Governor Rick Perry is one of more than half a dozen Republican governors resisting a federal Medicaid windfall set to begin in 2014. The Affordable Care Act, upheld by the Supreme Court last month, drives much of the growth potential. It envisions a major expansion in Medicaid, as states extend health coverage to uninsured, low-income Americans; but, states are not mandated to expand Medicaid. Perry pledges to reject the expansion despite the federal government picking up most of the expense. His decision effectively blocks $100 billion in federal money for the state over a decade, according to the state Health and Human Services Commission. It also blocks health insurance under Medicaid to an estimated 2 million Texans, including an estimated 135,000 El Pasoans.
James N. Valenti, CEO and president of University Medical Center of El Paso, discussed his disappointment in Perry’s decision in a recent open letter, saying the governor’s action will “drastically reduce what are called Disproportionate Share Funds (DSH). DSH funds are federal monies that are paid to hospitals like UMC that treat a disproportionately large number of uninsured individuals. Since the healthcare reform law envisioned a significant drop in how many Americans who are uninsured because of the required Medicaid expansion, fewer dollars are going to be earmarked for hospitals’ DSH payments.” Valenti went on to write, “…there is no doubt that it will further marginalize the poor in our community and have a profound impact on the doctors and hospitals that care for them.”
David Buchmueller, a retired healthcare consultant and educator in El Paso, expresses his thoughts about access to care in terms of health insurance coverage in a special guest column for Synapse this month.
Guest Column by David Buchmueller
New:
Study: New Medicaid expansion could be a lifesaver -- in brief: States that expand their Medicaid programs under President Barack Obama's health care law may end up saving thousands of lives, a medical journal report released July 25 indicates. Until now, the Medicaid debate has been about budgets and states' rights; but, a statistical study by Harvard researchers in the New England Journal of Medicine found a 6 percent drop in the adult death rate in Arizona, Maine and New York, three states that have recently expanded coverage for low-income residents along the general lines of the federal health care law. The study found that for every 176 adults covered under expanded Medicaid, one death per year would be prevented. In addition to the drop in death rates among adults ages 20 to 64, the study found a 21 percent drop in delays getting care blamed on cost barriers. The study compared key health statistics in the three states that expanded Medicaid coverage with outcomes in neighboring states that did not, examining five years before the expansion and the five years after.
New:
Friday's New York Times reported on the potential impact on safety net hospitals that treat large numbers of undocumented immigrants of scheduled cuts in Disproportionate Share Hospital (DSH) adjustment payments. The cuts were included in the Affordable Care Act. http://tinyurl.com/c9arjpb
Supreme Court Upholds Affordable Care Act, Texas and local leaders react
By a 5-4 vote, the Supreme Court on June 28 upheld the Affordable Care Act (the "Act"), the centerpiece of President Obama's domestic agenda in his first term, and the largest single piece of legislation in more than 70 years. Read the court's opinion
Here is a compilation of what Texas elected officials and other local leaders have said in reaction
COMPILED FROM NEWS REPORTS
Texas Sen. José Rodríguez, D-El Paso
"Today's decision is an incredible victory for the nearly 30 percent of El Pasoans, the 5 million statewide, and the 1.2 million Texas children who lack health insurance. I applaud Chief Justice Roberts for making the right decision to uphold the individual mandate and putting the Constitution above partisan politics."
U.S. Rep. Silvestre Reyes, D-Texas
"This historic legislation came at a crucial time for our city with over 230,000 people uninsured in 2009. When the new law is fully implemented in just a few years, El Pasoans who now lack health insurance will receive coverage -- many for the first time."
U.S. Rep. Francisco "Quico" Canseco, R-Texas, (district covers the far east edge of El Paso County)
"If we do not repeal it, Obamacare will leave Americans with more expensive and lower quality health care," he said. He added that Washington, D.C., not patients or doctors, would be in charge of health care.
Canseco said the Patient Protection and Affordable Care Act could threaten access to health care by seniors because of the more than half a trillion dollars in cuts to Medicare to pay for it.
U.S. Sen. Kay Bailey Hutchison, R-Texas
"The Supreme Court has declared the health care law constitutional, but that doesn't make it good policy. In fact, the majority said it was not ruling on fairness or wisdom of health care policy, but instead on the power of Congress to levy taxes."
U.S. Sen. John Cornyn, R-Texas
"The Supreme Court made clear today that the American people will be the ultimate judge of Obamacare. As Republicans, we will redouble our efforts to repeal this job-killing law."
Lawrence G. Duncan, CEO, El Paso Children’s Hospital
"While it is good for patients and specifically children to get additional insurance coverage, it does not expand the overall pool of Medicaid dollars. The money will need to come from somewhere, and my suspicion is it will be from the rates paid to physicians and hospitals."
James N. Valenti, CEO and President, University Medical Center of El Paso
“However you feel about yesterday’s Court ruling, few can argue that our nation’s healthcare system is not in need of reform. Nearly 60 million Americans are without healthcare coverage today. Those who have it are often dropped by their insurance companies when they get sick or face steep increases in their premiums. Reimbursement rates for the care that is being provided don’t even come close to covering expenses. And the rate of healthcare spending in the United States is simply unsustainable. The Affordable Care Act does not solve all of those issues, but the legislation still features many positives.”
