Texas Considers Medicaid Withdrawal

[sonias]

NYTimes 11/6/10
Texas Considers Medicaid Withdrawal
Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.

Far-right conservatives are offering that possibility in impassioned news conferences. Moderate Republicans are studying it behind closed doors. And the party’s advisers on health care policy say it is being discussed more seriously than ever, though they admit it may be as much a huge in-your-face to Washington as anything else.

“With Obamacare mandates coming down, we have a situation where we cannot reduce benefits or change eligibility” to cut costs, said State Representative Warren Chisum, Republican of Pampa, the veteran conservative lawmaker who recently entered the race for speaker of the House. “This system is bankrupting our state,” he said. “We need to get out of it. And with the budget shortfall we’re anticipating, we may have to act this year.”

The sub-title on this story should read "Or how Texas republicans will balance the budget on the backs of the poor". :mad:

The war on the poor in Texas has started. And Texan voters gave them the go ahead too. :(

[luvspeas]

1. "Arizona-style immigration law and a Texas withdrawal from Medicaid.."

says staunch social conservative and veteran legislator Warren Chisum, R-Pampa.

http://www.dallasnews.com/sharedcontent/dws/news/politics/state/stories/DN-txxgr_04tex.ART.State.Edition2.2c98719.html

[sonias]

3. ClusterF**K at the Texas Captiol

Some Republicans said Texas would shutter certain state boards and even entire agencies, and perhaps consider pulling out of the national Medicaid program for poor children, pregnant women, disabled adults and nursing home residents.

"There will be no tax bills coming out of the House of Representatives," Republican consultant Bill Miller said. "If anything starts with a 'T' for tax or 'F' for fee, forget it. They're struck from the legislative alphabet."

He also said that with more socially conservative Republicans in office, talk of expanded gambling would cool. "There's zero chance ... of gaming passing this session," Miller said.

I expect we will be the weekly flash point of many a national news story on how the right/tea party governs.

Testing lab for bad government policy just like Molly pinned it more than a decade ago.

[sonias]

2. Medicaid: Casualty Of The Texas House GOP Super Majority?

Captiol Annext blog 11/7/10
Medicaid: Casualty Of The Texas House GOP Super Majority?

(snip)
Never mind the fact that the Heritage Foundation’s studies aren’t worth the paper they are printed on, because this is very likely to become a reality. Even though it will only be a drop in the bucket toward dealing with the massive projected shortfall (which sources tell Capitol Annex is likely to grow to $32 billion by the time the session begins thanks to revised numbers from the Texas Comptroller), Republicans are likely to attack the program–especially CHIP, which many Republicans never wanted in the first place–with a ball peen hammer and blow torch.

The dumbest part of dropping the program is that, out of the $40 billion spent on the program per biennium, 60 percent of the tab is picked up by the federal government.
Medicaid won’t be the only casualty. We’re hearing that everything from home delivered meals programs to a wage freeze or even some wage cuts for state employees are being considered behind closed doors by far-right Republicans in the House. Of course, the Texas Enterprise Fund will remain untouched, but in this environment, not even teacher health insurance is safe. Look for big changes there.

This is really dumb as Vince points out. It's not like illness is going to go away because we scrap the Medicaid program. So instead of paying 40% of the cost with the government picking up the other 60%, Texas local communities will pick up the full tab at emergency centers. All they're doing is shifting more of the state cost to the cities. Which of course they want to punish anyway. Oh and of course make sure ill people die sooner. :puke:

[art3]

4. yeah but what do we plan to do to STOP them

my question- what do texans who give a damn plan to do to fight this? what kind of coaltion is being organized here w/clergy, leaders from both sides, orgs etc.. many of these gop reps represent very poor parts of tx with lots of folks on welfare. will this finally mobilize the poor in tx? it did in MO when guv blunt destroyed medicaid and he and msot repubs got flushe dout of office.

