David Balat’s article “Democrats’ Cruel Cuts to Health Care for Low-Income Patients,” published Nov. 5, quotes 20 Democrats from states that did not expand Medicaid and who wrote a letter to House Speaker Nancy Pelosi (D-Calif.) with concerns about the Build Back Better expansion of the Affordable Care Act.
In the letter, the lawmakers expressed concerns that the “pay-for” proposal in the bill will compromise the care already being provided. They state that limiting payments for uncompensated care and cutting disproportionate share hospital payments will undermine the care that hospitals provide.
However, these same 20 Democrats passed the bill with the same exact provision in place. Balat, the director of the Texas Public Policy Foundation’s Right on Healthcare initiative, uses the letter to point out the disparity between their words and votes.
“I think it may be appropriate to quote the 20 Democrats that represent the 12 states that did not expand in their letter to Speaker Pelosi and [Senate] Leader Charles Schumer,” Balat said. “They write, ‘The reality is limiting uncompensated care (UC) pools and cutting disproportionate share hospital (DSH) payments is a misguided penalty that puts our most vulnerable constituents at risk.’”
“They go on to say that, ‘compromising the very hospitals that provide care to our most vulnerable is not the solution.’
“They even say in the attached letter that if this proposal is implemented, that ‘the transition could be disastrous,’” he added. “Of course, this would impact our rural, children’s and specialty hospitals. The Democrats were right to be concerned enough to put their name to this letter but, unfortunately, they voted for the bill that will result in this troublesome outcome that will put our hospitals at greater risk.”
Texas is the most uninsured state in the nation as one of 12 has that has limited Medicaid coverage for adults, Spectrum News 1 reports.
“In Texas, we have over 600,000 people who are eligible for Medicaid but who have chosen not to enroll,” Balat said. “That number exceeds 1.2 million for those that are eligible for ACA [Affordable Care Act] tax credits and yet choose not to enroll. The expansion does not ensure that everyone will be covered by an insurance program. Even if they are insured, having coverage does not guarantee health care.
“We have a limited number of doctors that even accept new Medicaid patients or ACA plans, which has delayed wait times to get an appointment,” he added. “Due to this, more and more people are going to the ER for care or not getting it at all which is perhaps the reason we have so many that choose not to enroll.”
Texas already has a shortage of doctors enrolled in the Medicaid program and even less are accepting new Medicaid patients. Patients without a physician end up in the emergency department. A condition that would have been easily and less expensively addressed in a clinic ends up costing more to treat in an emergency room, Balat stated in a TPPF post last December. Texas spends more than $1 billion on emergency room care.
Balat argues that expanding Medicaid does not address the current problems that plague the program. Currently in Texas, approximately 166,416 people, mostly disabled and children, are on a wait list just to participate in the Medicaid program. The wait lists to find a Medicaid enrolled medical provider are also long. Adding another 1 million Texans will exacerbate the problem and will lead to even more crowded ERs and wait times, he argues.
States that have refrained from expanding Medicaid have not done so because they have yet to solve the problems of a paucity of accepting providers, limited treatment options and lacking prescription coverage, Balat says.
KHN reports that more than 2 million people, including 771,000 Texans, would be eligible for health insurance under the federal $1.75 trillion social spending plan. Those people are currently uninsured because Texas is one of the dozen states that did not expand Medicaid coverage under the Affordable Care Act in 2010. The uninsured have incomes too high to qualify for Medicaid but are below the $12,880 annual federal income minimum to qualify for ACA marketplaces.
KHN also reports that 60% of those in this coverage gap are black and Hispanic.
The proposed bill would increase the federal matching rate for Medicaid to 93% from 90% beginning in 2023 through 2025. The aim of this increase is so participating states could maintain and expand Medicaid.
The proposed federal bill would cut billions in Medicaid funding to the non-expansion states beginning in 2023 to pay for the increase and as a way to incentivize them to expand Medicaid.
Balat said the Texas Legislature has the right idea.
“The Health Families, Healthy Texas initiative in this last session was a bipartisan effort that sought to achieve three things, make health care more affordable, increase access, and fix our safety net for those for whom it was intended,” he said. “A number of bills signed into law focused on the uninsured in Texas to provide lower cost medications (House Bill 18), provide lower cost alternatives for coverage with the Farm Bureau and Texas Mutual, increased the options for telemedicine, made it easier for physicians to practice in Texas to increase the supply, and compel hospitals to post their prices so everyone can see what they are for non-emergency services.”
Balat has experience in both health care and politics, having worked for more than two decades as a hospital executive, and sought the Republican nomination for Texas’ Second Congressional District in 2018.
He said it’s important to keep an eye on the ultimate goal.
“The focus must be on fixing our healthcare system that is poorly performing and not on relying on insurance cards as a salve that is proving to not be as effective as everyone thinks,” Balat said. “An important example of this is the number of bankruptcies in this country due to medical bills. Nearly 80% of those going into bankruptcy due to medically related bills are those that have health insurance. People in Texas, as we’ve seen in the polling, care about making health care more affordable and we should too.”
