And They’re Comin’ Round the Corner and into the Final Stretch…

The prospect of an elusive Triple Crown has grown in recent weeks after impressive runs from American Pharaoh in the Kentucky Derby and the Preakness Stakes, so I thought it was only fitting to compare the 2015 Texas Legislature to the world of horse racing. Plus today marks the final 14 days of the constitutionally mandated 140 day session, which means everyone is racing to get their bills passed before the deadline on June 1.

Prior to 1993, both the House and Senate basically allowed for all committee and floor activities up until the final day, which always made that last day a truly epic sprint to the finish line that often included all sorts of crazy amendments and bizarre negotiations (or horse trading). Starting in 1993, both the House and Senate developed rules to ensure rational processes that allowed for proper vetting of legislation, amendments and resolutions. Under these rules, there are several deadlines that bill and resolutions must meet in order to remain viable for consideration. For example, any House Bill that did not make it out of the House as of last Friday (May 15th) is considered dead. Saturday (May 23rd) will be the deadline for Senate Bills to be reported out of a House Committee. This process means that the bills still alive in the final days of session are actually read and understood (although that might be a bit of an optimistic assumption) before they are voted on by the Representatives and Senators. It also means that several bills that died at the hands of the deadline may see new life as amendments that could be added to related bills that are still moving.

Of course, the most important horse in this race (and the only bill that the Legislature is required to pass) is the budget for the next two years. While the last couple of weeks in the Capitol have been very difficult for the budget conference committee, there seems to be a growing sense of optimism that the negotiators have made progress and can finish the race without collapsing before they reach the finish line. The stumbling block that has tripped them up recently is the disagreement between the type of tax cuts they should pass, with the House favoring sales tax and franchise tax reductions and the Senate preferring property tax reductions.

For HCHA’s purposes, we expect the final version of this budget to be somewhat of a mixed bag. On the one hand, we do not believe there will be cuts to the important health and human services that have been cut too many times since 2009, and it actually includes some increases in the areas of mental health and women’s health; but on the other hand, there will be no coverage expansion or even a directive incorporated in the budget to pursue alternative methods to draw down earmarked federal dollars. Most of the advocates in the health and human services arena would have preferred that the additional revenue be spent on improving the lives of low-income Texans, but most of the participants in this Texas Legislature believe that tax cuts benefit more people than increasing state services.

As a side note, like horse racing, the audience/fans often engage in partying and silly behavior, with generally no noticeable effect on the actual race, but this year at the Capitol may have a bit of a different story. There have been a number of stories coming out of Austin the last couple of weeks about a conservative group that has been secretly filming legislators, both inside and outside of the Capitol. Those stories have fueled further rumors that the 800 hours of recordings include enough embarrassing material that several elected officials may choose to end their political careers after the videos are released. Reportedly, none of the recordings will be released before June 1, but will begin to be shared after that date. Somewhat of a “photo-finish,” but from a different point of view (sorry, I couldn’t help incorporating at least one ugly pun).

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Focusing on the Fundamental Challenge: Texans Lacking Health Insurance

For months in Austin and across Texas, several different advocacy groups and a few legislators have been calling for Medicaid Expansion utilizing the Affordable Care Act (ACA); additional voices support the effort but call for an alternative that achieves coverage expansion in a Texas specific manner. On the other side, conservative think tanks have been posting up stories and articles opposing any form of Medicaid or coverage expansion that embraces the ACA (short of some sort of undetermined block grant). The arguments move from policy to financial to philosophical to political and everything in between.

In the coming weeks and months, it is expected that the debate will include the challenges of renewing the 1115 waiver in Texas that has increased mental health services as well as improving numerous other points of needed access to health services. Unfortunately, it would seem that at the moment, the leaders of Texas would prefer discussing anything other than the fundamental components of this challenge.

What has been lost in this debate is the actual problem that has been a challenge to the healthcare systems in Texas (as well as the country) for decades: people who lack health coverage still get sick and hurt, and as a society we support delivering care to those in need regardless of the ability to pay. In fact, President Ronald Reagan signed the law that mandates care back in 1986 (via emergency facilities in hospitals), and the federal government has been holding hospitals accountable to that mandate ever since.

A direct payment for the cost of delivering this care was not included in that act or subsequent acts of Congress, so hospitals (and communities) have created cost-shifting mechanisms to cover this uncompensated care, including pursuing special funds from the federal government to help offset the costs. With the passage of the ACA in 2010, Congress and President Obama called for a change in this uncompensated system by significantly reducing the number of uninsured, but the implementation of that law has been a challenge from the start.

We are not going to begin defending or critiquing the ACA, but with this change in law, the challenge of paying for the care of people who lack health coverage is shifting. The tools and mechanisms that have held health care delivery systems together, including those in Houston, can’t address the current situation. As the Harris County Healthcare Alliance, we are working to encourage an open and collaborative conversation about the best way to move forward, but we must first gain consensus from the leaders that indeed this challenge is the one we are working to solve: finding the most effective and efficient way to provide healthcare to Texans who are sick or hurt and have no health insurance coverage. If we can encourage leaders to agree on the problem, we are at least 80% of the way to finding a solution that is palatable to all Texans.

The Alliance will be working to build a consensus to make the case that this needs to be the focus of the discussions as the Legislature continues its work. We will keep you posted on how you can help. Stay tuned!