[sonias]

5. Not sure there is a way to stop them in the short term

Perry could veto the bills but lets face it, they have the votes to pass them. And I wouldn't trust Perry to be the stop on these measures.

I'm sure there will be organized opposition, but the mind set of the new membership in the House is feeding meat to their base. They're going to have the money and organization to push this through under the guise of "belt tightening".

Honestly I'm not sure that the voters of Texas have any idea how bad this can get. They'll pay more attention when it's their medical services under Medicaid and their kids insurance (CHIPS) gets cut.

But for the short term there will be horrible consequences.

:shrug:

[white cloud]

6. Censored????

Tried to email this out. I have had the same thing pop up with AOL regarding Obama going to spend 200 million a day.


An unknown error has occurred. Subject 'Emailing: Medicaid Casualty Of The Texas House GOP Super Majority Capitol Annex', Account: '[e-mail]', Server: 'outgoing.verizon.net', Protocol: SMTP, Server Response: '550 5.7.1 The message you attempted to send was determined to be spam. Please visit http://www.verizon.net/spamfaq for more information.', Port: 25, Secure(SSL): No, Server Error: 550, Error Number: 0x800CCC69

[sonias]

7. Wow

Maybe they've already taken control of the Internets!

Try changing the message heading so maybe it only says "Medicaid Casualty Of The Texas House". :shrug:

Surely you saw that Mike Huckabee tried to rein in the right wing crazy on the 200 million dollar a day India trip? Nobody is going to repeat his words - you watch and see. They will be calling him a liar and traitor soon. His 2012 presidential bid is toast now.

Huckabee Dings Republicans For Howling Over Cost Of Obama's India Trip

[white cloud]

10. LOL

The 200 million story is a funny one and the teapoopers all feel for it. I got some stuff I will post up on it.

[dems4texas]

20. Texans Can Push Back

It's obvious that Slick Rick is going to do whatever to get his way. He's being pushed on by that secession group that held a rally at the capitol last year. I know for a fact that they are working with His Slickness. I went to their website and saw that they are going to give a petition on secession when the legislature meets in January. What those bumpkins don't understand is that all of those petition names and info will be available to the public. We'll be able to see exactly who is behind it and hopefully be able to embarass Slickery enough to get him and the rest of the legislature to back off on all of this crap that they're getting ready to shove down out throats. Come on Texas! We can fight this.

[texastoast]

21. His Slickness

That's just one of the best!

Welcome to DU!

:toast:

[sonias]

24. Welcome to the DU Texas forum, dems4texas!

:hi:

Good points about following the loony trail. I hope you're right about embarrassing the Slickery because it seems he has no shame.

The only reason he might balk at being associated with them is his desire for higher office. Notice how he's backed off his call for secession. All of a sudden he's trying to move more mainstream for a chance at national office.

He makes me sick. :puke:

[BenzoDia]

30. Agreed, what are we going to do?

I've been thinking about this a lot lately concerning Medicaid and Affordable Health Care Act.

I've been toying with the idea of mailing multilingual pamphlets to poorer neighborhoods highlighting the major points of what's going on, and what we stand to lose.

A friend of mine suggested paying for ad space in local newspapers.

Bulletin boards in local Universities?

What should we do to motivate people to do what's right for our state?

[sonias]

8. Lawmakers Discussing Dropping Health Care Program

Texas Tribune 11/6/10
Lawmakers Discussing Dropping Health Care Program

Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.

Far-right conservatives are offering that possibility in post-victory news conferences. Moderate Republicans are studying it behind closed doors. And the party’s advisers on health care policy say it's being discussed more seriously than ever, though they admit it may be as much a huge in-your-face to Washington as anything else.

“With Obamacare mandates coming down, we have a situation where we cannot reduce benefits or change eligibility” to cut costs, said State Rep. Warren Chisum, R-Pampa, the veteran conservative lawmaker who recently entered the race for speaker of the Texas House. “This system is bankrupting our state,” he said. “We need to get out of it. And with the budget shortfall we’re anticipating, we may have to act this year.”

