A board of medical professionals appointed by Gov. Rick Perry said Wednesday that the state should provide health coverage to low-income Texans under the Affordable Care Act — a move the Republican-led Legislature has opposed.
The 15-member Texas Institute of Health Care Quality and Efficiency recommended that the state’s health commissioner be authorized to negotiate a Texas-specific agreement with the federal government to expand health coverage to the poor, “using available federal funds.”
“We’re trying to look at actions whereby more Texans can be covered,” said board chair Steve Berkowitz, the president and founder 0f SMB Health Consulting. “We’re trying to take the politics out of it.”This copyrighted story comes from the Texas Tribune, produced in partnership with KHN. All rights reserved.
Under the Affordable Care Act, President Obama’s signature health law, the federal government has offered to foot more than 90 percent of the bill for states that expand their Medicaid programs to cover adults living in poverty. Perry and other Republican leaders have criticized the program, which could insure more than 1 million currently uncovered Texans, as inefficient.
Lawmakers considered an alternative “Texas solution” to Medicaid expansion during the 2013 legislative session — an initiative that would have called on the state’s health agency to seek a waiver from the federal government to draw down funds to cover the uninsured. That proposal failed. Ultimately the GOP-led Legislature approved a requirement that the Health and Human Services Commission receive legislative approval before expanding Medicaid eligibility — an effort to ensure that they held the keys to any possible agreement with the feds.
Members of the Institute of Health Care Quality and Efficiency — which was established by lawmakers in the 2011 legislative session to identify evidence-based approaches to improving health care and cutting costs — said Wednesday that Texas’ rate of uninsured was “unacceptable,” and that state leaders should look for an alternative way to expand health coverage. The board’s recommendations are not binding and any such decision is up to the Legislature.
“We should be maximizing available federal funds through the Medicaid program to improve health care for all Texans,” said Joel Allison, a board member who is chief executive of the Baylor Scott & White Health System.
Florida legislators’ refusal to expand the eligibility criteria for Medicaid as called for under the Affordable Care Act might cost billions of dollars in lost funding for hospitals that treat many uninsured patients, according to a report released Monday by Florida Legal Services, a nonprofit legal advocate for the poor.
The financial impact would be felt most acutely by so-called “safety net” hospitals statewide, and in Miami-Dade, particularly by the taxpayer-owned Jackson Health System, according to Florida Legal, which estimated that Jackson could lose more than $570 million a year.
Other Miami-Dade hospitals, including University of Miami Hospital and Mount Sinai Medical Center, could lose as much as a combined $60 million a year, according to the report, while hospitals in Broward, Palm Beach and Monroe counties stand to lose more than $500 million in annual federal funding.This copyrighted story comes from the Miami Herald, produced in partnership with KHN. All rights reserved.
But if state legislators were to accept the government’s offer to spend about $5 billion a year to expand Medicaid to an estimated 760,000 more Floridians, the new revenue would more than offset the anticipated loss of federal funding for hospitals that treat many uninsured patients, Florida Legal reports.
Given that Miami-Dade is home to the state’s largest numbers of uninsured residents, the local public healthcare safety net risks serious damage without Medicaid expansion, said Charlotte Cassel, an attorney with Florida Legal and a co-author of the report.
“Miami-Dade cannot afford [for Florida] not to expand Medicaid,” she said. “It will be a crisis.”
Florida Legal’s report found that Miami-Dade is home to more than 160,000 residents who fall into the so-called “coverage gap,” which means they are not eligible for Medicaid and they do not earn enough income to qualify for government financial aid to buy private health insurance on the ACA exchange.
Miriam Harmatz, a senior attorney with Florida Legal and a co-author of the report, said Florida has an estimated 760,000 residents in the coverage gap who will not have access to health insurance even with ACA reforms.
“The Legislature has a chance to address that,” she said.
The anticipated funding cuts reported by Florida Legal derive from a series of agreements between Florida and the federal government, and the intent of President Barack Obama’s healthcare reform law, which had anticipated that more Americans would have access to insurance under the ACA, reducing the amount of uncompensated care delivered by hospitals.
The healthcare law calls for gradual reductions in certain payments known as Disproportionate Share Hospital (DSH) program funds. In 2014, Florida hospitals will receive almost $240 million in DSH funding, which the state then distributes according to a formula.
But the biggest loss stems from a July 2014 agreement between Florida and the Centers for Medicare and Medicaid Services, which administers the healthcare programs on the federal level.
That agreement calls for the elimination of about $1.8 billion a year in statewide funding through the Low Income Pool program (LIP) starting on June 30, 2015.
The federal funding cuts are scheduled to occur regardless of the Florida Legislature’s actions on Medicaid, according to Florida Legal’s report. For Medicaid expansion to occur in Florida, the legislature would have to approve a Medicaid expansion bill and Gov. Rick Scott, a Republican, would have to sign it.
Florida Democrats and some Senate Republicans have said the state ought to accept the federal money to expand the program, including Sen. Rene Garcia, a Miami-Dade Republican.
At a meeting of Miami-Dade commissioners Nov. 5, Garcia stumped for Medicaid expansion, repeatedly calling it “a game changer” for the state.
“There’s about $50 [billion] to $66 billion waiting to coming into this state,” he said, referring to a 10-year estimate of the federal government’s pledge to never pay less than 90 percent of the cost of adding more Floridians to Medicaid.
Then he laid down the gauntlet: “If the feds continue down this path” of eliminating DSH and LIP funding, Garcia told the commission, “Jackson will be out about $500 million. So you all are going to have to come up with that money.”
As Miami-Dade’s public hospital system, Jackson relies on a balance of local, state and federal funding to operate the $1.6-billion-a-year system of hospitals, community clinics and physician offices.
This year, Jackson administrators estimate that Miami-Dade will contribute about $370 million in local property and sales tax support.
According to Florida Legal, Jackson will receive about $570 million in LIP funds this year and about $75 million in DSH funds.
Carlos Migoya, chief executive officer for Jackson Health, said the nonprofit hospital system is looking at “statewide level” solutions to make up the funding if the federal government ends the programs.
Migoya said Medicaid expansion is “one of our very top priorities,” but that Jackson would also explore “other funding opportunities’’ to pay for care of the uninsured and indigent if the DSH and LIP programs end.
Still, Medicaid expansion will not help Jackson with a chunk of its uncompensated care — the amount spent to care for undocumented immigrants.
Jackson’s total costs for providing medical services to the undocumented in the year ending Sept. 30, 2014 was about $47.6 million. Jackson’s total costs for uncompensated care in the same time period was $485 million.
State Medicaid administrators, hospital representatives and others have been meeting with CMS officials in an effort to persuade the federal government to extend the LIP program beyond June.
Mark Knight, chief financial officer for Jackson, said that is among the hospital system’s preferred paths.
“Right now, we are supporting a revised LIP program,” Knight said, noting that California and Texas officials have negotiated continued federal support for the care of uninsured patients.
Call it the countdown to Saturday.
In total, the state Health Connector expects roughly 414,000 Massachusetts residents to use its new website to sign up for health insurance between this Saturday, Nov. 15, and Feb. 15, 2015.
Beginning at 8 a.m. Saturday — the first day of open enrollment — we’ll know if you can get back on track with a permanent plan, ending a year of frustrating dead-ends online, confusing calls and letters, and uncertainty about your care.
Here are some basic details:
— Open enrollment starts Saturday, Nov. 15. You must sign up by Dec. 23 if you want coverage to begin Jan. 1.
(Keep in mind that though you can enroll whenever, some people with temporary coverage will not be asked to enroll right away. If you have a “purple form,” you have to enroll before Dec. 23; for “green” or “blue” forms, your enrollment period comes later.)
— On Saturday, the call center — 1-877-623-6765 — is open from 7 a.m. to 7 p.m. It will be open 7-7 on Sunday as well.
— The website won’t be up until 8 a.m.
— If you have an old browser, like an old version of Internet Explorer, the site may not work.
— You should have your 2013 income tax return handy when you start, because if the income on that tax return doesn’t exactly match the one you plug into the site, you’ll get kicked off.
— The application process will take about an hour. You shouldn’t have to wait more than three to seven seconds for a response after you hit a button. The site is supposed to be able to handle 46,036 people at any given time.
— Don’t rush. Save and review often. If you notice a mistake after you’ve hit “submit,” like if you add an additional “0” to your salary, for example, you won’t be able to go back and fix the error. You’ll have to call 1-877-623-6765.
— Don’t try to fix errors unless they directly affect your coverage or eligibility. After you’ve hit submit, don’t try to add a phone number, for example, in this first enrollment stage.
— The site will time out after 20 minutes of inactivity. So again, be sure you’ve saved your work. If you start, and have to go look for a document or make breakfast for the kids, you may lose the info you’ve put in unless you hit save.
— When you select a plan, the site is supposed to be able to calculate your actual cost — the amount you will be required to pay every month.
— Many of you will want to know whether your regular doctor or doctors are included in the plans you review. To figure this out, you’ll click a link that will take you off the state site, to the physician network page for the plan you are considering.
— The Connector folks pledge that you will be able to: shop, figure out what level of assistance you qualify for, select a plan, complete your application online, and pay online. If you have any problems, we’d like to hear your story in the comments section below.
It should be noted, however, that the Massachusetts Association of Health Plans says that the portion of the website that validates your premium payment has not been tested. So the association can’t guarantee that you’ll have coverage after your online payment until testing has been completed.
Additionally, a minority of residents qualify for MassHealth (Medicaid) through programs the website will not recognize at this point. For instance: if you’re disabled you may not be automatically qualified for coverage through the new website.
— If you have problems online, the state website guru, Maydad Cohen, says reps at the call center are instructed to tell you how quickly you’ll get a call back. You are not supposed to hear anyone say, “We don’t know what you’re talking about.”
— If you have had coverage through the Connector at any time in the last year, and you don’t go online by mid-December, you will likely get a reminder call.
The Connector plans to post weekly updates using this format:
We’ll post these updates as they come in.
A close kid relative of mine can die if he eats gluten. Actually, this child is so allergic to gluten that you can’t even cook pasta if he’s in the room or he’ll break out in a rash, or worse. He’s been to emergency rooms, both in the U.S. and abroad, due to his allergies, and it usually happens when someone hands him a so-called “gluten-free” cookie or snack that actually wasn’t.
So gluten is a hot topic in our family. Recently, though, skepticism has been rising about the very notion of gluten allergies, or sensitivities. Exhibit A in this arena is Michael Specter’s latest New Yorker story on the current gluten-free craze, which has enraged more than a few parents whose kids have real and scary reactions to gluten. Specter writes:
While there are no scientific data to demonstrate that millions of people have become allergic or intolerant to gluten (or to other wheat proteins), there is convincing and repeated evidence that dietary self-diagnoses are almost always wrong, particularly when the diagnosis extends to most of society. We still feel more comfortable relying on anecdotes and intuition than on statistics or data.
Speaking on Here & Now yesterday, Specter reiterated the article’s takeaway that the national gluten-free obsession is mostly just the latest fad diet.
Maybe. But here’s some reaction from a parent who thinks Specter should have taken a broader view:
“My son has gone into anaphylaxis from accidentally ingesting gluten four different times over the course of his life. Each time we had to administer an emergency Epipen injection and rush him to the ER. I don’t think he was reacting to a fad…
It is fine to debate the merits of going gluten free as a diet or lifestyle choice for some. But for others it is a clear medical issue, with the most serious consequences. The number of Americans suffering from celiac or severe gluten allergy seems to be growing fast, and that merits substantial funding and research to figure out why and find cures. It would be a mistake if that fact were to be lost amid the current efforts at “de-bunking” the risks of eating gluten for some.”
Health officials in the central Massachusetts town of Westminster say they will not hold another public hearing on their proposed first-in-the-nation town-wide ban on tobacco sales, after a rowdy crowd of hundreds forced Wednesday night’s meeting to end in just 20 minutes.
Board members began the hearing with warnings that if the crowd couldn’t remain calm and respectful, they would end the meeting.
The hearing was dominated by opponents of the ban, such as Westminster resident Kevin West.
“I find smoking to be one of the most disgusting habits anybody could possibly do. On top of that, I find this proposal to be even more of a disgusting thing that anybody could ever give any town in the United States of America,” he said.
When repeated efforts to calm the crowd, which erupted into applause a number of times, failed, the meeting was ended and health board members were escorted out by police.
Instead of another meeting, the board will accept written comments through the end of the month.