening the definition of “navigator” to allow additional organizations — not just those that received federal grants — to hire and train navigators.

“These rules will help ensure Texans have confidence that anyone registered as a navigator has passed appropriate background checks and received the training they need to safeguard a consumer’s most sensitive and personal information,” Texas Insurance Commissioner Julia Rathgeber said in a news release.

The rules require navigators to receive 20 hours of state-specific training in addition to the federal requirement of 20 to 30 hours of training, to undergo background checks, and to provide proof of identity. The rules also prohibit navigators from charging consumers, selling or negotiating health insurance coverage, recommending a specific health plan, or engaging in electioneering activities or otherwise supporting a candidate running for a political office.

Democrats and representatives from various health care organizations and nonprofits have raised concerns at public hearings held by the department that the proposed rules would impede navigators’ ability to educate people seeking health coverage, and divert time and funding away from their primary objective: helping people find health insurance.

In response to the public comments, the department removed from the proposed rules a $50 registration fee for each navigator. It also reduced the training requirements to 20 hours of state-specific training, from 40 hours in the proposed rules.

“There was no justification for the original proposal other than conservative politics,” state Rep. Lon Burnam, D-Fort Worth, said in a statement, “so I’m glad TDI has relented and come up with training requirements that are at least somewhat logical.”


Texans must apply before March 31 to receive federal tax credits to help pay for private coverage on the federal marketplace. Navigators must comply with the state’s additional training requirements and register by March 1.

Given the tight deadline, Democrats have alleged that the rules are politically motivated and are intended to curb enrollment in health plans offered in the federal marketplace. And despite the modifications, some Democrats and organizations that have hired and trained navigators say the rules will still increase costs, and take time away from navigators’ efforts.

Martha Blaine, executive director of the Community Council of Greater Dallas, which is among the groups that have received a federal grant to hire navigators, said the 12 navigators working for her organization have already undergone background checks and met other requirements in the state’s rules. She said she is unsure whether those efforts will have to be duplicated to meet the state’s requirements.

“It’s a bad use of resources, time and money,” she said.

See here, here, and here for the background. There’s a lot of people who’d like to enroll in an insurance plan via the exchange if Rick Perry and his cronies would quit interfering and get out of the way. Having these rules be only slightly obnoxious instead of blatantly obnoxious was probably the best outcome we could reasonably get. Here’s a side by side comparison of the rules as they were originally proposed and the rules that wound up being published (which you can see in full here), provided by Rep. Lon Burnam. I also received a letter Rep. Burnam sent about the original rules, and statements from Sen. Sylvia Garcia, and Reps. Garnet Coleman and Ruth Jones McClendon about the rules that were adopted. Finally, the Texas Organizing Project sent out a press release announcing a new collaborative effort to help inform folks about their health insurance options.

Rick Perry doesn’t want people to get health insurance

There’s really no other viable explanation.

It's constitutional - deal with it

It’s constitutional – deal with it

On a White House conference call on Monday, Texas Democrats criticized Gov. Rick Perry and other Republican state leaders for “getting in the way” of implementing federal health care reform.

During the call, which was organized by the White House to tout the impact of the Affordable Care Act in Texas, state Rep. Trey Martinez Fischer, D-San Antonio, and Dallas County Judge Clay Jenkins accused state leadership of creating obstacles to keep Texans from obtaining health insurance, as required by the health care law, also known as Obamacare. The two Democrats cited Texas’ decision not to expand Medicaid, the lack of a state-based insurance marketplace and proposed additional rules for federal navigators.

Martinez Fischer called Texas the “poster child” for the uninsured, adding that the state’s rate of residents without health insurance — the highest in the nation at about 25 percent — had received “no relief from state leadership.”

“I wish we would use our energy and momentum in Texas with our statewide elected officials to actually embrace and work cooperatively with the administration to expand ACA opportunities in Texas rather than the trail of roadblocks,” Martinez Fischer said.

Jenkins questioned Perry’s request for additional regulations on federal navigators, who are charged with helping individuals sign up for health insurance.

“If they won’t help citizens gain access to coverage, they ought to stand down and stay out of the way for those of us who are willing to work to do the job for Texas,” Jenkins said.

Perry first requested the rules in September, citing consumer privacy concerns. Other Republican state leaders, including Lt. Gov. David Dewhurst and Attorney General Greg Abbott, followed suit.

Perry spokeswoman Lucy Nashed called the conference call an attempt to distract from the Affordable Care Act’s “continued failures.” She cited the technical problems of the federal online insurance marketplace, concerns surrounding the training of navigators and delayed enrollment deadlines.

“Texas families and businesses don’t need more empty rhetoric from the Obama administration to know that Obamacare is a failure,” Nashed said.

It takes a certain level of sociopathy to say something like that when you are the Governor of the state with by far the highest number of uninsured people, and you’ve been Governor for thirteen years without doing a single thing about it. Except for all the things you’ve done to deny health insurance to people, such as the CHIP cuts and our famously stingy Medicaid eligibility requirements and onerous enrollment processes. Hey, remember when we spent a couple hundred million dollars outsourcing our Health and Human Services Commission and gave the money to a private firm that didn’t know its ass from a pencil eraser? Those were the days, my friend.