Well lets see how the teabaggers are going to feel about having their medicaid cut. They hate socialized medicine after all, don't they?

[kjackson227]

9. I knew it would be only a matter of time...

but,this asshole couldn't wait to get back in office before deciding to cut programs.

[efhmc]

11. Heartless, inhuman people who have never had to face

life on a basic level, If they think they are Christians, then they cannot read. The New Testament is opposed to EVERYTHING they espouse.

[sonias]

12. Some how they can reconcile that in their black hearts

Or like you said they can't read and understand what they read.

Poor is mentioned in the bible far more times than money, but it's money they're fixated on.

eHow
How Many Times Is Money Mentioned in the Bible?

(snip)
Warning
The Bible warns that the pursuit of money can cause problems in one's faith and in other areas of life.

Ecclesiastes 5:10 notes, "Whoever loves money never has money enough; whoever loves wealth is never satisfied with his income. This too is meaningless."

In Matthew 6:24, Jesus says, "No one can serve two masters. Either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve both God and money."

Timothy 6:10 states, "For the love of money is a root of all kinds of evil. Some people, eager for money, have wandered from the faith and pierced themselves with many griefs."

[BlueGirlRedState]

13. Several "conservative" friends have children on SSI

I'm pretty sure they mean for medicaid to be withdrawn for the others -- not them. They are really short-sighted.

[sonias]

14. Exactly!

They can't understand the difference between the two parties until it hits home. But by then it's cost them a whole lot.

[w8liftinglady]

15. many of my neighbors get Medicaid...because they work for less

with no benefits.
Their kids will be some of the first kicked to the curb....
and yet-they defend the Christian Right.

[alarimer]

16. They will also balance it on the backs of state employees

By turning our health care into a catastrophic plan and charging us for the privilege of buying a plan we can't actually use.

[sonias]

17. Perry fueling the flames of right wing fire

DMN 11/10/10
Gov. Rick Perry calls for federal health care law's repeal as book tour returns to Texas

SAN ANTONIO – Gov. Rick Perry went to a barbecue restaurant Tuesday to throw out a little red meat and promote his new book after what he called a "whirlwind trip" into the seemingly enemy territory of Washington.

Returning to Texas after five days on the East Coast to promote his book Fed Up! Our Fight to Save America from Washington, he called for dismantling the national health care law, saying states could come up with better and probably cheaper plans.

"Repeal it in its entirety," he said. "Have them start anew from the premise the states can better handle these questions."

Perry has maintained that regulations prevent the states from innovating. He even suggested on CNN during his book tour that Texas could conceivably opt out of Medicaid and find its own solution.

More of the same bad policy crap. Rick Perry who used $13 billion dollars of federal stimulus to balance the Texas budget and has helped Texas into a $25 billion deficit budget hole thinks states like Texas can manage health care better than the federal government. Yea right! :crazy:

:puke:

[onestepforward]

18. Perry has a Medicaid waiver request pending for four years now.

http://www.dailykos.com/storyonly/2010/11/15/920736/-Perrys-Medicaid-opt-out-effort-concerns-Texas-doctors

-snip-

Perry doesn't have a plan for covering Medicaid recipients. In the CNN interview when Perry first brought up the proposal, he said they've had a waiver request with Health and Human Services for four years. States can get waivers to change some of the rules of the program, provided the state demonstrates that the coverage it is providing meets general Medicaid standards. Apparently, in the four years he's had a waiver request pending, he hasn't been able to demonstrate that there's a plan in place to cover Texas's 3.1 million Medicaid beneficiaries.

No wonder the providers are freaked out.

[sonias]

19. "No wonder the providers are freaked out"

Ah but those providers sure should have worried about him earlier. He never has a plan for anything positive. He flys by the seat of his pants most of the time. Bet most of them voted for him anyway.

Perry only focuses on two things - advancing his political career and making money for his friends off the public coffers.

