This commentary, written with fellow members of the Texas Well and Healthy Campaign, appeared in the Austin American-Statesman, on Sunday, August 5:
Lately when state leaders talk about health care, one thing that
almost never comes up is health. Every generation wants for the next one
to have a longer, better life and the one before to meet dignity in
aging. Medicaid does that for 3.5 million Texans.
The vast
majority of them are children, able to get preventive care and
treatments they need by seeing a doctor in a doctor's office, so they
grow up healthier. Medicaid also helps Texans with lifelong disabilities
receive support in their communities and gives expectant mothers who
otherwise couldn't afford prenatal care an opportunity to have healthier
babies. Vulnerable seniors, including 7 out of 10 Texans in nursing
homes, count on Medicaid every day.
For these patients and their
families, Medicaid truly is a lifeline, one overwhelmingly favored in
polls of American voters. What's not popular is the idea of
restructuring Medicaid as a block grant, as some in our state have
proposed. One 2011 survey found 60 percent of voters grasped what our
Texas leaders miss: A Medicaid block grant would do what it sounds like--
block many people from getting needed health care because, by giving
states more control of how the money is spent, it would open the door to
more restrictions on coverage.
Causing patients to lose the
coverage they have today and ignoring the needs of millions who have
none at all: This is what's at stake in the choices our state is
considering about Medicaid. The nation's health care law gives Texas a
cost-effective way to cover nearly 2 million more low-income,
currently uninsured Texans beginning in 2014. Gov. Rick Perry says he's
not interested, even though those additional folks won't cost Texas a
dime before 2017. The federal government picks up 100 percent of the
cost of growing Medicaid over the first three years, and no less than 90
percent after that.
Perry and others talk about Texas's finances,
and we'll come back to that. But what about the difference this could
make for people's health? Two recent studies of Medicaid's impact by
separate research teams at Harvard University provide clues. They found:
- Having Medicaid means better options.
A rigorous study in Oregon allowed researchers, for the first time, to
compare two truly alike groups, with the only real difference being that
one qualified for Medicaid. Those enrolled became significantly more
likely to say they felt healthy and were more likely to get screenings,
medications and primary care. Researchers saw big jumps in the overall
well-being of the group with health care.
- Having Medicaid reduces strain. In
the same study, the Oregon residents with Medicaid experienced depression much less frequently. They said their
peace of mind was better, and they had fewer medical bills sent to collection agencies.
When a doctor recommended a follow-up, they were more likely to get it.
- Having Medicaid saves lives. In
a separate study, researchers looked at Medicaid expansion efforts,
like the one in the nation's health care law, for three states: Arizona,
Maine and New York. Comparing those states with similar places without a
Medicaid expansion, the researchers noticed a 6 percent decline in
deaths in the states that extended Medicaid to more people.
To put
that in perspective, if that trend carried over here and each of the
uninsured adults newly eligible for Medicaid in 2014 got it,
Texas could save roughly 10,000 lives. That's the equivalent of
preventing a year's worth of fatalities from accidents.
The value
of improving so many lives should go without saying. Yet our state's
Health and Human Services commissioner suggested recently that Medicaid
is so problematic that Texas should contain it, rather than see it grow.
Luckily,
actions speak louder than words here. Commissioner Tom Suehs has spent
three years making Medicaid stronger and more effective, so more
children eligible for coverage actually get it. Before Suehs' tenure, it
was fair to characterize enrollment systems in the state's coverage
program for poor children as deeply challenged, but not today. In the
past few years, even as parents lost jobs that provided health care for
their children, the rate of uninsured Texas kids plummeted by 22 percent -- that's 200,000 more children with health care, mostly thanks to the
Children's Health Insurance Program and Medicaid.
Even when it
comes to costs (often state leaders' preferred measure of success),
Medicaid outperforms Medicare and private insurance. The average price
of Medicaid for each enrolled Texan is lower today than a decade ago. It
is true that Texas spends -- and gets back from the feds -- more today
than it did a decade ago, but that is because Medicaid is helping more
people. It's also because we finally started to get serious about
covering uninsured children. More work remains, but let's be proud that
more kids have coverage today than at any time in history.
Medicaid
works not only for those it serves, but for all Texans. According to
separate analyses from Texas economist Ray Perryman and Families USA,
having Medicaid for Texans means more money in Texas taxpayers' pockets.
Here's
why. When people can't afford health care, they see a doctor in the
most expensive place: the ER. If patients can't foot the emergency room
bill, hospitals must make up that cost. They do so through higher local
taxes and price hikes on what they charge private insurers.
Texas
hospitals have to cover more costs related to the uninsured in a single
year than Texas would spend over five years extending Medicaid to more
low-income Texans under the Affordable Care Act. Either way, our
communities, all of us, carry those costs. To anyone who's not a state
official, it should be obvious that the
larger-local-tax-plus-premium-hike scenario costs Texans more in the
end.
Enrolling eligible Texans in Medicaid will not only take the
pressure off hospitals, it will bring $100 billion in federal funds to
Texas over a decade. That money would flow into our local economies and
health systems, creating jobs along the way.
And, yes, some of
that funding comes from federal taxes that Texans pay on medical
industry products, tanning and very high income. Is Perry truly
suggesting that Texans forfeit benefits for their own community, while
potentially donating tax contributions to the hospitals, doctors and
patients of California and New York?
The Affordable Care Act isn't
perfect, but it moves in the direction state leaders often say they
want: It takes steps toward changing the bad incentives in the current
medical payment system. Without passing new burdens to patients, health
reform experiments with paying providers not based on the number of
tests and procedures they run but how effectively they treat their
patients. In this regard, both health reform and Texas's current
hospital Medicaid waiver could reduce costs while making patients safer,
too.
What's right for Texans' health and pocketbooks is embracing
the Affordable Care Act, especially a Medicaid solution that will
improve millions of Texans' lives.