The antipathy towards health insurance comes through in everything Rick Perry – and David Dewhurst and Greg Abbott and the rest of the sorry lot – does, from imposing needless burdens on navigators to refusing to expand Medicaid to refusing to implement an exchange, and on and on. If there were some honest ongoing effort over the past decade-plus to do something about the millions of uninsured in Texas, that would be one thing. But the record, and the inactivity, speak for themselves. There’s really no other way to characterize it. Millions of people have become insured around the country, but all we get here is rage and denial.

Oh, and bad journalism, no doubt influenced by the lying and obfuscation. Do make sure you click those two links and read the stories, which have now coaxed an apology for the half-assed job they did from the Star-Telegram. Senators Sylvia Garcia and Rodney Ellis have more.

Perry keeps asking for the same Medicaid waiver he hasn’t gotten in the past

Same as it ever was.

Corndogs make bad news go down easier

Free corndogs with every approved treatment!

Gov. Rick Perry is preparing for yet another battle in his war against Obamacare.

In a letter to the state’s health agency on Monday, the governor laid out his plan to request a federal waiver to reform Medicaid as Texas sees fit — without expanding eligibility.

“Seemingly, the president and his administration are content to simply throw money at a problem and hope that any problems will resolve themselves,” Perry wrote in a Monday letter to Kyle Janek, the executive commissioner of Texas’ Health and Human Services Commission. “My response, and the response of the Texas Legislature, has been crystal clear: Texas will not expand Medicaid under Obamacare.”

Instead, Perry has asked that the agency request flexibility in the form of a block grant — a fixed amount of money, rather than matching dollars for Medicaid services — from the federal government to fundamentally reform Medicaid. Specifically, Perry requested that the agency seek a waiver that allows the state to make changes to the program without receiving federal approval, continue asset and resource testing to determine eligibility, and initiate cost-sharing initiatives, such as co-payments, premiums and deductibles, among other reforms.

The waiver “should give Texas the flexibility to transform our program into one that encourages personal responsibility, reduces dependence on the government, reins in program cost growth and efficiently improves coordination of care,” Perry wrote.


In a second letter sent to HHSC on Monday, Perry requested that the agency develop a mechanism to continue collecting and analyzing income, asset and resource information on Texans who apply for Medicaid benefits. That’s despite a provision in the Affordable Care Act — one that takes effect on Jan. 1 — that requires the state to stop asset testing to determine Medicaid eligibility.

A copy of the letter requesting the block grant is here, and a copy of the letter on asset testing is here. Texas has been asking for a Medicaid block grant since at least 2008, when the Bush administration rejected the request. Perry knows full well what the answer will be, he’s just going through the motions out of spite and the continued delusion that he’ll be appealing to Iowa voters in 2016. If the CMS assigned me the task of writing the response, I’d start out by noting that in any negotiation, there must be good faith and a willingness to give something to get something. As the primary purpose of block granting Medicaid is the limit services, and the primary purpose of the Affordable Care Act is to enroll more people in health insurance plans, Perry’s proposal demonstrates neither of those things. Just this week, we’ve seen two examples of other Republican governors agreeing to expand Medicaid. They both wrung some concessions out of the feds in doing so, but the end result will be more people getting access to health care. And Lord knows, we need a commitment to providing access to health care in Texas.

Texas continued to have the highest rate of people without health insurance in 2012 at 24.6 percent, according to the Current Population Survey estimates released by the U.S. Census Bureau on Tuesday.

“Texas has often had the highest uninsured rate throughout the country,” said David Johnson, chief of the Census Bureau’s Social, Economic and Housing Statistics Division. He added that additional data from the American Community Survey that the Census Bureau plans to release later this week would provide more specific information on health insurance rates in states and metropolitan areas.

The Current Population Survey estimates revealed that the national uninsured rate declined in 2012, to 15.4 percent from 15.7 percent in 2011. The national real median income and official poverty rate were not statistically different in 2011 and 2012, according to the estimates.

Thanks to the insurance exchanges and the ACA subsidies, Texas’ unacceptably high level of uninsured people will decline, though as always Perry is doing everything he can to keep as many Texans as possible sick and unable to do anything about it. Perry and his fellow Republicans just don’t give a damn about the problem. Until they do, I see no reason for the feds to waste any time on these pointless requests.

When is it OK for the feds to intervene in Texas?

When the Affordable Care Act is involved.

It's constitutional - deal with it

It’s constitutional – deal with it

Though Texas will join 26 other states in defaulting to a federal marketplace for purchasing health insurance — a major component of the Affordable Care Act — it is one of only six that will not enforce new health insurance reforms prescribed by the law. It’s a decision some say could lead to confusion over who’s responsible for protecting Texas insurance consumers.

Because Texas did not create its own state-based marketplace, known as a health insurance exchange, under the Affordable Care Act, it must use a federally facilitated one instead. By federal law, the state must enforce provisions and regulations related to the insurance exchange and market reforms unless it notifies the federal government that it cannot or will not. If a state does not enforce those reforms, the federal Centers for Medicare and Medicaid Services will step in to do it.