:mad:

[texastoast]

22. You mean families will have to take care of their aged themselves??

Instead of Medicaid helping out with their nursing home bills?

Right?

[sonias]

23. Throw Momma From the Home

You got it!

Austin Chronicle 11/12/10
(snip)
Throw Momma From the Home

Even setting aside the raw economics, the politics of walking out on Medicaid would be a real GOP buzzkill. I asked Anne Dunkelberg of the Center for Public Policy Priorities to consider the actual shape of what these bozos are contemplating. Before getting into specifics, she noted at the outset that it would take yet another massive revision in federal health care law even to enable such a withdrawal. Yet Medicaid is an easy target (unlike the politically popular Medicare), because it's wrongly imagined as only helping "poor people."

Dunkelberg countered with some imposing statistics: "Seven out of 10 nursing home residents in Texas are paid for by Medicaid. Virtually 100 percent of Texans who have serious disabilities ... if they're living in some kind of institutional setting ... that's being paid for by Texas Medicaid. About 55 percent of the babies born in Texas are paid for by Medicaid, and about a third of our children are covered, between Medicaid and CHIP." Start adding up those categories, and pretty soon you've got a constituency even the House Conser­vat­ive Caucus can't ignore.

Writing in Michael Tomasky's blog at the Guardian, University of Chicago health care expert Harold Pollack followed the money. "Almost 60% of Texas Medicaid dollars cover services to the elderly or the disabled," he wrote, so public reaction to any withdrawal might well include "surprising numbers of angry Good ol' Boys asking what the hell happened to the nursing homes and visiting nurse agencies that help their elderly parents, or why their cousin's autistic child suddenly can't get services through his local school."

:kick:

[sonias]

25. Indiana’s experiment with Medicaid a flop

Houston Chonicle 11/20/10
Indiana’s experiment with Medicaid a flop

(snip)
n the case of Medicaid, we have a particularly good example from Indiana. The state's Healthy Indiana Plan offers subsidies to help certain low income uninsured people purchase private health insurance plans, in lieu of offering them traditional Medicaid. The concept sounds irreproachable. Beneficiaries who otherwise wouldn't be able to afford coverage get it, health care providers get better reimbursement than they would if the beneficiaries were covered via Medicaid, and the state pays less than it would if it offered the beneficiaries traditional Medicaid coverage. What's not to like?

Unfortunately, lots. First, many beneficiaries have to pay a lot more out of pocket than they would if they had traditional Medicaid coverage. Nonpayment has been the No. 1 reason for terminating beneficiaries from Healthy Indiana since the program began in 2008, with up to 35 percent of beneficiaries in certain income levels failing to make their first payment.

Second, providers serving Healthy Indiana beneficiaries have indeed been paid more than they would have if the beneficiaries had been covered under Medicaid. However, Healthy Indiana covers only about 44,000 Indiana residents, while more than 830,000 Indianans are uninsured. And in order to pay for the 44,000 Indianans in the Healthy Indiana Plan, the state took $50 million from funds that it uses to help reimburse hospitals for uncompensated care. In other words, 40 percent of the state's uncompensated care funds were spent on only 5 percent of Indiana's uninsured population.

(snip)
There is no evidence that Healthy Indiana beneficiaries are getting better care than Medicaid beneficiaries. However, the care they are receiving costs more, and leaves less for reimbursing uncompensated care for the remaining 95 percent of the uninsured.

"Texas should pay heed." the article goes on to say. Not like the repukes at the Lege would listen to actual experience before they decide to cut off their nose. :shrug:

[white cloud]

26. Why does Gov. Rick Perry want more uninsured Texans?

One of the weirder stories in the health-care sphere right now is that a handful of conservative states are threatening to pull out of Medicaid and instead free ride on the Affordable Care Act. I don’t think there’s much chance that this’ll happen, largely for the reasons that Edwin Park outlines here: First, it’s not actually clear that states can free ride on the new health-care law, and second, doing so would mean losing an enormous amount of federal funds.

