Friday, February 6, 2015

Uninsured Texas and ObamaCare: Republicans in Washington Ignore Realities Back Home

by Nomad

Nearly a million Texans have signed up for Obamacare since November surpassing all expectations. Although Texas is the uninsured capital of the nation, Texas Republicans in Washington are leading the crusade to gut affordable health care for all Americans.

Three days ago, the House of Representatives under Republican control, passed a bill attempting to shut down the Affordable Care Act. It was an exercise in futility and was the 56th vote to repeal the controversial healthcare reform. Even in the unlikely event, it passes the Senate, President Obama stands poised with his veto pen in hand to kill the legislation.

Meanwhile, back in Texas, the Republican heartland, it was a completely different story. Since open enrollment began on Nov. 15, nearly a million Texans have signed up.

According to an article in the Dallas Morning Observer, this year's enrollment figures are up by a third compared to last year's statewide enrollment campaign. Marjorie Petty, Texas regional director of the U.S. Department of Health and Human Services. is quoted as saying.
"This is the second year, and I think we’ve surpassed the numbers that were expected"
The sign up effort has for the first time been broken down by metropolitan areas. This shows that  the Dallas-Fort Worth area had the most enrollees in Texas, 277,015, according to HHS. Next were the Houston area with 256,982 and San Antonio with 89,821.
The article also notes:
  • In the first two months of open enrollment, 86 percent of Texas consumers who selected health insurance plans were determined eligible for financial assistance to lower their monthly premiums.
  • In Texas, consumers can choose from 15 issuers in the marketplace in 2015, up from 12 in 2014.
  • Texas consumers can choose from an average of 31 health plans in their county for 2015 coverage, up from 25 in 2014.
  • 80 percent of Texas marketplace enrollees as of December 2014 could obtain coverage for $100 or less after any applicable tax credits in 2015.
The numbers should not come as a big surprise. After all,  as the  Texas Medical Association reminds us, Texas is the uninsured capital of the United States.
More than 6.3 million Texans - including 1.2 million children - lack health insurance. Texas' uninsurance rates, 1.5 to 2 times the national average, create significant problems in the financing and delivery of health care to all Texans. Those who lack insurance coverage typically enjoy far-worse health status than their insured counterparts.
Reviewing data collected by the federal Agency for Healthcare Research and Quality, a 2012 report rated  the Texas healthcare system as "the worst in the nation." 

The study based its findings on "155 quality measures, including success of preventative care measures, disparities in treatment among different ethnic groups and the effectiveness and cost of care for patients with chronic or terminal conditions such as diabetes and cancer." 

Despite the grim situation in Texas, Texas State Senator Ted Cruz recently made a new attempt to repeal the new healthcare law.

His crusade against affordable healthcare comes even as his own state saw a large percentage of first time enrollees. Of the total, 56 percent re-enrolled from last year and 44 percent were new.
Oblivious to the realities on the ground, Cruz told reporters:
"In November voters all across the country spoke loud and clear that Congress must do everything we can to repeal Obamacare."
The bill, even if it passes the Senate, will be vetoed by the president. Senator Cruz, who became famous/notorious for his pointless 21-hour filibuster in which read Dr. Seuss to an empty auditorium, said in a statement.
"We must send this bill to the President's desk. If he vetoes it, the GOP Congress should pass bill after bill to stop Obamacare. Each will have broad support among the American people, and Democrats in both chambers will be hard-pressed not to support them,"
Meanwhile, in the real world, Marjorie Petty was attributing the good enrollment figures on "amazing local leadership."  She also thanked local and civic groups across the state who are assisting the sign-up effort.

The Courts' Decision
As  the Supreme Court reviews the King vs. Burwell case, which could affect important aspects of the healthcare plan,  Dallas County Judge Clay Jenkins was encouraging Dallas-area residents to make an effort to get enrolled, either online or by seeking out an event where people are signing up  before the Feb. 15 deadline.

At the same time, back in Washington, Texas  House Republican Michael Burgess said a few days ago,  
“With the Supreme Court case looming, this body must be prepared to work for the American people and stave off possible chaos that may ensue."
That's not just an example of fear mongering or hyperbolic politics. 
The Supreme Court could declare that the federal government cannot offer healthcare subsidies to low and moderate income residents in the 37 states that have opted out of creating their exchanges. If it does, then it is, according to a Kaiser Foundation report, possible that more than 13 million people could lose subsidies in 2016.

In July of 2014, the Texas Tribune pointed out the scope of the state's problem if the courts rule out subsidies.
Texas, like dozens of other states with Republican leaders, declined to create its own state-based insurance exchange under the ACA. Instead, Texas relies on a federally managed marketplace. 
As we all now, most people are now required to purchased health insurance or face penalties. However in Texas, the federal government is helping pay the bills for  the 84 percent of the Texans who purchased coverage through the federal exchange and qualified for subsidies. (According to the U.S. Department of Health and Human Services. those people are receiving $233 in monthly tax credits,)

But whose chaos will it be? President Obama or the Congressional Republicans.. or the Texas voters that put people like Ted Cruz in office in the first place?

Partisan Politics Spells Death
Clearly nothing could make the Republicans happier than to see Affordable Healthcare put down. The collateral damage to the GOP's plan is that millions of Americans, many of whom now have health insurance for the first times in their lives, will find themselves suddenly in limbo-land.

But healthcare does not stop for the political process to work itself out. Children with serious illnesses cannot wait until Republicans and Democrats are able to find a compromise.

While Republicans continue to battle affordable health care, the number of patients will climb, Many Texans, for example, will be diagnosed with cancer or life-threatening illnesses during this time. They require immediate treatment that they cannot -without subsidies- afford.

One option could come at a state level- an unlikely situation given the Red State animosity for ACA. One source observes:
At the state level, Texas’ Republican leaders have also staunchly opposed the ACA since it was passed in 2009, rejecting both a call to expand Medicaid eligibility for young adults and a call to create a state-run insurance exchange.
If the courts rule that those who enroll in the federal marketplace are not eligible for subsidies, state legislators would have to decide whether to create a state-run exchange so that Texans would qualify for the subsidies, said Stephanie Goodman, spokeswoman for Texas’ Health and Human Services Commission.
In the end, a Supreme Court ruling against Obamacare will undoubtedly be a disaster for the country. In Texas, with its poor state of healthcare, partisan politics could become a matter of life or death for the state's uninsured.