After education, Health and Human Services make up the second-biggest part of the Texas budget. Despite the billions of dollars being spent, Texas remains the state with the highest proportion of uninsured in the country, at almost 24 percent.
To deal with that, a growing coalition across Texas is clamoring for the state government to pull the switch on Medicaid expansion. That’s an optional part of the Affordable Care Act that would help cover about 1 million uninsured Texans. Hospitals, clinics and even business groups say something must be done about the burden of the uninsured, and expanding Medicaid is the easiest and cheapest way to do it.
State senator Charles Schwertner, the Republican chair of the senate committee on health and human services, said that won’t happen.
“People know that Medicaid is broken and costly an unsustainable and expanding Medicaid in its current form is a non-starter,” he said.
So how about Medicaid in a different form?
Chris Turner, a Democrat representative from Arlington, said Texas could follow the lead of Republicans in other states, and ask for permission from the federal government to redesign Medicaid in a way that would be politically palatable to both parties.
“We’ve seen it in Arkansas, we’ve seen it in Utah, Indiana’s doing it now,” said Turner, who ran part of Wendy Davis’s gubernatorial campaign.
“So I would think that if all those states can find a way to draw down their federal tax dollars to help their states’ health care situation, I would think we’re smart enough to do the same in Texas,” Turner said.
Schwertner said he’s open to that idea, but added it’s not up to the Legislature, it’s up to the Governor and his administrative team to open negotiations with the federal Department of Health and Human Services.
But Turner countered that the legislature should push the governor to do it. Otherwise, the state loses out on almost $10 billion a year in federal money.
“We’re losing that opportunity to make our citizens healthier, we’re losing that opportunity to create jobs and improve our economy,” he said. “So that’s what the legislature should do.”
George Masi is president and CEO of Harris Health.
Back in Houston, the decision not to expand Medicaid is having a huge impact on Harris Health, the county’s hospital and safety-net system.
“That has been really, really profound for us,” said George Masi, president and CEO of Harris Health. “We’re trying to avoid direct service cuts as best we can, but I would not rule that out if the situation becomes truly dire.”
Earlier this month, Harris Health laid off more than 100 employees and eliminated 150 vacant job openings. Even after all of those cuts, it passed a proposed budget with a $14 million dollar deficit.
Masi said it’s directly related to the state’s failure to expand Medicaid. He explained that 85 percent of Harris Health’s outpatients, and 65 percent of the inpatients, are uninsured. Property taxes cover only half of the system’s expenses.
In addition, the federal government has recently cut financial assistance to all hospitals, on the assumption that they’ll make up for it through expanded Medicaid, Masi said. But that never happened in Texas and 21 other states.
“So you get a sense of what an exquisite vise this is we’re caught in, without the Medicaid expansion,” Masi said.
Sen. Schwertner, who is also an orthopedist, said he has other pressing health and human service priorities this session. For example, he wants to reform child protective services.
“Right now, only 26 perecent of the time of caseworkers is spent directly with families and children,” he said. “That needs to change.”
Schwertner also wants to keep more doctors in Texas by paying for the creation of more medical residency slots at teaching hospitals.
“So [right now] we’re educating physicians and then sending them out of state for their graduate medical education,” he said.
Schwertner also called for more funding for women’s health and for mental illness, though he didn’t have specifics yet.
“Mental health is very important to address at an early stage, to where we don’t see it on the back end in our emergency rooms, our schools and in our jails,” he said.
Schwertner has also introduced new bills to crack down on the abuse of painkillers