Consider the case of Texas, which with 25 percent uninsured, leads the nation in not providing for its residents. If the state pulls out of Medicaid, as Gov. Rick Perry (R) is suggesting, that would put it at 40 percent uninsured, as Medicaid covers 15 percent of the state. Texas might try some other form of coverage, but it will have lost hundreds of millions of dollars of federal funding. You can occasionally do less with more, but when you have a lot less, you generally just do less. Whatever the state tried next would cover fewer people with less-comprehensive insurance, and it’s a safe bet that the rate of uninsured would ultimately settle above 30 percent. Some legacy.

>>>>>>>>

http://southcapitolstreet.com/2010/11/23/why-does-gov-rick-perry-want-more-uninsured-texans/

[sonias]

27. Great article link

Thanks. Ezra Klein is a good researcher.

Just goes to show you what an idiot Perry is.

(snip)
Texas, in fact, will be one of the biggest winners from health-care reform, as its huge pool of uninsured residents means the state will get an uncommonly large amount of subsidies to bring that down to manageable levels. Texas “can expect to see Medicaid enrollment rise by 46 percent while state spending on Medicaid rises by about 3 percent.” Pretty good deal.

And it’s not that different for other states. The new Medicaid costs are being almost entirely borne by the federal government. As Park says, the Feds will pick up “96 percent of the cost over the next ten years,” which means “the expansion will add just 1.25 percent to what states were already projected to spend on Medicaid over that period in the absence of health reform.”

He would rather leave huge amounts of federal money on the table and let people die in Texas. And it's not like other states won't step in and pick it up gladly!

[Honeycombe8]

28. The reason this sort of thing happens, IMO, is that most voters don't use Medicaid,

and have never needed Medicaid. While those who have used Medicaid don't vote. They have enough on their plate just trying to get by...registering to vote and getting to a polling place is too complicated, on top of the other problems they face.

My sister has used Medicaid (in another state) extensively, and is currently using Medicaid. As far as I know, she has never voted.

[sonias]

29. How do you think she will take losing the program?

I mean is that enough to get her to think about voting?

I agree that many people who use social services are not active voters, and they should be. If they connect that voting makes an impact on their lives, maybe they will become active voters.

[Honeycombe8]

31. Well, I guess she will die. She had a stroke at a young age and is in a

nursing home, paid by Medicaid fully. She cannot live on her own, and no single person could care for her (she requires staff assistance). She is in her 50's, so Medicare doesn't apply, I think.

Maybe Medicare would apply if Medicaid were taken away. I don't know.

I encourage her to vote, and I was disappointed that she did not. But I guess I understand. She's overwhelmed by her situation. But even before then, she never voted. Next time, I'll see if I can help her get registered and early vote by mail, if that's available in her state.

She would've voted for Democrats, too, I'm pretty sure.

[sonias]

32. Heartbreaking

Is it possible for her to be moved out of state? I'm very serious about this suggestion.

If she needs Medicaid to live - Texas is not the best state to live in. You and she need to start researching her options for health care that will allow her to live. She needs to live in a state that gives a damn about the poor and working poor. Texas is not that state. I'm not suggesting that it's going to happen tomorrow but I fully expect that there will be massive cuts to social service programs in Texas come this next legislative session starting in January. How quickly that spreads into nursing home care is unknown. I think you and she just need to be prepared for that possibility.

I wish you both the best of health and luck. :hug:

[Honeycombe8]

33. If you think TX is bad...she's in Louisiana. At least Texas has some provisions

for assisted living, when that was possible for her. Of course, that's no longer possible.

Our family is only in Louisiana and Texas, so we're limited to those two states. Not much of a choice. Also, I had checked into Texas for her awhile back, but the residency requirements made it so that it was not possible at that time.

Thanks for your concern. I'll check into the Medicare option, to see if that kicks in, if there's no Medicaid. I think Medicare is tied to age, but I'll check.