Dr. Jose Manuel de la Rosa, Vice President for Health Affairs at Texas Tech University Health Sciences Center and the founding dean of the Paul L. Foster School of Medicine
"This is an important step for improving health care for all of us. The research we perform within our own school specifically addresses problems of our population and attracts physicians and researchers alike from across the country." Additionally, he said he would like to urge Congress to move quickly to "provide federal support for additional doctor training by funding more residency and fellowship programs in order to ensure that the border has access to care -- not just an insurance card."
State Sen. Kirk Watson, D-Austin
"If the Legislature expands Medicaid in Texas to comply with the law and this decision, then thousands of Central Texans will have new access to health coverage, and the region will need doctors to treat those people before minor health ailments become catastrophic ones. That's why a medical school is so critical for Austin's future: To attract and train more physicians, we need a reliable stream of medical students, residents and doctors that a medical school would provide."
U.S. Rep. Lloyd Doggett, D-Austin
"The Supreme Court's decision to uphold the Affordable Care Act is a win for Texas families, a win for Texas seniors, and a win for Texas small businesses who have and will continue to benefit from this important law."
U.S. Rep. Michael McCaul,
R-Austin
"The Supreme Court has validated what we have called this all along and what the president flatly denied: that this is the biggest tax increase on the American people."
U.S. Rep. John Carter, R-Round Rock
"We have two grave issues now at stake – our health care system and our individual freedoms. This decision means that in the court's opinion, there are no longer any limits on what individual actions the government can force us to undertake."
U.S. Rep. Lamar Smith, R-San Antonio
"While millions of Americans are disappointed by today's decision, Congress will not be deterred in our commitment to repeal Obamacare."
Gov. Rick Perry
"This ruling will be a stomach punch to the American economy. It is a shocking disappointment to freedom-loving Americans desperate to get our country back on track."
Lt. Gov. David Dewhurst, Republican candidate for U.S. Senate
"Obamacare has been a disaster since it was passed — increasing America's tax burden to cover the out-of-control costs. Obamacare has further weakened our economy."
Bill Hammond, president, Texas Association of Business
"Unless Congress takes action to replace this plan with something that is more workable, we will see many jobs lost, and many businesses that offer insurance to their employees now will drop that coverage."
Becky Moeller, president, Texas AFL-CIO
"Working families in Texas have cause for historic celebration today."
Doug Ulman, CEO, Lance Armstrong Foundation
"Today, cancer survivors throughout the U.S. are celebrating. ... The Affordable Care Act's life-saving measures, so critical to cancer survivors and their families, will be preserved, and we are enormously relieved that justice has prevailed."
Supreme Court hears health care reform arguments beginning today [orginally posted Mar. 26, 2012]
The Supreme Court begins a six hours of oral arguments starting today about the constitutionality of the Patient Protection and Affordable Care Act (“Affordable Care Act”). The Court’s decision is not expected before June 2012. Until then, a basic understanding of the questions the Court will consider, coupled with information about how those questions were briefed and decided by lower courts, may be viewed at http://www.jdsupra.com/post/documentViewer.aspx?fid=3da8cee9-7b61-4159-a6c5-fefea5bca326.
Supreme Court sets date to hear health care reform arguments [orignally posted Dec. 20, 2011]
The Supreme Court announced Monday (Dec. 19) it will hear 5½ hours of arguments spread over three days March 26-28 about the sweeping healthcare reform law championed by President Obama.
The Patient Protection and Affordable Care Act (PPACA or ACA) was signed into law March 23, 2010, passed by a Democratic congressional majority with the support of the president. It has about 2700 pages and contains 450 some provisions.
A ruling from the court is expected by late June and regardless of the outcome, will become a major issue in a presidential election year.
The largest and broadest legal challenge to the Patient Protection and Affordable Care Act comes from a joint filing by 26 states, led by Florida. It was that series of appeals the high court had accepted for review.
At issue is whether the "individual mandate" section -- requiring nearly all Americans to buy health insurance by 2014 or face financial penalties -- is an improper exercise of federal authority. The states also say that if that linchpin provision is unconstitutional, the entire law must be also go.
Joining Florida in the challenge are Alabama, Alaska, Arizona, Colorado, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Nebraska, Nevada, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.
Four issues will be addressed by the Supreme Court:
- Anti-Injunction Act
- Individual mandate
- Severability
- Medicaid 'coercion'
Supreme Court to Rule This Spring on Health Care Law [originally posted Nov. 14, 2011]
The Supreme Court announced today (Nov. 14) that it would hear arguments on the Obama administration’s signature legislative achievement: the health care law. Arguments are expected sometime this spring with a decision coming in early summer, months before the next presidential election. The court will review a key provision of the law, known as the Affordable Care Act, the individual mandate that requires individuals to buy health insurance by 2014 or pay a tax penalty. It will also hear arguments regarding whether the mandate can be severed from the rest of the law, whether the challenge is barred by a federal tax law whether the law’s Medicaid expansion presents an undue burden on the states. Justices have budgeted five-and-a half hours for the arguments – much more than is generally allotted for a single case.
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