Texas, Arizona, Alabama, Missouri, Oklahoma and Wyoming have all notified the federal government that they will not be policing the health law. John Greeley, a spokesman for the Texas Department of Insurance, said his agency cannot enforce regulations tied to the federal insurance exchange or market reforms because it is not authorized to do so.

“We can’t act on anything that doesn’t exist in state law,” he said.


In the states that will not enforce the exchange and market reforms, the federal government will have to review insurance forms and respond to consumer complaints about health insurance, said Kevin Lucia, an assistant research professor with the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms. Those duties, he added, are “typically reserved for state insurance departments.”

[Stacey Pogue, a health policy analyst with the liberal Center for Public Policy Priorities] said the state’s decision could create an “administrative burden” for insurance plans and could result in confusion for Texans who purchase health insurance under the federal exchange. For instance, she said, if people worry their insurance providers are discriminating against them based on their gender — a practice banned by the federal reforms — they may not know whether to report a complaint to CMS or to TDI.

“There’s all this opportunity to be bounced back and forth, which is a burden for consumers,” she said. If consumers have to report insurance violations to the federal government, that could prevent TDI from having a complete picture of consumers’ experience with insurance providers, she added.

“Consumers can be experiencing a lot of problems on the market that the state regulator doesn’t know about,” Pogue said.

That would be a feature, not a bug, as far as the state leadership is concerned. They care far more about scoring a political win by making the Obamacare implementation look bad than they have ever cared about actually solving the problem of people not having health insurance. How much effect this will have I can’t say – the Texas Department of Insurance claims they’ll still be there for Texans that have problems, for whatever that’s worth – but the bottom line remains that the state is determined to do everything in its power to keep as many people off health insurance as possible. After all that chest-thumping about being severely “pro-life”, you just have to wonder how some of these people sleep at night. But at least now we don’t have to wonder about when the federal government is evil and intrusive and anathema, and when it is not. Think Progress has more.

Just a reminder that women’s health isn’t the only thing they don’t care about

In case you needed one.

It's constitutional - deal with it

It’s constitutional – deal with it

Texas officials have declined to establish a state-based health insurance marketplace, a major provision of the federal Affordable Care Act. So private organizations are working to educate Texans about coverage options through the federal health insurance exchange, which opens on Oct. 1.

Of the more than 6.3 million uninsured Texans — the state has the country’s highest rate of uninsured residents — almost half will be eligible to buy insurance through the federal exchange, an online tool for coverage shopping.

But Texans suffer from a “general lack of knowledge” about the law, said Allison Brim, a director at the Texas Organizing Project, one of several groups working to reach uninsured families before the federal exchange’s rollout.

“Folks just don’t have a lot of information about the exchanges and what their options will be,” she said.

The Texas Department of Insurance has made no extra effort to publicize the federal exchange, said John Greeley, an agency spokesman. In 2010, it conducted a federally financed campaign about health insurance options but has done nothing comparable since, he said, adding that those with questions could use the department’s website or telephone service.

Brim criticized the state for not promoting the exchange, saying its help would make it possible to reach all eligible Texans by October.

“The state has, as far as we know, done nothing to spread the word to uninsured Texans about the exchanges or the Affordable Care Act,” she said. “It leaves a mountain of work for us.”

In response to questions about publicizing the exchange, Lucy Nashed, a spokeswoman for Gov. Rick Perry, wrote in an email that the state was “not interested in implementing Obamacare, including the exchange.”

That pretty much sums it up. You know the old joke about how God must love the poor because He made so many of them? Rick Perry must love uninsured people, because he’s doing everything he can to make sure there will always be plenty of them.

Like it or not, Obamacare is coming to Texas

The Better Texas blog reminds us that as the Affordable Care Act fully kicks in next year there are things that need to be done in Texas to be compliant

It's constitutional - deal with it

[W]hat I hope to see are bills that prepare Texas for 2014 market changes to help keep premiums reasonable, encourage competition, and ensure that the Texas Department Insurance (TDI) can protect Texas consumers.

Starting in 2014:

  • Insurers can no longer deny coverage based on pre-existing conditions or charge sick people, women, and small businesses more;
  • Subsidies will be available to help Texans above the poverty line buy private health coverage in the new exchange;
  • New risk adjustment mechanisms kick in.  They aim to eliminate incentives for insurers to avoid enrollees in poor health, while keeping any one insurer from bearing more than its fair share of risk from sicker enrollees; and
  • Many policies must contain “essential health benefits,” a new floor for coverage.

In light of these sweeping market changes, TDI needs appropriate tools to protect health insurance consumers.  First, TDI needs to be able to reject unreasonable rate increases. Insurers will incorporate all of the changes listed above will into health insurance premiums.   Consumers will benefit if the experts and actuaries at TDI check that insurers have made reasonable assumptions about costs and savings that come from these changes and have authority to deny excessive rate increases.

Second, TDI needs clear authority to enforce new consumer protections, such as no more pre-existing condition exclusions.  Unless Texas updates its Insurance Code to reflect consumer protections that take effect in 2014, conflicting state and federal laws will create confusion for consumers and insurers alike.  And if TDI isn’t authorized to enforce new consumer protections, federal regulators may step in.

Well, the feds are going to be running our insurance exchanges, so why not let them handle consumer protection, too? How much do you trust Rick Perry’s TDI to get this right? The irony here is that not giving TDI the tools to enforce the new insurance regulations might be seen as poking a finger in the feds’ eyes when in fact it’s opening the door for them, much as the refusal to implement insurance exchanges was. The logic sure is hard to understand sometimes.

Rick Perry must love federal intervention

He sure does his dangedest to invite it.

Brought to you in part by a grant from the Federal Corndog Trust

Perry, a Republican, has vowed not to expand Medicaid and not to create an insurance exchange. Consumer advocates in Texas say the Perry administration has also been dragging its feet when it comes to insurance rate review.

To make insurance more affordable, the federal law requires every state to conduct a special review whenever a health insurer wants to raise premiums more than 10 percent. This rate review would help protect small businesses and individuals who buy their own policies. The provision went into effect last September, and since then, insurers made nine such requests in Texas.

But so far the Texas Department of Insurance hasn’t completed any reviews. Officially, they’re all pending.

In the meantime, the insurance companies can go ahead and raise the rates anyway. An insurer called Celtic, for example, has raised rates on three policies in Texas by 20 percent.

“We were growing increasingly frustrated,” said Mimi Garcia, organizing director for Texas Well and Healthy, an advocacy group that has been active on the rate review issue.

“They’ve been very unresponsive,” Garcia said of the Department of Insurance. “They have not returned calls. They have not returned repeated requests. And it really took having over 1,600 Texans signing on to a petition to say, ‘Hey, this is something we care about and we need to know what’s going on with this.’ ”

What does that mean? TPM will tell you what that means:

To protect consumers, the Affordable Care Act requires states to review insurance rate hikes above 10 percent and, if deemed unreasonable, compel the companies to justify them. Since the provision took effect last September, insurers have made 9 requests, NPR reports, and nearly a year later Texas hasn’t reviewed a single one, even though it accepted a $1 million federal grant for rate review. Meanwhile, state insurers are freely raising their rates, including one company that jacked rates by about 20 percent.

The law gives states the first pass at rate review. But if they are deemed by the administration not to have “an effective and timely” process, the federal government takes over. At this point, Texas is goading the Obama administration to move in that direction.

“Under the circumstances it seems like HHS needs to reevaluate whether Texas meets these criteria,” said Tim Jost, a professor of health law at Washington and Lee University.

As the government’s Affordable Care Act website explains, “If your state doesn’t have a Rate Review program, or has a Rate Review program that is ineffective, the federal government will conduct Rate Reviews in your state.”

Maybe Perry is just biding his time, as the TPM story suggests; perhaps he’s looking for some legal pretext to get Greg Abbott to file another lawsuit, or maybe he’s just waiting to see if the feds will blink. Maybe he relishes another confrontation for all the fundraising and base-whipping it allows him to do. Maybe he just hasn’t thought it all through, or has been too busy with other things to make this a priority. Any of these explanations are plausible, and there are likely others I’m not thinking of. But it sure is a weird dynamic, defying the feds by forcing them to step in.

Millions more Texans will have health insurance under the Affordable Care Act

Can’t happen soon enough.

The percentage of Texans with health insurance will increase to 91 percent – up from 74 percent today – after the national health care law takes effect in 2014, the state’s Medicaid director told lawmakers Monday.


An estimated 2.3 million Texans will still lack health insurance after the Affordable Care Act takes effect, partially because undocumented immigrants are not eligible for coverage, State Medicaid Director Billy Millwee told a joint meeting of the House Public Health and Insurance committees.

Texas also has not yet developed a health insurance exchange, which the federal law created as a way to increase competition, cut costs and make buying insurance easier because residents will be able to compare insurance prices and benefits. The state has until Jan. 1, 2013 for proving a state exchange is on track.

Gov. Rick Perry opposes the exchanges because he believes the Supreme Court will find the law – the signature measure in President Barack Obama’s first year – unconstitutional.

Rep. Garnet Coleman, D-Houston, wondered what consequence will befall Texas if it refuses to create a health insurance exchange: “Do we turn into a bunny?”

“The federal government will establish an exchange in states that don’t,” answered Katrina Daniel, an associate commissioner in the Texas Department of Insurance.

Millwee said the state is prepared to implement the rules regardless of whether the high court declares them constitutional. “I think we’re going to be well-positioned, whether it’s found to be constitutional or not,” Millwee told the Associated Press.

Yes, it’s Rick Perry’s hope that the Supreme Court will allow him to go on not caring about people who don’t have health insurance or access to health care, as he always has. Some of the sillier candidates for office this year would go so far as to amend the Constitution to ensure that health care remain unaffordable and unattainable for millions of Americans. I’m still waiting for them to propose some alternate plan for accomplishing what the Affordable Care Act aims to do. Rick Perry has been Governor since the dawn of time. What has he ever done about this? What would he do if he weren’t being forced to do it? I think we know the answer to that.

The Trib has more on the hearing, including this bit of misdirection:

Lawmakers remain concerned over how Texas will fund the expected increase in Medicaid patients. The Health and Human Services Commission predicts that by the end of 2014, Medicaid will expand from 3.5 million beneficiaries to 4.7 million. HHSC is still calculating the actual cost to taxpayers, but it could be as much as $27 billion over the first 10 years, with the federal government paying for nearly all the cost of the new law in the first two years.

What always goes unsaid is that there is a cost to not doing anything as well. It costs the taxpayers money when an uninsured person goes to the emergency room, for routine care or to treat something that has gotten worse because it wasn’t dealt with early on. It costs us all when people are forced to go to work sick, or children are forced to go to school sick. Children who don’t have access to basic health care have worse outcomes in life. Those costs are harder to quantify, but they’re there, and we’re paying for them. Spending it on Medicaid, especially in a state that stands to benefit disproportionately from federal subsidies, is a much better deal. EoW and BOR have more.

Who watches the bounce houses?

As the father of two young children, I’ve been to many places that had bounce houses, from outfits like Pump It Up to back yards with a rented inflatable. As such, this story about the way such things are regulated was fascinating to me.

The Texas Department of Insurance is legally responsible for keeping an eye on what in the industry are known as continuous airflow inflatables — and by millions of birthday party guests as bouncy houses and jumpolines.

Yet legislators didn’t give the agency much enforcement authority. So its oversight can seem underwhelming. The typical penalty for operators who consistently refuse to comply with state rules requiring that they carry liability insurance and get each of their units inspected once a year is a series of strongly worded letters under department letterhead. For especially egregious cases, the law says the attorney general’s office can issue an injunction, though it never has.

Occasionally, the Insurance Department directs complaints to local police, who, according to the law, can cite scofflaws for violations. Word has not spread widely, however.

“I’ve never heard of that,” said Detective John Foster, a Williamson County sheriff’s spokesman. “Never.”


Without an enforcement provision, the state law is essentially an honor system supported by snitches. The Insurance Department has no field inspectors, so the typical way it learns that a company is in business is when it registers with the department.

“If a new operator came into the state and started up (without registering), we wouldn’t know,” [TDI spokesman Jerry] Hagins said. Notices of violators “usually come from whistle-blowers” — furious compliant operators.

Because the department has no authority to levy or collect fines, its response is limited to registered letters. It has sent about 600 in the past two years. If the offending company still doesn’t comply, the department fires off another, more strongly worded letter.

The missives have spurred resolution of 136 cases, with the companies agreeing to follow the rules or notifying the agency that they are closing up shop. Yet because the agency has no formal follow-up, it’s unclear how successful the enforcement effort has been.

“We’ve had some companies just change their names,” Hagins said. “So we start over again. It’s a moving target.” Meanwhile, the agency lists 480 cases as still unresolved.

For operators who don’t respond to the first strongly worded letter, Hagins said the Insurance Department copies local police on subsequent warnings.

“We don’t hear back from the police very often,” he said.

Sending a letter that says “Stop, or I’ll send you another letter telling you to stop” doesn’t seem like a particularly vigorous enforcement mechanism, but I doubt there will be anything else unless and until someone gets seriously hurt or worse. Until such time, it’s probably not a bad idea to ask the business owner if they’re registered with the Insurance Department, and keeping your own eye on things.

Tort “reform” is still a scam

I know, I’m as shocked as you are.

A national report released Wednesday says the 2003 Texas law that limited damage awards in malpractice suits has caused health care spending to rise and has not significantly increased the number of doctors in Texas.


The 24-page report by Public Citizen, “A Failed Experiment,” says that using Texas as a model would benefit doctors and insurers — not residents.

The report claims that Medicare spending in Texas has risen faster than the national average, and so have private health insurance premiums. It also says that, contrary to Perry’s claims, the per capita increase in the number of doctors practicing in the state has been much slower since the state passed the so-called tort reform law than it was before the law.

Organizations that support the 2003 law — the Texas Medical Association and the Texas Alliance for Patient Access — disputed the report’s assertions on the number of physicians who have come to the state. As for health care costs, “we never said consumer costs would go down,” Jon Opelt, the alliance’s executive director, said Wednesday.

You can see the Public Citizen press release here, and the full report here. I wish I had done enough blogging on the 2003 tort “reform” issue to take a crack at evaluating Opelt’s claim that no one promised this would help consumers, but I didn’t so I can’t. It sure sounds bogus to me, and I don’t believe him for a minute. I distinctly remember seeing pro-tort “reform” propaganda in the waiting room of our obstetrician around the time of the vote, and while I can’t remember exactly what it said, I’m sure it promised some benefits to the voting public. Anyway, while I can’t directly judge that claim I can say that the pro-tort “reform” side did make some outlandishly exaggerated promises about insurance rate reductions for doctors that they later tried to walk back. The Public Citizen report notes that insurance costs have eased a bit for doctors since 2003, but not that much. Anyway, check it out for yourself, and if you have any clearer memories – or better yet, evidence you can point to – about what the tort “reform” crowd said would happen if we all gave the insurance lobby a pony, leave a comment and let us know.

The Affordable Care Act will help millions of Texans

So says the Texas Department of Insurance.

Even as Texas leaders rail against the national health care law and call for its repeal, the state Department of Insurance has issued a report that says the law will make it easier for many Texas families to get health coverage.

The report also helps make the case that the current system is not working, as the number of Texans with health coverage through their employers has dropped nearly 18 percent in the last eight years.

In 2001, about 58.5 percent of Texans had employer coverage. By 2009, that figure had dropped to 48.2 percent — well below the national average.

“While most states have experienced declining rates of employer-sponsored coverage in recent years, the decline in Texas is more pronounced,” the agency said in a report to the Legislature on health insurance availability and affordability in the state.

The report noted that 26.1 percent of Texans are uninsured — 6.4 million residents — compared with a national average of 16.7 percent. Most are in families with low to moderate incomes.

Those are among the people who will benefit from the health care overhaul passed by Congress last year and signed into law by President Barack Obama.

The TDI has a Federal Health Care Reform Resource Page, which has numerous useful summaries and highlights of the PPACA, but I did not find anything that cited the figures above or that looked like a new report, so I’m not sure exactly where this comes from. It’s all somewhat academic, since the Republican Party has refudiated the concept of universal coverage as a policy goal, and while the Lege will debate Rep. John Zerwas’ bill to create insurance exchanges, I’d bet more time and energy will be spent on grandstanding and ridiculous sideshows, none of which will do a thing to help anyone. But the next time someone asks, you can tell them that the state of Texas officially believes that the PPACA will be good for it, no matter what our so-called leaders may say. On a related note, here’s a statement from Rep. Garnet Coleman about what “repeal” would mean, and here’s a reminder that GOP claims about PPACA’s effect on employment are bogus and misleading. And of course, the PPACA will reduce the federal deficit over time, while repealing it will increase the deficit. Someone should tell Rick Perry about that.

Worker’s Comp goes before the Sunset Commission

The worker’s comp battle has moved to the Sunset Advisory Committee, with testimony being given about how the Division of Workers’ Compensation does its business. Elise Hu continues her reporting on the war of words between several former employees of that division and their boss – see a letter one of them wrote in response to Commissioner Rod Bordelon’s counter-accusations. The Texas Association of Business is weighing in as well. The first day of hearings set the stage for what is to come.

Dr. Ken Ford, who served for six years as Assistant Medical Advisor at the Division, is one of six employees who have exited their positions since January, alleging fraud probes have been buried by their boss, Commissioner Rod Bordelon. Public scrutiny of the Division — following a May 12 Texas Tribune story — began in earnest Tuesday night, as members of the Sunset Advisory Commission questioned Bordelon and former workers’ comp investigators about cases against doctors accused of overtreating or overbilling patients during the last half decade. The commission’s recommendations, which won’t be voted on for several months, are typically used to guide changes during the legislative session.

More hearings are planned for this summer as lawmakers scrutinize the roiling controversy, which includes allegations that Bordelon may have bent to political pressure in spiking at least one case in January and closed the books on eight others that had already moved into the enforcement stage.

“The [Division’s] Office of Medical Advisor has discovered tens of millions of dollars in unnecessary medical care, and it’s all been swept under the rug,” Ford told the commission.

Under questioning from lawmakers, Bordelon defended his decision to dismiss the nine cases, blaming his former employees — including Ford — for tainting the selection of the doctors for review. He said those employees “targeted” the physicians selectively, creating a potential roadblock to prosecuting them. “The defendants bring up as a defense that they have been targeted,” Bordelon told the panel.

Ford, in his testimony, called Bordelon’s assertions “a lie,” saying that the doctors were selected based on complaints from their patients. The doctors enjoy ample safeguards, he said. “Where it seems to bog down is, once they go to enforcement, they just seem to disappear,” said Ford.

I daresay this will all be a lot more exciting than what you’d normally expect given the subject matter. Hearings will continue in June.

The Worker’s Comp Commissioner fires back

How can you tell when whistleblowers are having an effect? When the entitiy they blew the whistle on attacks them.

As the Division of Workers’ Compensation heads into a public hearing at the Sunset Advisory Commission next week, Commissioner Rod Bordelon is blasting his former employees for their allegations in the Texas Tribune earlier this month, putting the blame on them for abuse and mismanagement in the system. The former staff members, who were in charge of investigating medical fraud by doctors in the workers’ comp system, say the agency – and specifically the Commissioner – failed to sanction or enforce dozens of doctors who are abusing the workers’ comp system, possibly for political reasons.

Bordelon calls the allegations “completely false and baseless” in a letter to lawmakers who sit on the Sunset Commission, which is currently overseeing the top-down review of the Division.

Click the link to read the letter. Let’s just say I look forward to those legislative hearings that we’ve been promised.

More on worker’s comp fraud

Elise Hu has a followup to her story from last week about worker’s comp fraud and the lack of investigation of same. It seems she attracted the attention of the Lege.

“My primary concern is patients getting improper treatment — things that are going to end up hurting them or getting them hooked on painkillers,” said state Rep. Joe Deshotel, D-Beaumont, who chairs the House Business and Industry Committee, which oversees workers’ compensation laws in Texas. “What’s the impact of fraudulent claims on our already strapped budget?”

Deshotel said he plans to hold a committee hearing as early as mid-June to address the enforcement questions. Nearer on the horizon — May 25 — is the Sunset Advisory Commission’s public hearing and final recommendations for changes to the Division’s statutory structure, which will guide legislation next session. Bordelon is expected to appear before the Sunset commission, according to its chairman, state Sen. Glenn Hegar, R-Katy.

“I will ask the Commissioner questions regarding the issues brought up in the [Tribune] story,” Hegar says. “I firmly believe that Texans deserve quality medical care, especially those who have been injured in the workplace. We don’t want any doctors scamming the system in any shape, form or fashion. I am very interested in making sure there is a fair and equitable process.”

Good, and not surprising. This really is low-hanging fruit, the proverbial “waste, fraud and abuse” we’re all supposed to be on the lookout for. Why it hasn’t been pursued more vigorously is a question that deserves an answer. I’m glad to see the Lege playing its role in getting to that answer.

Blowing the whistle on worker’s comp fraud

Really good article in the Trib about worker’s compensation fraud and why so little of it is being actively investigated these days. This is the sort of thing that really ought to get traction, as it has something for all kinds of different political interests. For the budget hawks, there’s “waste, fraud, and abuse” in its purest form; for the good government types, there’s a campaign finance angle; and of course there’s the evidence of dysfunction in yet another agency with a Rick Perry-appointed chief, which should concern everyone. Check it out.

Who will administer Texas’ health insurance exchange?

As we know, one of the provisions of the Affordable Care Act is the creation of health insurance exchanges for those who are currently uninsured and need assistance in getting it. The states are supposed to operate these exchanges, and that means some kind of action needs to be taken to get it up and running. In particular, some entity needs to be responsible for it. State Rep. John Zerwas, the chair of the House Select Committee on Federal Legislation, thinks that a new agency may need to be created for this purpose.

Zerwas, of Richmond, said he was not sure yet if the new entity would be a commission or an independent agency or something else.

But he said he does believe an organization other than the state Department of Insurance or the Health and Human Services Commission will be needed because neither agency has the capacity to take on the task.

Because of so many unknowns, Zerwas was unable to say how much money and how many people would be needed.

Zerwas added that one model could be the authority that handles a health insurance exchange in Massachusetts, the only state that currently requires residents to buy insurance.

Massachusetts Health Connector, an independent state agency that helps residents find health care coverage, opened in 2006 with $25 million in seed money appropriated by the Massachusetts Legislature. It has about 50 employees and generates its own revenue, spokesman Dick Powers said.

In Texas, legislative action would be needed to create an entity to oversee an exchange , Zerwas and other lawmakers said.

“I would be receptive to being the author,” Zerwas said.

Zerwas was an unconvincing critic of the health care legislation as it was being crafted and debated, but I have no reason to think he’d do anything but a good job figuring this out; State Rep. Garnet Coleman is also on this committee, which is an even stronger reason for optimism. I don’t have a preference at this time for how this should be approached, but with any Texas agency, the main concern is always oversight. The list of state agencies that have demonstrated that they cannot be trusted without strict supervision is a long one, and though that’s more than partially the fault of the guy who picks the heads of these agencies, this isn’t exactly a new problem. So let’s please try to get this right.

Stiffed by State Farm

Those good hands we’re supposed to be in? They’re squeezing the heck out of us.

To leading lawmakers and even some insurance industry experts, State Farm hasn’t exactly been like a good neighbor in recent dealings with state regulators.

The state’s largest property insurer shows no sign of compromising on its marathon legal battle over the state’s ruling that it overcharged homeowners hundreds of millions of dollars.

The insurer – which had an improved bottom line in 2009, according to figures released Monday by the state – has yet to pay a penny to policyholders.

After filing twice in eight months to increase rates, company officials gave a cold shoulder last month to state Insurance Commissioner Mike Geeslin, who suggested State Farm needed to give its customers a break.

And on Thursday, State Farm will take Geeslin and the Texas Department of Insurance to court in an effort to keep the agency from publicizing documents related to the rate spikes, which represent a statewide increase of 13 percent.

That was today, and State Farm won a temporary restraining order barring the TDI from posting the documents, though that could change depending on what Insurance Commissioner Geeslin does. The Chron’s Loren Steffy explains what State Farm is trying to get away with.

State Farm’s cry that disclosure will be anti-competitive is just another industry red herring.

Homeowners insurance is a market with fixed demand, meaning it isn’t really free to begin with. In a free market, after all, competition drives down prices.

Yet in Texas, the Big Three — State Farm, Farmers and Allstate — repeatedly push to raise rates and would hike them even higher if the state didn’t restrict the increases.

Because homeowners rarely change insurers, yet most are required to have it by their mortgage companies, the Big Three retain a stranglehold on the market even as they raise prices and reduce coverage.

State Farm has been battling the insurance department since 2004, demanding higher rates, rejecting the state’s finding that it’s overcharging and appealing the order that it refund hundreds of millions of dollars to customers.

Now it wants to hide the its rationale for yet another rate hike.

Insurance rates have been going up faster than property taxes for a lot of people, not that anyone in the state’s Republican leadership seems all that worked up about it. Democrats, however, are all over it.

Under the current file and use system, insurance companies can introduce drastic rate hikes without obtaining approval from the state insurance commissioner, the Legislature, or Texas consumers. The commissioner has few tools to keep the marketplace in balance.

“There is no backstop here. The solution could not be clearer, we must give our commissioner the tools to bring these companies in line,” said Representative Jessica Farrar. “We need a system of prior approval requiring insurance companies to justify rate increases before they pass them on to their customers and TDI Sunset provides that opportunity.”

It sure would be nice to have some accountability for the insurers, wouldn’t it? We’ll see how the lawsuit proceeds.

Homeowners insurance

An awful lot of attention gets paid to property taxes and the rate at which they rise due to higher appraisals. There are other variable costs to home ownership, however, and one of them is homeowners insurance.

As a result of a dramatic increase in mold claims prior to 2003, homeowner insurance rates were pushed to record heights. In response, legislators in the 78th Legislature passed SB 14, which, among other things, moved Texas to a “file and use” system.

Previously, rates were established by the Commissioner of the Texas Department of Insurance, and companies had to petition the department for approval to raise their rates above the established level. However, a loophole allowed most companies to shift their policies outside of the regulations, meaning consumers still saw high premiums.

The “file and use” system passed in 2003 did little to alleviate the problem. Under the new system, insurance companies were simply required to inform the department of a rate change before they implemented it. The department had no mechanism to regulate insurance companies as they implemented premium rates.

Texas homeowners have failed to see any significant relief from the rates that were in place prior to 2003.

And that’s without taking into account utility rates and flood/windstorm insurance for those who need it, which have also been rapidly rising. Sure would be nice to see some of this addressed in the next legislative session, wouldn’t it? Having a Governor that cares about the issue would help, too. EoW and BOR have more.

So what happens now?

Hell if I know.

In a last-minute legislative meltdown, the Texas Senate adjourned Monday night without passing key measures to avert a shutdown of the Texas Department of Transportation and other state agencies, raising the specter of a special session this summer.

The sticking point was $2 billion in transportation bond funding that the House failed to pass before gaveling out the 2009 regular session a few hours before the Senate.

Angry Republican senators said it was preferable to quit and let Gov. Rick Perry call the Legislature back into a 30-day special session to continue the agencies and pass the bonds. Several Democrats argued against the move, saying it was dangerous to begin the shutdown process of major agencies.

Sen. Troy Fraser, R-Horseshoe Bay, blamed the House for the 11th-hour unraveling of the session — saying the chamber acted irresponsibly by adjourning sine die — the Latin phrase used to describe the final day of the session.

“The House had the ability to act,” he said. “They went sine die after destroying the bulk of four and a half months of work that passed through this body.”

Sen. Leticia Van de Putte, D-San Antonio, said it was foolish to allow tension between the two chambers to derail the session. Both the transportation agency and the Texas Department of Insurance would face a shutdown by September 2010 unless Perry calls the Legislature back into session to reauthorize their existence.

“I don’t think the people of the state of Texas care if the Legislature is doing a ping-pong across the rotunda of blame, of ‘no you did it, no you did it’ “ she said. “I’m afraid that we are shirking our responsibility.”

Lt. Gov. David Dewhurst made it clear senators wanted the transportation bonds passed.

“We’re all upset about it,” Dewhurst said. “That came as a little bit of a surprise.”

The only opinion that matters at this point is Rick Perry’s, and as of this posting he hasn’t said anything publicly yet. If he calls the Lege back, he can get them to take another crack at passing voter ID. But he can’t raise money while the Lege is in session, which one presumes might matter to him, and it’s not clear what he might want the Lege to achieve with some of this stuff, most notably the TDI. Like I say, hell if I know. BOR has more.

UPDATE: My bad, he can raise money during a special. But so far, at least, he’s not sounding like he wants to call one.

Said Perry spokesperson Allison Castle: “Tonight’s action in the Senate will not impact the business of state agencies. These agencies will continue to conduct business as usual and serve the people of Texas. This has been a successful legislative session and there is still important business to take care of during the next 20 days of evaluating legislation that has passed this session.”

I hope he stays true to that.

We want more regulation!

Here are some words I never thought I’d hear in Texas, at least while the current regime is in charge.

Texas regulatory agencies could get as much as $41.2 million more over the next two years to better do their jobs keeping an eye on everything from banks to investment advisers to doctors.

The spending is recommended by Senate budget writers, partly in response to the national economic crisis.

“A lot of the problems that are going on in our country now appear to have been related to lax regulation and lax enforcement,” said Senate Finance Committee Chairman Steve Ogden, R-Bryan. “And so one of the issues in here is to make sure that our regulatory agencies have the adequate resources so that they can go do their job, and hopefully, at least in Texas, we won’t have as many problems because we had sufficient oversight and regulation going forward.”

The money would be used for such things as more frequent inspection of investment advisers by the State Securities Board; salary increases for financial examiners to prevent federal agencies from luring them away; more people to handle complaint investigations involving doctors; and more people addressing fraud, complaints and solvency monitoring at the Texas Department of Insurance.

The cost would be covered mostly by fees paid by those who are regulated.

Now that’s the kind of gittin’ tuff on crime I can believe in. Martha has more.