For those of us who have seen Medicaid at work with loved ones, we know the enormous benefit it provides. Where would these poor (literally...poor) people go, what would they do? Is it her fault that she didn't make provisions for this situation when she was younger? Yes, but does that mean we dump these people on the street to die? The care is by no means luxurious. It's a minimum of care, but at least it's something, some place for her to stay and be cared for.

[sonias]

34. Sorry I didn't know it was Louisiana

Frankly the whole south is probably just as bad as far as low service states.

Medicaid is not tied into age. It's a federal public health insurance program for people with low income and limited resources but the levels are determined by individual state participation.

Medicare is limited to people 65 and over unless they are disabled.


Medicaid Federal Program website:
www.cms.gov/home/medicaid.asp?

Medicare Federal Program website:
www.cms.gov/home/medicare.asp

I'm with you on supporting these minimum of care programs. No one in this country should die for lack of health care. Unfortunately we have a much more heartless wave of rich politicians in control of policy in the states and our federal government now. :(

[sonias]

35. ...the eligibility to receive state benefits will go down

Texas Tribune 11/29/10
Pitts Readies Constituents for Coming Budget Cuts

(snip)
Pitts told the crowd that the state is studying Medicaid and other forms of government-run health care with the idea of getting out of it. A man in the audience mentioned a friend on the program and asked whether lawmakers would “throw him out on the street.”

“If we did exactly what we’re doing today, we wouldn’t be throwing him out on the street,” Pitts answered. “But if we have any savings on getting out of Medicaid, we will have to throw some people out in the street. I’m not telling you that your friend would be, but the eligibility to receive state benefits will go down.

“Let me be sure that I said that right,” Pitts continued. “Fewer people will be on our Medicaid rolls if we get out and have some savings.”

The initial budget he and his fellow budget writers will present a few weeks from now will eliminate some state agencies, make large cuts to others — “75 or 80 percent,” he said — and might include furloughs of state employees. Lawmakers, at least in that first version, will balance the budget without tapping the state’s Rainy Day Fund.

The story is also titled "There will be blood" on the Tribune home page.

:kick:

[sonias]

36. HHSC/TDI: Texas In No-Win Situation With Medicaid

http://www.texastribune.org/texas-state-agencies/health-and-human-services-commission/hhsctdi-texas-in-no-win-situation-with-medicaid/">Texas Tribune 12/03/10
HHSC/TDI: Texas In No-Win Situation With Medicaid

(snip)
Opting out of federal Medicaid, something Republican leaders have been considering as a method to wipe out Texas’ estimated $25 billion budget shortfall, would create major difficulties, the report states — not just for the millions of poor and vulnerable Texans covered by Medicaid, but for the county governments and public hospitals where much of the financial burden would be shifted.

Up to 2.6 million Texans — many of them children — could become uninsured. And hospitals would still be required by federal law to treat medical emergencies, potentially adding billions of dollars in annual uncompensated care costs funded at the local level. Meanwhile, Texans would continue to pay federal taxes to support other states’ Medicaid spending, the report notes.

Texas would "lose billions each year in federal funds; billions of dollars in indigent health care costs would shift from the state and federal levels to local governments, public hospital districts, medical providers, and the privately insured; and 2.6 million Texas residents could lose health insurance," the report states.

(snip)
Here are some of the report's other findings:

* Agency officials cast doubt on a Heritage Foundation report that predicted Texas could save $8.7 billion a year by dropping Medicaid. The HHSC/TDI report notes that Heritage's findings were based on an assumption that Medicaid clients would become eligible for federal subsidies under new health insurance exchanges. "The final version of the federal law indicates that most Medicaid-eligible individuals up to 133 percent of the poverty level likely will not be eligible for these subsidies," the report notes. If the feds do interpret the law to allow those patients to get the subsidies, the HHSC/TDI officials say, that could alter their own analysis substantially.

:kick: