PUBLIC BENEFITS

CPPP has compiled data for all 254 Texas counties to illustrate the expected impact of Affordable Care Act (ACA) implementation on uninsured numbers and rates by county. The sources are drawn from respected and reliable experts including the US Bureau of the Census, Texas demographers Michael Cline, Ph.D. and Steve Murdock, Ph.D., and the Texas Health and Human Services Commission.

The center's Anne Dunkelberg testified at the Legislative Budget Board-Governor’s Office on Budget and Policy public hearing on the Texas Health and Human Services Commission’s Legislative Appropriations for the 2014-2015 budget period. The center’s testimony stressed the importance of the $3.7 billion GR in additional appropriations for 2012-2013 that will be needed to continue Medicaid and CHIP operations after March 2013.

Texas is projected to see the largest percentage gain in insurance coverage of any state under health care reform. With nearly one in four of the 25 million Texans lacking coverage today, any significant gain in coverage will reduce local charity care and uncompensated care costs and tax burdens. A recent model developed by Michael E. Cline, Ph.D., and Steve H. Murdock, Ph.D. of Rice University provides county-level projections to help local officials and residents plan for how increased coverage under the Affordable Care Act could affect their communities.

The center testified at an interim hearing of the Senate State Affairs Committee that allowing Texans to purchase health insurance from companies in other states will not make coverage affordable for the uninsured. Instead, cross-state health insurance sales would create a “race to the bottom,” letting insurance companies choose their regulator and skirt state consumer protection laws.

The Medicaid Women’s Health Program (WHP) provides essential well-woman services to low-income women, saving the state over $40 million annually in the cost of unplanned births and, subsequently, abortions. For every dollar the state spends in the program, the federal government provides nine more. Federal funding in WHP was forfeited when Texas adopted existing program rules designed solely to exclude Planned Parenthood, which provided about 45 percent of services in WHP. These rules conflict with federal Medicaid law by denying women freedom of choice to select their own health care providers, and are currently being challenged in court.

When consumers are treated by doctors who are not part of their health insurance’s network, they may be billed by the doctor for everything insurance did not cover �" a practice called balance billing. Even diligent consumers who carefully check whether providers take their insurance can end up unexpectedly being treated by an out-of-network provider and balance billed.

The U.S. Supreme Court’s June 28 decision to uphold the Affordable Care Act (ACA) could benefit Texas more than any other state, offering an opportunity to dramatically improve uninsured rates, increase family economic security, and reduce uncompensated care burdens. Legal experts say that the only change to the ACA was the removal of a full loss of federal Medicaid funds as a potential penalty for states denying coverage to U.S. citizen adults in 2014�"all other Medicaid provisions remain in effect. Still, the Court’s decision raises the possibility that Texas could refuse to expand Medicaid to adults below and just above the federal poverty line, leaving billions of federal dollars on the table and millions of our poor uninsured.

Starting in 2014, the Affordable Care Act (ACA) requires that health insurance plans for individuals and small businesses contain “essential health benefits” �" a new floor for benefits that will help ensure people have comprehensive coverage. Essential Health Benefits (EHB) must also be included in the benefit package offered through the Medicaid expansion to adults up to 133 percent of the federal poverty level starting in 2014. The ACA outlines ten broad categories of essential health benefits (EHB) that include hospitalization, ambulatory care, maternity, mental health care, prescription drugs, and pediatric services.

Anne Dunkelberg, associate director and senior policy analyst, delivered this presentation to medical students and health care professionals on Tuesday, July 10, 2012, at the University of Texas Medical Branch’s 2012 Health Policy Lunch and Learn Lectures in Galveston, Texas. Her lecture covered the facts and remaining questions about the Medicaid expansion option and what it means for Texas. Materials will soon be revised to reflect new cost estimates released by the Texas Health and Human Services Commission this week.

Associate Director Anne Dunkelberg on the Governor’s announcement about Medicaid expansion and establishment of an insurance exchange as part of the Affordable Care Act.

“Expanding Medicaid is a great deal for Texas and refusing to do so is not something the Governor should decide by himself before Texans have had a full and thoughtful conversation about what's at stake for our state, and then the Legislature needs to decide on a course of action. Our state has an opportunity to help millions of Texans get the quality, affordable health care they need, and we should not pass it up."

(AUSTIN, Texas)�"The Center for Public Policy Priorities released the following statement today regarding the Supreme Court’s decision to uphold the Patient Protection and Affordable Care Act:

“Today’s Supreme Court decision to uphold the Patient Protection and Affordable Care Act is great news for Texas families. With more than 6 million Texans uninsured and billions of dollars in federal funding on the table for our state, Texas has the most to gain from today’s pivotal decision."

Texas is arguably the biggest beneficiary of the Affordable Care Act (ACA), the national health reform law. That means Texans have the most to gain or lose as the U.S. Supreme Court determines the constitutionality of the ACA. This policy page describes what is at stake for Texans as the Supreme Court reviews the ACA.

The U.S. Department of Health and Human Services recently posted guidance for states on Federally Facilitated Exchanges and Partnership Exchanges. Health insurance exchanges are new, competitive health insurance markets that will open in all states by 2014. The Affordable Care Act allows states to set up their own exchanges, but provides the fall-back of a federal exchange in states that choose not to act. Because Texas has chosen to delay planning for an exchange, it is likely that Texas will have a Federally Facilitated Exchange in at least 2014, and possibly longer. The creation of an effective and user-friendly exchange in Texas will be fundamental to expanding coverage in the state, where one of four people is uninsured. The center submitted the following comments on how the federal guidance can be strengthened so that FFEs better serve consumers’ needs.

The Food Research and Action Center (FRAC) released a national analysis today that shows Texas’ participation in the Summer Food Programs remains low. Only 9.4 percent of low-income kids received summer meals on an average day in July 2011, according to the Hunger Doesn’t Take a Vacation report. Texas’ poor performance, which is lower than the national average of 1 in 7, means missed meals for children and missed dollars for the state. Texas families can find nearby summer meal sites and more information by calling 2-1-1 or through the Texas Department of Agriculture’s website.

The center is excited to join with our partners to launch a new website, the Texas Hunger Research Project.

The website is maintained through a collaborative effort between three Texas anti-hunger organizations: Texas Hunger Initiative at Baylor University, the Texas Food Bank Network, and CPPP. The site will serve as a clearinghouse for hunger and nutrition-related data, research, and publications. County and state-level statistics on participation in federal nutrition assistance programs along with other relevant indicators will be available and updated as new data is released.

While the Supplemental Nutrition Assistance Program provides low-income Americans with resources they need to avoid going hungry, it can also be an important contributor to the fight against obesity. Recent research has found that the more SNAP benefits a household received, the more their vegetable, dairy, and meat consumption improved. Low-income Americans who are not participating in the SNAP program or receive relatively low levels of SNAP benefits have been found to be at a significantly higher risk of being overweight or obese than those on the program.

In April, the Texas Health and Human Services Commission (HHSC) launched the newest version of its web-based, “self-service benefit portal.” The new self-service portal is designed to streamline the way that eligibility for benefits is determined. At YourTexasBenefits.com, clients can access information about their application status or benefits from any computer, anytime.

In April, the Texas Health and Human Services Commission (HHSC) launched the newest version of its web-based, “self-service benefit portal.” The new self-service portal is designed to streamline the way that eligibility for benefits is determined. At YourTexasBenefits.com, clients can access information about their application status or benefits from any computer, anytime.

Associate Director Anne Dunkelberg testified before the Texas Senate Committee on Health and Human Services May 8. The committee was hearing public testimony related to current and future spending cuts to the Texas Medicaid program. Her testimony stressed that Medicaid per capita costs have grown more slowly than either Medicare or private insurance, and that Texas Medicaid costs per enrollee have dropped over the last decade.

The center submitted comments to the Texas Health and Human Services Commission on the agency’s draft proposal to federal Medicaid and Medicare authorities for a “Texas Dual Eligible Integrated Care Demonstration Project” which would pilot having low-income seniors who qualify for Medicaid and Medicare get coordinated health care and long term services and supports from a single HMO.

The center submitted comments to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius on two sets of rules relating to the eligibility determinations and enrollment of individuals into health coverage under the Affordable Care Act (ACA). These rules are critically important to ensure the successful implementation of the ACA and that consumers have a family-friendly and seamless experience in the years ahead. The center’s comments focus on how coordination requirements for Medicaid, CHIP, and new Health Insurance Exchanges can be strengthened to reduce the barriers faced by families.

Texas households experience food insecurity at a rate of nearly 19 percent (one of the highest in the nation). Kids without access to meals are less likely to perform well in school and more likely to be at risk of poor health. While most children have access to meals during the year through the national school lunch program, participation in summer nutrition programs is drastically low, causing food insecurity rates to jump during summer months.

The center on yesterday’s vote by the U.S. House of Representative’s Agriculture Committee to cut the Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps).

“Yesterday’s vote by the U.S. House of Representative’s Agriculture Committee to cut SNAP by $33 billion will hurt the families struggling to afford food in this time of high unemployment and economic distress. A cut of this magnitude would affect over 300,000 Texas families who will struggle to put food on the table without the support SNAP provides. SNAP was designed to expand when unemployment is high and contract as economic conditions improve. In this way the program assures that Texans stay healthy during period of job loss and stimulates our struggling economy. Cuts to this program will only weaken our nation’s ability to weather these rough economic times and return to prosperity."

Millions of Texans already benefiting as the Supreme Court considers the law

March is a big month for the Affordable Care Act or the health reform law. March 23rd marks the health reform law’s second anniversary. The health reform law will not be fully implemented until 2014, but many provisions are already in effect and benefiting millions of Texans. From March 26-28, the U.S. Supreme Court will hear legal arguments challenging the constitutionality of the health reform law. Their ruling is expected in late June. We can’t know the final outcome of the case yet, but several lower courts and leading conservative judges have upheld the law.

Governor’s proposal for a state-only program that excludes Planned Parenthood is a poor choice

The Women’s Health Program provides essential well-woman services. The program is part of Medicaid, a federal-state partnership. For every dollar the state spends in the program, the federal government provides nine more. These federal dollars are at risk, however, because of a new state rule that excludes Planned Parenthood from participating in the program. This new state rule violates federal law, which guarantees women freedom of choice to select their own providers. Now the Governor has proposed keeping the state’s new rule but paying for the program with state funds only. This policy paper examines the state’s alternatives and explains why paying for the program with state funds only is a poor choice.

CPPP provided testimony on the Affordable Care Act (ACA or health reform) to an interim joint hearing of the House Public Health and House Insurance Committees on February 27. Testimony from Anne Dunkelberg provided context on health care spending and highlighted ACA provisions that are in effect now and already benefiting millions of Texans. Testimony from Stacey Pogue focused on the steps Texas needs to take this year to define its “essential health benefits” package, a floor for the coverage millions of Texans will have staring in 2014.

The center on the Congressional House Government Oversight Committee hearing on fraud in the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps).

“The Center for Public Policy Priorities shares the federal government’s commitment to safeguard taxpayer dollars and applauds USDA’s success, in partnership with the states, at reducing SNAP fraud to historic lows. Given its efficiency and effectiveness at preventing hunger and reducing food insecurity, we call on Congress to maintain its investment in SNAP and reject any efforts to cut benefits or otherwise undermine the program’s ability to fight hunger.

“SNAP, which helps low-income individuals and families supplement their food resources, is critical in Texas where one in six families struggle to afford food. Over three-quarters of the 3.6 million Texans who receive SNAP benefits are children, seniors, or persons with disabilities. To qualify, a family’s net earnings must be below the federal poverty level, $22,350 for a family of four. The majority of SNAP households include someone who works, and program rules require all able-bodied adults to work to receive benefits."

The center on Texas’ plans to exclude Planned Parenthood from participating in the Women’s Health Program.

“Every one of us wants to live and work in healthy communities where we all have the opportunity to reach our potential. But our state’s elected leaders are pursuing a tragic course that undermines these goals. Effective March 14, the state plans to implement a new rule designed to exclude Planned Parenthood from participating in our state’s Women’s Health Program, but which in reality will destroy the program.

"The Women’s Health Program provides essential well-woman services, including pap smears, birth control, and breast exams to low-income women without health insurance ages 18 to 44. By implementing this new rule, the state provokes an almost certain cut-off of 90 percent of the program’s funds, which come from the federal government."

A national report shows employer-provided health coverage has been on the decline over the last decade, and Texans are among the Americans least likely to be covered by their job, or by their spouse or parent’s job. The report from the Economic Policy Institute in Washington, D.C., compares employer-provided health coverage rates for persons under 65 across the states between 2000�"01 and 2009�"10. While on the decline, however, the report confirms that employer-provided health coverage is still the primary way Americans are covered.

"Feeding Minds: Texas Takes on Hunger and Obesity" is a documentary film that explores the overlapping challenges of childhood hunger and obesity, and what seven cities in Texas are doing to solve this problem.

Providing affordable, quality health care for all is a tough challenge for our state and nation. Health care costs have grown far faster than inflation, and despite spending more than all other industrialized nations, nearly 50 million Americans�"one in four Texans�"lacks health coverage. Slowing health care cost growth depends on reforms to private insurance, Medicare, and Medicaid. This year, Texas’ health challenges were worsened by a deep revenue shortfall from the global recession and an outdated state tax system. Still, we are in a time of great possibility, with market reforms underway and expanded coverage in 2014 under the Affordable Care Act (ACA) health reform law.

The center along with nine other Texas consumer groups submitted comments to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius to offer ways in which HHS’ approach to essential health benefits can be strengthened and improved to support access to quality, affordable health care for all Texans.

Two new national reports on the National School Breakfast Program demonstrate Texas’ strong commitment to improving the nutrition, health, and academic achievement of its students by providing them a nutritious start to the school day.

Unemployment insurance (UI) is a critical piece of ensuring financial stability for families and economic recovery for communities during times of high joblessness. Over the next several days, Congress will debate whether to continue emergency unemployment insurance benefits through 2012 as well as various changes to the program. Even as the unemployment rate continues to improve, it will take several years of strong job growth to return to pre-recession employment levels. There are too few jobs available for the number of job seekers, with more than four workers per job opening. Since the federal UI extensions began in Texas in 2008, Texans have made more than two million federal unemployment claims, totaling well over $9 billion. These dollars have protected families and generated demand for goods and services, helping maintain jobs. Cutting off UI abruptly will devastate families and undermine communities. Emergency UI will automatically phase out as the economy improves and the unemployment rate drops. In the meantime, Congress should continue UI through 2012 and reject phony reforms proposed in the House that would allow states to lower benefit amounts, use UI revenues for other programs, and deny UI to workers.

Federal officials today rejected the Texas Department of Insurance’s (TDI’s) request to delay full implementation of a new rule that requires insurers to increase the value of health insurance or provide rebates to policyholders.

On December 16, 2011, the U.S. Department of Health and Human Services (HHS) released a bulletin describing its proposed approach to defining the “essential health benefits” under the Affordable Care Act (ACA, commonly referred to as national health reform). Starting in 2014, the essential health benefits (EHB) will serve as a floor for the package of health care services that must be covered in many health insurance policies. The ACA establishes some parameters for EHB, but HHS’ recent bulletin leaves it up to the states to define EHB within the federal framework. HHS is accepting public comment on its EHB approach through January 31, 2012, via EssentialHealthBenefits@cms.hhs.gov. This Policy Page explains EHB, reviews Texas’ options, and discusses what we still do not know about minimum standards for coverage in 2014.

Associate Director Anne Dunkelberg on the approval of the “Texas Healthcare Transformation and Quality Improvement” Medicaid 1115 Waiver. (Note: This waiver is different from the waiver to block grant Medicaid, which the Health and Human Services Commission has not yet submitted and about which the Center has grave concerns.)

The health of our entire state is improved when every one of us has access to quality, affordable health care. A key new consumer protection from the national health reform law will make it easier for Texans to purchase health care plans that provide better value for our money. Insurers are now required to meet minimum standards for how much of each premium dollar is used for health care, and to make rebates to consumers if they miss those standards. A recent request from the Texas Department of Insurance (TDI) seeks to delay full implementation of this new consumer protection, which will redirect to insurance companies hundreds of millions of dollars in rebates due by law to Texas consumers.

(AUSTIN, Texas) - On Monday, Federal officials finalized an application from the Texas Department of Insurance (TDI) to delay full implementation of a new rule that requires insurers to increase the value of health insurance or provide rebates to policyholders. If approved, Texans who buy insurance on their own outside of the protection of an employer could lose $350 in forthcoming rebates on average.

The Better Texas film. Together we can make our state a better place for all of us. A place of opportunity and prosperity. Because we all do better when we all do better.

The U.S. Senate and House Agriculture Committees have recommended a $4 billion cut to the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) over the next 10 years as part of the deficit reduction plan being developed in Congress. A cut of this magnitude would harm thousands of low-income Texas families who struggle to put food on the table. It would also harm the food industry, Texas agriculture, food retailers and cost jobs. Our state and local economies receive an enormous boost from SNAP spending, particularly during a recession. Last year, 3.6 million Texans received SNAP assistance, pouring over $5 billion into the economy and generating a total of $9.1 billion in overall economic activity. Low-income Texans should not be asked to bear the burden of budget cuts. Congress has smarter and fairer ways at its disposal to balance the budget and resolve our long-term deficit problem, through a balanced package of selected tax increases and careful spending cuts.

CPPP submitted comments on several proposed federal rules that implement pieces of the Affordable Care Act related to Medicaid, Exchanges, premium tax credit eligibility and enrollment, and uniform summaries of insurance benefits. Taken together, these rules outline a sweeping vision for consumer-friendly tools and processes to help people understand and enroll in affordable coverage through Medicaid, CHIP, and the Exchange.

Executive Director F. Scott McCown regarding what should be done by the Joint Select Committee on Deficit Reduction (the “supercommittee”). The Budget Control Act requires the committee to propose by October 14 a way to reduce the federal deficit by $1.2 to $1.5 trillion over the next 10 years.

“For the good of the country, the committee needs to succeed. But success requires a balanced package that combines selected revenue increases with careful spending cuts. A cuts-only approach would devastate low- and moderate-income Americans because it would mean severe cuts in critical areas like Medicare, Medicaid, and Social Security.

“Our state would be among those hit hardest by a cuts-only approach because we have so many low-income families. Doing nothing would also be hard on Texas because it would trigger automatic cuts, including to defense. Texas benefits from significant federal spending, including from military bases and defense contracting. Most important, though, is that doing nothing would leave the country with an unsustainable imbalance between revenue and spending."

Temporary Assistance for Needy Families (TANF) is an important federal program designed to help needy families achieve self-sufficiency.

Nearly 4.4 million Texans live in poverty. At 17.9 percent, Texas’ poverty rate is the 8th highest among the 50 states. Children in Texas are hit particularly hard: 25.7 percent, or more than one out of four children, are living below the poverty line.

While TANF caseloads are projected to increase 7.6 percent from state fiscal year 2011 to 2013, federal funding for TANF remains stagnant and threatens to decrease.

American Community Survey

• The Texas Top 10 (PDF)
• ACS Tables: Metro Area Poverty and Uninsured (xls)

New data from the Census Bureau’s 2010 American Community Survey (ACS)¹ illustrates that poverty and uninsured rates vary dramatically by age, race and ethnicity, and across Texas’ metropolitan areas. Our analyses of the ACS data, released September 22, focus on 10 of the most striking findings.

The September 13 data released by the U.S. Census Bureau’s Current Population Survey shows that in 2010, Texas remained the state with the highest uninsured rate in the nation at 24.6 percent. The total number of uninsured Texans is 6.2 million people, roughly 250,000 fewer than in 2009.

Children continued to lose coverage through their parents’ job-based insurance. A significant positive note for Texas was the decline for a second consecutive year in the number and percent of uninsured children. This improvement is largely due to more children signing up for Medicaid and CHIP’s public insurance (which more than made up for the loss in job-based coverage), showing the essential role of these programs in protecting children during economic hard times.

Get the full story in the links below.

The U.S. Department of Agriculture (USDA) released its annual report that illustrates the struggle low-income Texans face in affording a consistent and nutritious diet. The USDA report, Household Food Security in the United States in 2010, reveals that almost one in five Texas households (18.8 percent, or 1.7 million households) were food insecure between 2008 and 2010, compared to 14.6 percent of households nationwide. Over one-third of these households (6.9 percent) are classified as having very low food security�"the more severe condition associated with food insecurity�"compared to 5.6 percent of U.S. households. Texas ranks second in the nation for the highest percentage of food insecure households, and is tied for third in the share of households experiencing very low food security.

The 82nd Legislature’s state budget for 2012-13 includes Medicaid-CHIP provisions with a mix of specific direct cuts and spending reductions totaling $2.03 billion general revenue (GR: state dollars) including $805 million GR in cuts to fees paid to Medicaid service providers; other benefit and spending cuts totaling about $843 million GR; managed care expansion savings of nearly $386 million GR; and roughly $4.8 billion GR in under-funding�"an IOU that will come due early in 2013. This Policy Page summarizes high-level Medicaid-CHIP decisions adopted for health and human services agencies; key funding developments for non-Medicaid health programs will be featured in an upcoming August analysis.

CPPP submitted comments to the U.S. Department of Health and Human Services (HHS) urging HHS to protect health insurance consumers by broadly applying rate review and disclosure provisions from the Affordable Care Act. Rate review is an important tool for expanding health insurance coverage by controlling costs. HHS requested comments on whether health insurance sold through “association health plans” should be treated like other insurance sold to individuals and small businesses, and subject to new rate review protections.

Federal and state high-risk pools provide key coverage options for Texans

The health of our whole state is ensured when all of us have access to quality, affordable health care-when we can count on the preventative care we need to stay healthy and see a doctor when we are sick. For many of us with pre-existing medical conditions, we can only get coverage through a high-risk pool. The Pre-existing Condition Insurance Plan (PCIP) is a federally administered high-risk pool created by the Affordable Care Act. Recently, the federal government announced changes that will help increase access to this coverage�"premiums in Texas were reduced by 24 percent and applicants can now prove they have a pre-existing condition by providing a letter from a health care professional, instead of waiting to receive a rejection letter from an insurance company. PCIP is one of two high-risk pools that provide coverage options for Texans.

Over 4 million Texans�"3 million children and 1 million seniors, adults with disabilities, expectant mothers, and very poor parents�"rely on Medicaid or CHIP for the critical health care and community supports they need.

Now, Medicaid and CHIP are targeted for extreme cuts in Austin and Washington.

Under the Patient Protection and Affordable Care Act (ACA), health insurers must spend a reasonable share of premium dollars on medical care and quality improvement efforts, as opposed to administration, marketing, and profits. These standards, known as medical loss ratio (MLR) requirements, hold insurers accountable for how they use consumers’ premium dollars.

Today, U.S. Department of Agriculture Secretary Tom Vilsack awarded performance bonuses to the states with the best payment accuracy rates in the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) in fiscal 2010. The Texas Health and Human Services Commission (HHSC) earned $6.2 million in payment incentives for its performance in two categories: best payment accuracy and most improved payment accuracy. Center for Public Policy Priorities (CPPP) Senior Policy Analyst Celia Cole released the following statement.

“CPPP applauds HHSC Executive Commissioner Tom Suehs for his leadership, and HHSC’s frontline staff for their hard work in achieving this recognition. At 97.87 percent, Texas’ payment accuracy rate was above the national average of 96.19 percent. (Payment accuracy is measured by the amount of benefits issued accurately as a share of total benefits issued.) And at 4.77 percent, Texas’ tops the nation in most improved accuracy rate."

On June 7 the Governor added to the call for the special session: “Legislation relating to the use of the federal Secure Communities Program by law enforcement agencies, the issuance of driver's licenses and personal identification certificates, and the abolishment of sanctuary cities in Texas.”

Last year, we released Common-Sense Principles for Immigration Reform, which is a useful starting point to considering these issues. In that paper, we concluded: “To maintain national security, we must be able to control our borders. To grow our economy, we must welcome immigrants who want to work and who have the skills we need. And, we must enforce our laws in a way that honors American traditions and constitutional principles. We can do all this through a common-sense, fact-based approach to immigration reform.”

As the Legislature considers any legislation in response to the Governor’s call, we urge a common-sense, fact-based approach that recognizes the important role immigrants play to our economic vitality and is consistent with who we are as Americans.

CPPP testified in opposition to House Bill (HB) 5 of the first called Session. HB 5 would allow Texas to ask Congress’ permission to convert all federal health spending for Texas into a block grant based on 2010 levels. Medicare, Medicaid, CHIP, and all public and mental health block grants would be included; only military, veterans, and Indian Health funding would be excluded. As proposed, Texas could choose to eliminate any current federal standards for these programs (including who cover). The House Committee on State Sovereignty approved the bill for a vote by the full House.

April and May 2011 tracking polls from the Kaiser Foundation find most Americans oppose the idea of converting Medicaid to block grant financing to reduce the federal deficit, and the public remains opposed to major Medicare spending cuts as a way to reduce the federal deficit.

CPPP testified in favor of Senate Bill (SB) 7 of the first called Session. SB 7 includes elements from the 82nd Regular Session’s SB 23, SB 7, House Bill (HB) 32, HB 3537, and SB 8, plus some additional provisions. CPPP registered concerns about selected provisions of the bill, as well.

Major health care bills have been quickly re-filed in the 82nd Texas Legislature’s First Called (“special”) Session. Bills set for a hearing on Thursday, June 2�"the third day of the new session�"include a stand-alone proposal for Texas to ask Congress to turn Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and all mental health and public health funding into a Block Grant to be run by Texas state government, and to end all federal minimum standards for who gets health care and how federal funds are used [Senate Bill (SB) 5 and House Bill (HB) 5]. Also set for hearing are nearly-identical large “omnibus” bills (SB 7 and HB 7) which set the stage for generally-positive health care payment and delivery reforms, with some troublesome provisions included.

With one or more U. S. House-passed, budget-cutting proposals expected on the Senate floor for debate this week, the Center for Public Policy Priorities (CPPP) and the Texas Food Bank Network (TFBN) say that the cuts proposed to the Supplemental Nutrition Assistance Program (SNAP, formerly known as Food Stamps) would weaken the program’s proven ability to help poor and hungry Texas kids and families.

Access to birth control for low-income Texas women will be critically wounded under the conference committee proposed budget, collateral damage in battles over abortion. Contraceptive services�"not abortion�"will be gutted in the state budget on two fronts. Like all states, Texas funds family planning through federal block grants and through Medicaid coverage. It should be noted that these programs provide not only birth control, but also preventive care and basic check-ups to low-income and largely uninsured women (one-third of Texas working age adults are uninsured). Sadly, the Texas legislature now proposes to profoundly undermine both areas of birth control access (again, not abortion services, which are not covered under either funding source, or funded in any way through our state budget). As proposed, these budget actions will cause over 400,000 Texas women to lose family planning and basic health services.

The conference committee on the state budget for 2012-13 adopted recommendations for nearly all health and human services issues on May 16. Medicaid provisions adopted include a mix of specific direct cuts and spending reductions totaling $1.65 billion general revenue (GR: state dollars) including $805 million GR in cuts to fees paid to Medicaid service providers; and a $4.8 billion GR under-funding or IOU that will come due early in 2013.

CPPP supports efforts to reduce obesity and encourage Texans to pursue a healthy diet. However, we are opposed to proposals currently being debated in the Texas Legislature [House Bill (HB) 1151 and HB 3451] and the United States Congress that would restrict the use of Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) benefits. These proposals have the potential to erode the value of SNAP benefits─already too little─and would weaken the programs proven ability to help the poorest and hungriest among us.

CPPP has teamed up with nine other consumer, patient, and faith-based organizations to voice our opposition to a group of bills in 2011 Legislature which fundamentally undermine or radically restructure Texas Medicaid and health reform.

The Texas House and Senate have adopted two different budget bills, and a conference committee has begun to work out a compromise budget.

Both chambers provide less money for Texas health and human services than was budgeted in 2010-2011. But the Senate’s version of the budget provides substantially more money for health care and social services than the House version.

Associate Director Anne Dunkelberg testified for Senate Bill (SB) 7 by Senator Jane Nelson.

As the 2011 Legislature winds down, time is running out for Texas to pursue its surest route to a state-based health insurance exchange. A health insurance exchange is a competitive marketplace where individuals and families can purchase private health insurance starting in 2014. Exchanges are established by the Affordable Care Act (ACA or federal health reform), which lets each state choose whether to design and run its own exchange, or turn the task over to the federal government. The ACA’s timeline gives states a limited window in which to pursue a state-based exchange before the federal government assumes the responsibility. Inaction this legislative session does not guarantee that Texas will ultimately have a federal health insurance exchange, but it certainly makes that outcome much more likely.

The 2011 Texas Legislature is considering a range of bills that would make major changes to Medicaid, from block granting the program along with Medicare and all other federal health funding, to using Medicaid as the laboratory for testing new models of care delivery and payments. Several bills, including the House and Senate budget bills, assume provisions to start charging some level of co-payments in Texas Medicaid. Given the current extreme revenue shortfall, the pressure to introduce co-payments is greater than ever before; for example, adoption of co-payments for visits to the emergency room that involve non-emergency medical care is considered likely. This Policy Page describes the Health and Human Services Commission’s (HHSC) proposals for Medicaid and the Children’s Health Insurance Program (CHIP) co-payments, the changes proposed in current bills, and the federal law and rules that Texas must comply with when imposing Medicaid and CHIP co-payments.

Associate Director Anne Dunkelberg testified against House Bill (HB) 5 by Rep. Lois Kolkhorst.

House Bill (HB) 2723 by Representative Walle ensures that people who buy health insurance in the individual market (directly from an insurer, not through an employer) will be sent notices of premium increase at least 60 days in advance. This mirrors the notice timeline for job-based health insurance, giving families sufficient time to either shop around for more affordable coverage, or adjust their budgets to be able to absorb the increase.

Senate Bill 1430 authorizes a new type of fully insured health benefit plan, an exclusive provider organization (EPO), that combines features from preferred provider organization (PPO) plans and health maintenance organizations (HMOs). EPOs have the potential to lower premiums, which can increase access to coverage for small employers and families. However, lower EPO premiums come with tradeoffs for consumers�"less access to out-of-network care than a PPO and higher and less predictable out-of-pocket costs (deductibles and coinsurance) than an HMO.

The House’s adopted budget and the Senate Finance Committee’s approved budget (the full Senate has not yet voted on this bill) take significantly different approaches to allocating and cutting funding for Texas Medicaid and CHIP. Still, one important approach used by both chambers is a substantial under-funding of the program overall that is not associated with particular policy changes or program cuts. Since Medicaid is an entitlement, an underlying assumption is that the state will keep paying Medicaid and CHIP health providers for services every month as long as there is money available, and can cover the “unassigned” budget cuts with a supplemental appropriations bill in the 2013 session as long as funds do not “run out” before January 2013.

The Center for Public Policy Priorities and Methodist Healthcare Ministries are pleased to release this updated primer, designed to give readers an introductory overview of factors shaping Texans' access to health care. Readers will be better able to contribute to federal, state, and local debates about how to improve health care access.

Senate Bill (SB) 1454, by Senator Eddie Lucio, Jr., and House Bill (HB) 2414, by Representative Boris Miles, seek to improve the nutritional health of Texans by exploring ways to increase access to healthy and affordable food.

The Affordable Care Act (federal health reform) creates new health insurance “exchanges” or marketplaces that will open in 2014. Each state will have an exchange, and will decide whether to design and run its own exchange, or turn that job over to the federal government.

If Texas chooses to set up and run its exchange, the state will have broad flexibility to design a health insurance marketplace that meets the needs of Texans. If Texas leaders do not act soon, the federal government will have the responsibility of designing Texas’ exchange. Whether decisions are ultimately made by the Texas Legislature or the Obama administration, Texas’ exchange should be designed to give Texas families and small businesses more control, high-quality choices, and better protections when buying health insurance.

The Center for Public Policy Priorities supports Senate Bill (SB) 1004, because it addresses two major challenges facing Texas: the need to fund a balanced approach to the 2012-13 budget, and the need to improve nutrition and curb obesity, which cost the state $9.5 billion in 2009. Imposing a tax on soft drinks could raise up to $4 billion over the biennium. Increasing the cost of soft drinks has been proven to discourage their consumption, which is associated with poor diet, high rates of obesity and risk for diabetes. Texas needs this additional revenue, along with dollars from the Rainy Day Fund, to minimize damaging cuts to public education, higher education, and health and human services.

House Bill 13 by House Public Health Committee Chairman Lois Kolkhorst would direct The Texas Health and Human Services Commissioner to seek a “waiver” of federal law to dramatically restructure the Texas Medicaid program. In laying out the Committee Substitute for her bill, Chairman Kolkhorst identified a recent Rhode Island “1115 waiver” as a model for what Texas might seek. CPPP testified in opposition to the bill. Our testimony details our objection to overly broad terms of the bill that do not give any guarantee of protections for current beneficiaries, covered populations and services. We detail a list of specific provisions which would prevent the concept from being workable in Texas without substantial additional changes to Texas law and protections for Medicaid’s vulnerable population of children, seniors, Texans with disabilities, and expectant mothers.

The Center for Public Policy Priorities (CPPP) released the following statement regarding U.S. House Budget Committee Chairman Paul Ryan’s budget resolution.

Texas Medicaid and the Children's Health Insurance Program (CHIP) provide vital health care and life-saving supports for some of our poorest and most vulnerable.

Medicaid funding in the House’s budget falls $5.8 billion in general revenue (GR) below what is needed to maintain the program benefits and populations (state dollars; $13.7 billion all funds). This is after the House added $1.8 billion in GR ($4.3 billion all funds).This is still six times the size of the painful cuts to Medicaid and the Children's Health Insurance Program (CHIP) made by the Legislature in 2003.

House Bill (HB) 643 would ensure more children in low-income neighborhoods have access to nutritious meals during the summer. This legislation by State Representative Eddie Rodriguez would increase the number of school districts subject to a state law requiring districts in low-income communities to operate the program. The Summer Food Program provides over $52 million in federal funds each year to low-income communities in Texas to help serve nutritious meals to children in safe, enriching environments. The Summer Food Program is critical in a state like Texas, where too many children are in poor nutritional health.

CPPP supports HB 3397, which would make felony drug ex-offenders eligible to receive federally funded food assistance and employment services through the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps). Enabling this population to receive SNAP services would help ex-offenders to rebuild their lives and reintegrate into our communities, thereby reducing recidivism and the state cost of reincarceration. This legislation comes at a critical time for Texas, as lawmakers are considering eliminating $21.2 million for Project Rio, one of the few sources of funding for reentry services.

The House Human Services Committee will hear HB 3397 on Tuesday, March 29. HB 3397, by Representative Alma Allen would make felony drug ex-offenders eligible to receive federally funded food assistance and employment services through the Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps). Enabling this population to receive SNAP services would help ex-offenders to rebuild their lives and reintegrate into our communities, thereby reducing recidivism and the state cost of reincarceration. This legislation comes at a critical time for Texas, as lawmakers are considering eliminating $21.2 million for Project Rio, one of the few sources of funding for reentry services.

When finger imaging was first implemented, the eligibility determination process for food stamps was paper-based. At that time, there was no way for the Health and Human Services Commission (HHSC) to electronically verify an applicant’s identify to prevent that person from applying for benefits more than once. HHSC has since deployed the TIERS system and introduced electronic third-party verification using sources such as Data Broker and other electronic interfaces. This technology provides HHSC with more cost-effective tools to verify applicant information and confirm identify.

Celia Cole provided testimony to the House Committee on Human Services on HB 710, explaining that the finger imaging requirement for food stamps both undermines HHSC’s efforts to develop more efficient eligibility and enrollment processes, and costs the state of Texas millions in crucial taxpayer dollars.

Opponents to national health care reform are proposing to use federal dollars to fund alternative interstate health care compacts that effectively Block Grant federal health care funding.

Texas Department of Insurance (TDI) and Office of Public Insurance Council (OPIC) are under “Sunset review” this session and must be reauthorized by the Legislature to continue. Both agencies are needed to protect Texas insurance consumers.

House Bill (HB) 1 and Senate Bill (SB) 1 under consideration today fall short of continuing all state services by at least $27 billion in state General Revenue (GR). The Legislative Budget Board (LBB) estimates Medicaid alone is short $7.6 billion GR�"$18 billion including the loss of federal-matching funds. This under-funding would be more than seven times the depth of the disastrous 2003 Medicaid and Children’s Health Insurance Program (CHIP) cuts.

The health insurance connector (or exchange) will play a critical role in expanding coverage to low- and moderate-income working Texas families. Under health reform, connectors must both create a consumer-friendly, competitive marketplace for purchasing health insurance and determine eligibility for and facilitate enrollment in exchange premium subsidies, Medicaid, and CHIP. House Bill 636 will establish a Texas health insurance connector. Decisions made by the Texas Legislature in designing a state-based connector will determine whether it can serve the best interest of Texas small businesses and families and enhance constructive competition.

The Affordable Care Act (commonly called federal health reform) creates new health insurance “exchanges” that will open in 2014. An exchange is a competitive marketplace for health insurance�"think of Travelocity for airplane tickets and Amazon for books�"that will give consumers more control, quality choices, and better protections when buying health insurance.

Medicaid funding proposed in HB l is estimated by the Legislative Budget Board (LBB) as falling $18 billion (All Funds) below the amount need to maintain current benefits, provider fees, and eligibility standards. This underfunding would be more than 7 times the depth of the disastrous 2003 Medicaid and CHIP cuts. While delivery reforms and best practices can and should be aggressively implemented, the best program improvements combined cannot achieve savings anywhere near the $7.6 billion GR shortfall. The Legislature should begin immediately looking for ways to mitigate the damage to our state’s most vulnerable through a balanced approach to balancing the budget that looks to savings and new revenues, not a cuts-only approach.

CPPP, La Fe Policy Research and Education Center, Texas Legal Services Center, and Texas Public Interest Research Group submitted comments to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius in response to the notice of proposed rulemaking for Rate Increase and Disclosure Review. While the proposed rule gives consumers and regulators more information on proposed rates hikes, we urge HHS to strengthen the standards for effective state review to better protect consumers and help constrain the growth in health insurance rates.

The Texas eligibility system delivers over $25.7 billion in benefits annually, and more than 6.4 million needy Texans rely in these services. When our eligibility system fails, Texas loses out on billions of federal dollars that fuel our state and local economies�"particularly during a recession when unemployment has risen and consumer spending has dropped.

We need to provide adequate funding to support the Texas Health and Human Services Commission's eligibility system and DSHS WIC/Farmer's Market Nutrition services.

Medicaid funding proposed in HB l is estimated by the Legislative Budget Board (LBB) as falling $18 billion (All Funds) below the amount need to maintain current benefits, provider fees, and eligibility standards. This underfunding would be more than 7 times the depth of the disastrous 2003 Medicaid and CHIP cuts. While delivery reforms and best practices can and should be aggressively implemented, the best program improvements combined cannot achieve savings anywhere near the $7.6 billion GR shortfall. The Legislature should begin immediately looking for ways to mitigate the damage to our state’s most vulnerable through a balanced approach to balancing the budget that looks to savings and new revenues, not a cuts-only approach.

The Texas eligibility system delivers over $25.7 billion in benefits annually, and more than 6.4 million needy Texans rely in these services. When our eligibility system fails, Texas loses out on billions of federal dollars that fuel our state and local economies�"particularly during a recession when unemployment has risen and consumer spending has dropped.

We need to provide adequate funding to support the Texas Health and Human Services Commission's eligibility system and DSHS WIC/Farmer’s Market Nutrition services.

On January 13, CPPP Executive Director Scott McCown was invited by the Texas Public Policy Foundation to debate Ted Cruz, former Solicitor General of Texas, on federalism and the constitutionality of the Affordable Care Act. Scott explained why conservatives should support the Act and the advantages for Texas.

What do we want Texas to be? A state that won’t squander an opportunity to properly implement the new health reform law.

The new law changes the health care landscape in Texas. It is an important tool Texas can use to achieve our own health policy goals, such as increasing coverage, improving transparency and quality, and controlling costs.

Congress should extend Unemployment Insurance through 2011: 1) to protect hardworking Texas families whose breadwinners are struggling to find work after the global economic recession, 2) to protect Texas jobs in an economy only beginning to recover, and 3) to avoid shifting costs to the federal-state public assistance programs, particularly when states faces massive revenue shortfalls. With the so many workers chasing so few jobs, it is far too soon for Congress to cut off Unemployment Insurance. This emergency spending is essential to our economic recovery, and Congress should not require offsetting spending cuts. Public opinion strongly favors Congress acting now to protect families and our economy.

The new national health reform law will change the health care landscape in Texas. Though Texans’ opinions of the new health care reform law cover the full spectrum from approval to those who would have preferred a different approach, the new law is an important tool that states can use to achieve their own health policy goals, such as increasing coverage, improving transparency and quality, and controlling costs.

We commend Executive Commissioner Suehs and the Health and Human Services Commission for the significant progress HHSC has made in improving the performance of the eligibility and enrollment system over the last year. This progress is the result of the infusion of 850 additional workers and a set of policy and procedural changes designed to improve worker productivity. However, sustaining these improvements will be impossible unless the Legislature gives HHSC the staffing and other resources its needs to handle growing caseloads and the implementation of national health care reform in 2014. HHSC’s LAR exceptional items related to staff retention and hiring (#6 and #7) outline these essential needs. Without these resources, the performance of the eligibility system will deteriorate, and Texas will lose out on billions of federal funds that are critical to the health and well-being of our state’s residents and economy.

The year 2009 definitively shows Texas has the most to gain from the health reform law, as Texas remained the state with the highest uninsured rate in the nation at 26.1 percent, or 6.4 million uninsured people, new Census Bureau data show.

The Bureau also released preliminary state-level data showing that poverty rose substantially in Texas, with 428,000 new Texans joining the ranks of the poor from 2008 to 2009; the state's poverty rate rose to 17.3 percent from 15.9 percent.

On July 31, 2009, Stacy Howard and Linda Thornberg on behalf of themselves and all others similarly situated filed a class action in federal district court against the Executive Commissioner of the Health and Human Services Commission for failure to comply with federal timeliness standards in processing applications for the Supplemental Nutrition Assistance Program (SNAP), formerly called Food Stamps.

Thanks to national health reform, Texas now has two separate high-risk pools that offer health insurance to Texans who cannot get coverage in the private market due to pre-existing health conditions: the state-administered Texas Health Insurance Pool, established in 1998, and the federally administered Pre-existing Condition Insurance Plan created by the new federal health reform law.

An important reform of the 2010 Patient Protection and Affordable Care Act launched July 1 when Texans who have been without health coverage for at least six months and who have been denied coverage because of pre-existing health gained access to more affordable, quality coverage. They will receive it through a new Pre-existing Condition Insurance Plan created by the U.S. Department of Health and Human Services (HHS).

There is much work to be done to educate fellow Texans about health care reform, protect it against attacks, and ensure strong implementation of new state roles.

The new federal health reform law will significantly change the health insurance market in the next few years. Changes must occur at the Texas Department of Insurance and the Office of Public Insurance Council as well, as the state takes on new roles and functions necessary to successfully implement the health reform law. The sunset review process provides an opportunity for legislators and the public to rethink the roles of these vital agencies and give them the tools needed to protect consumers and foster competition in a changing health insurance market.

CPPP Senior Policy Analyst Don Baylor presented this testimony on modernizing Texas' unemployment insurance system to the House joint hearing on unemployment insurance and the trust fund.

The federal health reform law establishes new accountability measures for unreasonable health insurance premium increases and "medical loss ratios"�"a measure of how insurers spend premium dollars. CPPP recently submitted public comments to a request for information from federal agencies developing health reform regulations on these topics. The center has done research on rate review and medical loss ratios in Texas, and submitted comments to the federal agencies encouraging strong standards that benefit consumers.

CPPP joined the Legislative Study Group House Caucus last Thursday for a briefing on health care reform and its impact on Texas. The Event was cosponsored by the Texas Legislative Black Caucus and the Mexican American Legislative Caucus.

CPPP’s Texas Voice for Health Reform team hopes to focus much of our energy over the next several months traveling across the state to help Texans learn about the new health reform law. We know from polling that many Americans still know little about the law, and that support for the new law is high when people learn about what reform will do.

The State Auditor’s office released a report today on the Supplemental Nutrition Assistance Program (SNAP) at the Health and Human Services Commission (HHSC). The report provides a blueprint for restoring access to SNAP (formerly called Food Stamps) and fixing the state’s eligibility and enrollment system for SNAP, Medicaid, and Temporary Assistance for Needy Families (TANF) cash assistance. HHSC’s Executive Commissioner Tom Suehs requested the audit to inform his efforts to end severe delays in SNAP application processing. The delays cause food hardship to tens of thousands of needy Texans struggling to feed their families in the worst economic downturn since the Great Depression.

With more than one in four Texans currently lacking health care insurance and runaway premiums adding daily to that 6.1 million count, relief cannot not come too soon for our overburdened health care system. In addition to providing new economic security to millions of Texas families, the national health reform bill will also bring billions of dollars back to Texas each year through health insurance tax credits for middle class and low-income Texans, and Medicaid coverage for our poorest citizens.

Our state leadership should move promptly and in good faith to facilitate the implementation of health insurance reforms. Texans can look to the establishment of the Children’s Health Insurance Program (CHIP) and our response to Hurricane Ike as recent examples of the excellent performance of which our state government is capable when it has the backing of leadership.

CPPP sent a letter today to the Texas Congressional Delegation urging passage of the health care reform bill. The letter included the real-life health care-related struggles of Sarah, Mario, Andrea, Bruce and Cher, showing how the bill Congress is currently considering will improve their lives and the lives of other Texans just like them.

Passing health reform isn’t just the right thing to do because it will cover many of the uninsured; it will also create tremendous economic benefits for Texas families and small businesses. Health reform makes health insurance coverage more secure, 1) reducing bankruptcies caused by medical bills, 2) allowing entrepreneurs to start new ventures without fear that leaving a current job will mean losing health coverage, and 3) letting small firms operate without providing health benefits while ensuring that their employees still have access to high-quality affordable coverage. Health reform also slows the growth in health care costs, 1) reducing the federal deficit, 2) shoring up Medicare, and 3) allowing employers to increase wages, hire new employees or make other investments in their business with money that would otherwise be eaten up by skyrocketing health insurance premiums. This Policy Page examines the many economic benefits of health reform. For an overview of provisions in the Senate health reform bill, see at the recent CPPP publication What’s in the Health Reform Bills?

Want to prep for the 2/25 health reform summit with a good update on What's in the Health Reform Bills�"what they will mean for Texas, and what is happening with them in Washington? Have questions you’d like to get answered?

On February 24 from 10:30 a.m. - 12:00 p.m. CST, the CPPP hosted a webinar to answer all your questions about what's in the health reform bills.

We covered:

• The latest on the debate and process in Washington
• The main building blocks for expanding coverage and insurance reform
• Issues where compromise is still being worked out
• Immediate reforms and Medicare improvements What YOU can do to affect the debate

Click here to view a video recording of the webinar, or click here to download the powerpoint presentation.

CPPP Associate Director Anne Dunkelberg made this presentation, "Texas & National Health Reform: Who Will Gain Coverage? Issues for Texans and State Government," at the Texas Hospital Association's 2010 Leadership Conference on February 17, 2010. The panel, "The Trickle-down Effect: How Health Care Reform will Impact the Texas Budget," included State Sen. Steve Ogden (R-Bryan), and Tom Suehs, executive commissioner, Texas Health and Human Services Commission, Austin.

CPPP Associate Director Anne Dunkelberg made this presentation to a meeting of the Texas Medical Association’s Select Committee on Medicaid, CHIP and the uninsured. The committee includes primary care and subspecialty physicians from across the state and is charged with developing TMA’s regulatory and legislative policy relating to indigent health care, Medicaid, and CHIP.

The Kaiser Family Foundation released mid-January poll results that found Americans squarely divided on national health reform proposals�"at least at first glance. The poll went on to show that large proportions of Americans are unaware of the major provisions of heath reform bills, and their support increases dramatically when told about provisions like tax credits to help small businesses cover their employees, health insurance exchanges where coverage options can be compared; closing the Medicare drug benefit “doughnut hole,” and eliminating denials and rate hikes because of pre-existing conditions.

The sometimes raucous debate over hot-button issues (and outright untruths) of the last 6 months has worked against Americans getting a clear picture of the framework of health reform. This Policy Page provides a high-level outline of the key insurance coverage elements of the Senate bill, noting areas in which compromises with the House are likely.

Texas particularly needs national health care reform: 6.1 million Texans have no health insurance, including 1 in 3 working-age adults and 1 in 5 children. Narrowing the scope of pending legislation to address only health insurance reform won’t help Texas because so many Texans cannot afford health insurance. If Congress abandons two of the key provisions of reform�"help with premiums and out-of-pocket costs for low-to-moderate income Texans and Medicaid expansion for working poor adults�"Texas will see very little reduction in uninsured citizens.

CPPP senior food and nutrition policy analyst Celia Hagert delivered this presentation on "fighting hunger, improving nutrition" to the Texas Food Policy Roundtable, a new initiative founded by the Christian Life Commission of the General Baptist Convention of Texas.

CPPP today issued a statement on national health care reform, urging Congress and the Administration to move forward with the reform effort.

As the Senate and House leadership worked to negotiate a compromise national health reform bill, the CPPP’s Anne Dunkelberg made this presentation comparing key coverage features of the bills and illustrating the scope of increased Medicaid enrollment and costs under the 2 bills to the Texas Public Policy Foundation’s Annual Policy Orientation. Medicaid expansion and increased take-up by already-eligible kids will require significant new state Medicaid dollars, but those will be offset with Texas receiving from 10 to 13 new federal matching dollars for each state dollar Texas must contribute.

Last month, Texas Health and Human Services Commissioner Tom Suehs asked the Texas State Auditor to review the agency’s Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program) operations and recommend changes to address the persistent and severe backlogs and delays in application processing, among other performance problems. The audit presents a critical opportunity to investigate the root causes of the problems facing our eligibility system and identify solutions.

This Policy Page outlines the problems, summarizes recent efforts to resolve them, identifies areas for further investigation, and offers potential solutions.

The Center for Public Policy Priorities and Methodist Healthcare Ministries are pleased to release this updated primer, designed to give readers an introductory overview of factors shaping Texans' access to health care. Readers will be better able to contribute to federal, state, and local debates about how to improve health care access. There are two versions of the primer: The Booklet Version was designed for two-sided printing. The Side-by-Side Version was designed for on-screen viewing.

Every legislative session, Texas legislators struggle to allocate sufficient state dollars to ensure public health. Because of our hit-or-miss approach to health care and our lack of an adequate state revenue system, a higher percentage are shut out of health insurance in Texas than in any other state in the nation.

The following report summarizes how health care fared in the 2009 legislative session. It shows how often Herculean efforts resulted in mostly slight improvements in our state’s public health care structures. For example, while the state took a few small steps forward in funding health care and access to coverage, the session was defined by the high-profile missed opportunities related to the CHIP program buy-in and the Texas Department of Insurance Sunset. Small steps forward are inadequate in light of the health care crisis in our state.

With more than 6 million Texans lacking health insurance coverage and the cost of coverage growing much faster than incomes, Texas needs to take bolds steps to confront barriers to health coverage. Healthy Texas, a new public "reinsurance" program has the potential to put private health insurance coverage within reach of many uninsured Texans. To help the program live up to its goals, a few provisions in the proposed rules related to continuation rights, medical underwriting, and payroll supporting documentation should be modified. CPPP submitted the comments below on the proposed Healthy Texas rules to the Texas Department of Insurance.

Austin, Texas--The Center for Public Policy Priorities today released a statement regarding the center’s position on the U.S. Senate’s national health reform bill. During the holiday recess and the weeks to come, please visit and call on your member of Congress to do everything in their power to improve the final bill by including the House’s stronger affordability and market reform provisions in the final bill.

Texas has one of the largest School Lunch Programs in the nation, serving meals to more than 2.5 million low-income children every day. The Summer Food Program is intended to serve the same population, yet it reaches only a fraction of the low-income children who eat lunch during the school year. This paper compares participation in the Summer Food Program to participation in the School Lunch Program for each county in Texas. It documents Texas’ progress in the Summer Food Program, explores the barriers to participation, and makes recommendations for expanding the reach of the program in Texas.

CPPP Executive Director F. Scott McCown and CPPP Associate Director Anne Dunkelberg sent a letter to Texas' congressional delegation urging them to:

• Adopt the House bill’s stronger affordability measures for families below 250 percent of the federal poverty income guidelines; and
• Require the House’s much stronger standards for a Health Insurance Exchanges--whether through a single national exchange or state-level exchanges--to empower exchanges to negotiate with insurers and deliver better value to individuals and small businesses.

Millions of Unemployed Workers and Dependents Received Federal COBRA Subsidies, but for Many Those Subsidies Expire on November 30

To Buy COBRA Coverage without Subsidies, Texas Families Must Pay an Average of $1,081 per Month �" More Than 78 Percent of Average Unemployment Insurance Checks

Washington, D.C. �" On December 1, many of the millions of laid-off workers and dependents who received federal subsidies to help pay for health care coverage will lose those subsidies and may join the ranks of the uninsured, according to a report issued today.

Texans with health insurance today through their jobs stand to benefit greatly from national health reform that makes coverage more affordable, stable, and secure for employers, employees, and employees’ families. This Policy Page examines trends related to employer-sponsored health insurance and ways national health reform can shore up employer-sponsored health insurance to establish stable and secure coverage Texans can count on.

On November 17, CPPP sent a thank-you letter to the members of the Texas congressional delegation who voted to approve HR 3962, the Affordable Health Care for America Act. Their votes were a historic step toward making real health reform a reality for our country.

Policy Institute Urges State to Fix Eligibility System to Get Help to Hungry Texans

Austin, Texas�"The Center for Public Policy Priorities (CPPP) today pointed to a new report from the U.S. Department of Agriculture (USDA) to show the urgent need for Texas to fix its system for enrolling needy families in the Food Stamp program. USDA reports 16.3 percent of Texas households struggled to afford food during 2006-2008. Nationally, 12.2 percent or more than 17 million households were food insecure in 2008 �" up from 13 million in 2007 and 12.6 million in 2000. The 2008 figures represent the highest level of household food insecurity observed since the survey was initiated in 1995.

Joint letter urges meaningful action on health care affordability, highlights utility of public option

Austin, Texas�"Twenty-one Texas organizations today submitted the following letter to the Texas congressional delegation strongly urging passage of meaningful health care reform in 2009. These groups organized their effort through Texas Voice for Health Reform, a project that aims to educate Texans and give them a voice in the national health reform debate. The letter urges legislators to take meaningful steps to make health care affordable and conveys the groups’ consensus that a public option is an important tool for achieving affordability.

Below is the full text of the letter.

In explaining why they oppose national health care reform, specifically the Senate Finance Committee’s version, Governor Rick Perry and Senator John Cornyn both point to the increase in the cost of Medicaid for the state budget based on a preliminary estimate by the Texas Health and Human Services Commission (HHSC). HHSC says costs would increase by “$20.4 billion over 10 years.” In this paper, we analyze HHSC’s cost estimate and compare it to the benefit to Texas’ economy from Medicaid expansion. We explain that HHSC’s estimate includes paying for already eligible but unenrolled children and a shift of certain costs from local to state. We also explain that the estimate cannot be compared to other national estimates because it covers a longer time. We conclude that the agency estimate is unrealistically high, but that by any measure, including the estimate itself, the economic benefit to Texas dramatically outweighs the cost to the state budget.

Texas’ short-staffed eligibility system for safety net programs continues to struggle to provide accurate and timely service to needy Texans seeking assistance in feeding and caring for their families. The 81st Legislature took some baby steps to address this crisis, including mandating a staffing analysis, but failed to provide adequate staff or resources to improve the system’s performance. Serious and widespread delays in processing Food Stamp applications resulted in the filing of a federal lawsuit in July against the Texas Health and Human Services Commission (HHSC) for failure to meet the application processing timeframes required by federal law. The lack of adequate numbers of trained staff also has caused Food Stamp/SNAP error rates to soar, which could cost Texas millions in federal sanctions. This Policy Page discusses these developments and the actions needed to fix the crisis in our eligibility system.

Austin, Texas�"The Center for Public Policy Priorities today condemned the Legislative Budget Board’s (LBB) denial of a request from the Texas Health and Human Services Commission (HHSC) to fund hundreds of new eligibility staff for our state’s overwhelmed public benefits system. The new staff would be an essential step toward fixing our system, which cannot process applications timely or accurately. LBB’s denial comes as the state faces an increased need for public safety net services during the worst economic climate in a generation, a demand by the U.S. Department of Agriculture on September 24 for immediate corrective action, and a private class-action lawsuit against the state for failure to meet federal Food Stamp timeliness standards.

Texas’ short-staffed eligibility system for safety net programs continues to struggle to provide accurate and timely service to needy Texans seeking assistance in feeding and caring for their families. The 81st Legislature took some baby steps to address this crisis, including mandating a staffing analysis, but failed to provide adequate staff or resources to improve the system’s performance. Serious and widespread delays in processing Food Stamp applications resulted in the filing of a federal lawsuit in July against the Texas Health and Human Services Commission (HHSC) for failure to meet the application processing timeframes required by federal law. The lack of adequate numbers of trained staff also has caused Food Stamp/SNAP error rates to soar, which could cost Texas millions in federal sanctions. This Policy Page discusses these developments and the actions needed to fix the crisis in our eligibility system.

Austin, Texas �" The 2008 American Community Survey (ACS) data released by the U.S. Census Bureau on September 21 show that Texans stand to gain the most from national health reform. Nearly all of Texas’ metro and rural area uninsured rates exceed the U.S. average. Texas again had the nation’s highest statewide uninsured rate, and some localities far exceeded the statewide rate of 24.1 percent. Texas entered the recession later than the rest of the nation and experienced low rates of unemployment through most of 2008, so these new data reflect only the very beginning of the recession’s impact on Texas.

New data released today by the U.S. Census Bureau show that in 2008, Texas remained the state with the highest uninsured rate in the nation with an uninsured population that now tops 6 million people. With so many Texans lacking health security, Texas has more to gain than other states from national health reform legislation, which the Congressional Budget Office projects will cover 94 percent of Americans under age 65. Due to the steep rise in the state unemployment rate in 2009, Texas’ uninsured population is most likely even larger today than these latest 2008 estimates indicate.

Austin, Texas�"The Center for Public Policy Priorities (CPPP), Houston Food Bank, and San Antonio Food Bank today highlighted the findings of a new report revealing millions in unclaimed federal benefits available for hungry Texans, as well as newly-calculated data showing the significant effect of anti-hunger stimulus spending on the Texas economy.

This summer, Share Our Strength, a national organization that works to prevent child hunger in America, is talking with teachers across the country about child hunger in their classrooms. The Hunger in America's Classrooms: Share Our Strength's Teacher Project is intended to raise awareness about child hunger in America and build a movement of Americans dedicated to ending it. You can help by spreading the word to teachers across Texas.

If the First Infantry suffered 9 percent wounded, while the Second Infantry suffered “only” 7.9 percent, sending medicine to the First Infantry, but not the Second, would make no sense. Every wounded soldier deserves help. And, if the Second Infantry is bigger than the First, sending help to the Second would be even more important to the strength of the army. Yet, HR 3404 (McDermott) and S 1647 (Reed) propose to trigger an additional 13 weeks of critically important Emergency Unemployment Compensation for unemployed American workers based upon state unemployment rates. Unemployed workers in 28 states, including Texas, would not get help because of state rates below the trigger. This approach is unfair to American workers and counterproductive for the national economy. Congress should help workers in all states equally.

National health reform will bring more security and stability to Texans who have health insurance coverage today and extend coverage to millions of uninsured Texans. To stop reform, some opponents have spread misinformation and downright lies about the bills. Understandably, this misinformation alarmed many recipients. This Policy Page highlights House Energy and Commerce Committee amendments passed just before the August recess that explicitly prohibit practices falsely alleged to be in health reform bills, including “rationing care,” “covering undocumented immigrants,” and other misinformation. This document also summarizes the significant amendments resulting from compromises with both the “Blue Dog” and progressive Democrats.

The most important natural resource Texas has is Texans. Unfortunately, our state suffers from a “brain drain” as many of our best and brightest students leave to further their education. A contributing cause is a lack of “tier one” universities in Texas. Proposition 4 (a constitutional amendment to create a National Research University Fund to help fund certain state universities to become nationally recognized research institutions) would provide funding to Texas universities seeking to attain tier-one status. With more university research, the state hopes for new jobs, increased wages, and more state and local tax revenue. This Policy Page describes criteria commonly used to determine tier-one status, the benefits of having more tier-one universities in Texas, progress of selected Texas schools toward tier-one status, and the specifics of Proposition 4.

Austin, Texas�"The Center for Public Policy Priorities (CPPP) today released the following statement from CPPP Associate Director Anne Dunkelberg decrying attacks made against Medicare and Medicaid during the governor’s press conference on health reform.

Austin, Texas�"On Friday, July 31, 2009, the Texas Legal Services Center (TSLC) and the National Center for Law and Economic Justice (NCLEJ) filed a class action complaint in U.S. District Court against the Texas Health and Human Services Commission (HHSC) for failure to process Food Stamp applications within the timeframes required by federal law.

Health reform bills moving through Congress right now will extend affordable, quality health coverage to 97 percent of Americans and protect families against high health care costs. If you lack health insurance, your best chance to get it is health reform. If you do have health insurance, you may soon lose it without health reform. The U.S. House is considering a very strong bill, expected to be far stronger than the Senate Finance Committee’s forthcoming package. In this Policy Page, CPPP provides a very high-level view of the major strengths of the House bill, and a few key observations on the potential Texas impact.

Austin, Texas--The Center for Public Policy Priorities today expressed disappointment with the Texas House of Representatives’ failure to vote on the Conference Committee Report for SB 2080, legislation that would have made more uninsured children eligible for the Children’s Health Insurance Program (CHIP). The Senate adopted the CCR for SB 2080 on Sunday night, but the House adjourned on Sunday without considering the legislation and refused to consider it today before adjournment.

Austin, Texas�"A broad coalition of Texas organizations today released the following joint statement applauding Senate passage of Senator Averitt's CHIP buy-in proposal, which was included as an amendment to HB 1795. The legislation would allow more families without meaningful access to private health insurance coverage to insure their children by paying monthly family-income-based CHIP premiums. Last night's Senate passage of this legislation will allow for a House vote on the final bill before it is sent to the Governor's desk.

Austin, Texas�"Several statewide organizations (listed below) today released the following joint statement on the legislative process regarding SB 841 and HB 2962--strong, similar Children’s Health Insurance Program (CHIP) bills which passed their originating chambers of the state legislature with bipartisan sponsorship and support. Each of these bills, currently delayed in the legislative process, would allow more families without meaningful access to private health insurance coverage to insure their children by paying monthly family-income-based CHIP premiums.

Nearly 6 million Texans are uninsured, and premiums in Texas are growing ten times faster than our incomes. With only one-in-three small employers offering coverage, bolstering access to employer-sponsored coverage through small businesses is an essential step in covering the uninsured. Because previous efforts to increase access for small employers have had limited success, we need bold, innovative steps like SB 6. Healthy Texas can put private health insurance coverage within reach of many uninsured Texans working for small employers by addressing the primary barrier to coverage�"the high cost of premiums�"using an innovative public-private partnership. SB 6 passed out of the House Insurance committee and is waiting to be set on the House calendar.

The Center for Public Policy Priorities (CPPP) in Austin, Texas is a nonpartisan, nonprofit 501(c)(3) research organization founded in 1985 and committed to improving public policies and private practices to better the economic and social conditions of low- and moderate-income Texans. CPPP appreciates the opportunity to comment on the Senate Finance Committee’s May 14, 2009 report, “Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans.”

Unemployment is high and continues to rise. As of May 5, more than 353,000 Texans were receiving unemployment benefits, more than triple the number of Texans receiving UI benefits a year ago. SB 1569 by Senator Eltife is on the House’s Major State Daily Calendar for Wednesday, May 20, 2009. SB 1569 strengthens our UI system to protect unemployed Texans and qualifies Texas for $555 million in federal funding to reduce UI taxes for employers. The bill also provides a vehicle to extend unemployment compensation for about 70,000 Texans who will otherwise exhaust their federal Emergency Unemployment Compensation (EUC) beginning in July. The federal government would pick up the entire cost to extend UI for these Texans, delivering more than $250 million in federal funding for the Texas economy.

One in four Texans lacks health insurance. All of us pay for care for the uninsured through taxes and higher health insurance premiums. We need to strengthen our private health insurance market to ensure more of us are covered and all of us are getting the most for our health care dollar. This policy page outlines one way to strengthen our private market�"the required disclosure of medical loss ratios. A medical loss ratio is a number calculated by dividing the cost of health insurance claims paid by the amount of health insurance premiums collected to show the percentage of premiums that go to paying for health care rather than insurance company administration and profits. Requiring disclosure of medical loss ratios increases the efficiency of the market by empowering consumers to shop for policies with a better understanding of what they get for their premium dollars. This policy page also discusses how regulators can use medical loss ratios to strengthen the market.

The Texas House’s CHIP Buy-In bill, CSHB 2962 by Coleman, will be voted on by the full House on Thursday, May 14. CSHB 2962 would create a new kind of CHIP coverage for uninsured children with working parents earning between 200-300 percent of the federal poverty level. These families would be able to buy discounted CHIP coverage for their children, paying a “sliding” monthly premium that increases with income. While provisions for a monthly-premium CHIP program for children from 200-300 percent FPL are virtually identical to the Senate’s bill, the House bill includes a limited Full-Cost Buy-In program from 300-400 percent FPL for children who would otherwise lose Medicaid or CHIP due to family income. This compromise addresses technical state agency concerns and may be acceptable in the Senate. This Policy Alert describes differences between SB 841 and CSHB 2962, and provides additional background information on the need for this kind of coverage for uninsured Texas children.

Conferees deciding the final form of the Texas state budget for 2010-2011 must decide whether or not to keep alive House Rider 52 in Article II, Special Provisions Relating to all HHS agencies, which funds 12-month children’s Medicaid only in 2010-2011, while additional Medicaid funding is available from the American Recovery and Reinvestment Act.

The Center for Public Policy Priorities (CPPP) appreciates this opportunity to testify on SB 6, which will create the Healthy Texas program. With nearly 6 million Texans lacking health insurance coverage and the cost of coverage growing ten times faster than incomes, Texas needs to take bolds steps to confront issues with access to health coverage. Healthy Texas has the potential to put private health insurance coverage within reach of many uninsured Texans working for small employers by addressing the primary barrier to coverage�"the high cost of premiums�"using a public-private partnership.

The federal economic recovery act includes federal subsidies to help people being laid off buy private health insurance coverage for nine months while seeking new jobs. Under current law, employees laid off from larger companies are already eligible for the subsidy if they lost their job after September 1, 2008. But companies with fewer than 20 employees fall into a different category. For those employees to take full advantage of the health care subsidy, the Legislature must make modest changes to state insurance law that require no General Revenue. SB 1771 makes needed changes and will help keep more Texans covered through the private market instead of joining the growing ranks of the uninsured.

Three bills by Rep. Naishtat relating to the Food Stamp Program passed the House Human Services Committee and have been sent to the House Calendars Committee to be scheduled for a vote by the full House: HB 1627, HB 612, and HB 886. These bills are designed to maximize federal food assistance to low-income Texans and/or reduce the workload of the eligibility staff who process Food Stamp applications. We urge you to call the members of the House Calendars Committee today and ask them to schedule these bills for a vote as soon as possible.

CPPP is committed to working for an affordable coverage option for every child in Texas. SB 76 would create new coverage options for some children, but it will also allow the potential substitution of existing adult coverage with coverage for children in some cases. It may also encourage some small employers to drop the plans they offer today for employees and dependents and replace them with plans that cover children only.

Consumers expect that when they obtain health insurance, their insurance company has completed all medical underwriting and cleared up any questions about information they provided on the application. Once the policy is in force, consumers expect to be covered according to the terms of their insurance contracts. These expectations are not met when health insurance policies are rescinded�"a retroactive cancellation of a policy in force. SB 206 and 207 enhance the Texas Department of Insurance’s ability to monitor rescissions to better protect consumers and decrease insurance industry incentives that could drive up rescission rates.

Austin, Texas---The Center for Public Policy Priorities today released the following statement applauding the Texas Senate for taking steps toward repairing and modernizing the state’s unemployment insurance (UI) system. CPPP also released an analysis of the benefits of UI modernization for each Texas Senate district. Last night, the Senate approved CSSB 1569 on second reading, paving the way for its final passage in the Senate.

The Texas Senate approved its version of a 2010-2011 state budget bill, and the full House is expected to debate the House Appropriations Committee’s version of the bill this Friday, April 17 (supplemental appropriations will be debated the day before). Complications caused by the recession and the federal recovery funding from the American Recovery and Reinvestment Act of 2009 (ARRA) compound the usual challenge of understanding the chambers’ competing funding proposals for Medicaid, CHIP and other health care-related programs. This Policy Page highlights key differences between the chambers’ Medicaid and CHIP proposals, plus selected other health care issues and items missing in both bills.

Texas’ commercial health insurance market is considered “healthy” because it has a relatively large number of carriers writing coverage, is subject to a low level of regulation compared to other states, and generates $22 billion in premiums annually. The effect of this market on Texas consumers, however, is anything but healthy. For Texas health insurance consumers, this market produces some of the fastest growing premiums in the nation, one of the lowest rates of coverage through job-based insurance, and small employer premiums as high as $29,000 a year per employee. SB 1257 makes changes in the health insurance market which will allow consumers to maintain coverage during certain disputes with insurers, provide consumers with more information on health insurance, and establish a mechanism to review large rate increases for small employers to ensure they are justified.

The federal economic recovery act includes federal subsidies to help people being laid off buy private health insurance coverage for nine months while seeking new jobs. Under current law, employees laid off from larger companies are already eligible for the subsidy if they lost their job after September 1, 2008. But companies with fewer than 20 employees fall into a different category. For those employees to take full advantage of the health care subsidy, the Legislature must make modest changes to state insurance law that require no General Revenue. HB 2453 makes needed changes and will help keep more Texans covered through the private market instead of joining the growing ranks of the uninsured.

As the overseer of the insurance market in Texas, the Department of Insurance plays a critical role for the state and its citizens. With one in four Texans lacking health insurance coverage and the cost of coverage increasing ten times faster than incomes, the high cost of health insurance or lack of coverage is something that affects each of us and our communities. The Texas Department of Insurance (TDI) sunset process provides a much needed opportunity for the Legislature to examine TDI’s role and equip it with the tools needed to not only foster a competitive marketplace, but also to make affordable health insurance available to more Texans.

The Health and Human Services Commission is redesigning the application for Medicaid, Food Stamps and TANF to make it easier to read, understand and fill out. HHSC has invited stakeholders to provide feedback on the new application and is conducting focus groups around the state to get feedback from clients. A web phone conference to answer questions and share focus group findings is scheduled for April 13 at 2 p.m. Comments are due April 20.

The House Human Services Committee will hear HB 3859 on Thursday, April 9. HB 3859 would ensure adequate staffing of the health and human services eligibility system and prevent premature expansion of TIERS, the computer system that the Health and Human Services Commission (HHSC) has been piloting since 2003.

The House Human Services Committee will hear HB 613 on Thursday, April 9. The bill would increase participation in the Food Stamp Program and improve the performance of the eligibility system by simplifying the Food Stamp enrollment process. HB 613 directs the Health and Human Services Commission to exercise the option in federal law to lengthen certification periods for Food Stamp recipients and reduce unnecessary interview requirements. This Policy Page explains the options available to states to simplify Food Stamp enrollment and summarizes the arguments for adopting these changes to Food Stamp policy in Texas.

More than half a million uninsured Texas children have incomes above the current limits for CHIP. In addition, children often fall off of the "CHIP cliff," losing their CHIP coverage when their parents' incomes increase by a small amount, even though those earnings are still too low to purchase private coverage. Texas families turn down raises and cut back work hours just to keep their children covered. Through a CHIP buy-in option, SB 841 by Sen. Averitt keeps families from having to choose between slightly more income or their children's health care. SB 841 has a first hearing April 2 in the Senate Finance Committee. This Policy Page describes the bill, including important details of the expected Committee Substitute.

The federal economic recovery act includes federal subsidies to help people being laid off buy private health insurance coverage for nine months while seeking new jobs. Under current law, employees laid off from larger companies are already eligible for the subsidy if they lost their job after September 1, 2008. But companies with fewer than 20 employees fall into a different category. For those employees to take full advantage of the health care subsidy, the Legislature must make modest changes to state insurance law that require no General Revenue. CSSB 1771 makes needed changes and will help keep more Texans covered through the private market instead of joining the growing ranks of the uninsured.

CPPP offered testimony today on SB 66, a bill which would attempt to provide health insurance coverage through private insurers for children in Title IV-D child support cases. CPPP Executive Director Scott McCown told committee members that the bill might help or hurt low-income families, depending on its implementation.

Only half of Texans get health insurance coverage through an employer�"one of the lowest rates in the nation. Access to employer-sponsored health insurance will decline as the recession deepens and companies cut jobs. The American Recovery and Reinvestment Act of 2009 (federal economic recovery act) includes a temporary COBRA and state continuation premium reduction to help recently unemployed workers and their families maintain private health insurance coverage while they seek new jobs. However, the Texas Legislature must make modest change to our state insurance laws to help Texans losing job-based coverage maximize federal premium assistance. These changes, which require no state general revenue dollars, will help more Texans keep private health insurance and prevent some Texans from joining the growing ranks of the uninsured.

Historically, federal and state welfare policies focused on moving low-income, custodial parents off of public assistance and into the workforce, and very little attention was paid to the circumstances of low-income non-custodial parents. Texas’ Non-Custodial Parent (NCP) Choices program, a pilot program administered by the Texas Workforce Commission (TWC) and the Office of the Attorney General’s Child Support Division, expanded the reach of state welfare programs to include non-custodial parents. NCP Choices, which focuses on increasing the earnings of non-custodial parents who owe child support, shows that placing a greater emphasis on low-income, non-custodial fathers is a highly effective strategy to lift families out of poverty and improve child well-being. HB 2636 would expand this pilot program to make NCP Choices services available in every child support office in the state. This Policy Page explains how NCP Choices works and why this cost-effective, successful, and innovative program should be expanded.

Public structures such as Medicaid, Food Stamps, and Unemployment Insurance were created to help families in tough economic times and to help the economy recover from a down cycle. These are indeed tough times�"we face the worst economic crisis since the Great Depression. Tragically, many Texans are becoming aware for the first time of the crumbling nature of many of our public structures, weakened by years of neglect when times were good. Now that times are tough, we find our systems unprepared. Fortunately, though, the new federal economic recovery law makes resources available to help repair and improve these systems, which will in turn energize economic activity and get Texas on the road to recovery.

But, Texas will only get the federal funds�"and the needed improvements to our public structures�"if state policymakers make the right choices, soon.

The House Human Services Committee will hear two Food Stamp bills on Thursday, March 26, that would maximize federal funding to provide food assistance for needy Texans. HB 1627 would use the Low-Income Energy Assistance Program (LiHEAP) program to maximize Food Stamp benefits for currently eligible families. HB 612 would eliminate the current ban on Food Stamps for drug felons. This Policy Page explains these bills and summarizes the arguments for adopting these changes to Food Stamp policy in Texas.

Consumers and employers deserve to know that their hard-earned money going to health insurance premiums is used by insurance companies primarily for health care costs rather than insurance company administration, marketing, and profits. HB 531 sets standards for how insurance companies use premiums dollars that will introduce a much needed level of accountability and transparency to the health insurance market.

As the overseer of the insurance market in Texas, the Department of Insurance plays a critical role for the state and its citizens. With one in four Texans lacking health insurance coverage and the cost of coverage increasing ten times faster than incomes, the high cost of health insurance or lack of coverage is something that affects each of us and our communities. The Texas Department of Insurance (TDI) sunset process provides a much needed opportunity for the Legislature to examine TDI’s role and equip it with the tools needed to not only foster a competitive marketplace, but also to make affordable health insurance available to more Texans.

CPPP is committed to working for an affordable coverage option for every child in Texas. SB 76 would create new coverage options for some children, but it will also allow the potential substitution of existing adult coverage with coverage for children in some cases. It may also encourage some small employers to drop the plans they offer today for employees and dependents and replace them with plans that cover children only.

Reliable means of transportation are essential for families trying to get to and from work, and they are especially important for out-of-work Texans trying to find employment. Current asset tests for determining eligibility for public benefits unfairly penalize Texan families for owning reliable means of transportation. CPPP staff recently offered testimony in support of updating Texas' asset tests to ensure that needy individuals and families get the help they need and still have transportation.

Long-Term Costs Due to Leaving Kids Uninsured Outweigh Short-Term Savings

The House Human Services Committee will hear seven bills Thursday, March 19, that would extend the coverage period for Texas Children’s Medicaid from the current 6 months to 12 months. This change would benefit Texans from every practical angle:

• reducing the number of uninsured Texas children by 25 percent; reducing avoidable hospitalizations to cut costs-per-child by about the same amount;
• improving access to well-child care to improve health and comply with federal court requirements;
• reducing real taxpayer costs by bringing back federal tax dollars to Texas; and
• dramatically reducing workloads for Texas’ crisis-ridden eligibility system.

Legislators concerned about the cost of 12-month coverage must look past the state budget bill to consider the huge price paid by Texas taxpayers for costs passed on to local jurisdictions when the state leaves needs unmet and federal dollars on the table. This Policy Page reviews the history of and arguments for 12-month enrollment for children.

The Texas Health Insurance Risk Pool (risk pool) was created by the Legislature to provide health insurance to eligible Texas residents who, due to medical conditions, are unable to obtain health insurance. Because Texas state law allows health insurers to deny coverage to people with preexisting conditions in the individual market, many Texans with medical conditions can only get coverage through the risk pool. Risk pool coverage provides a lifeline to some, but the high cost of risk pool coverage places it out of reach for most Texans. SB 879 and HB 2064 create a sliding scale discount program in the risk pool that will help more low- and moderate-income Texans afford coverage.

Texas is expected to get $5.45 billion in federal funds to help pay for Medicaid through 2011. Congress intended these funds to make sure that in a time of economic hardship when the need is greatest:

1. states do not cut Medicaid, and
2. states have extra funds to meet the increased number of uninsured as unemployment rises and incomes decline.

The American Recovery and Reinvestment Act (ARRA) includes federal funds to help people being laid off maintain private health insurance coverage through COBRA and state continuation while seeking new jobs. The Texas Legislature must modify state insurance laws to maximize the coverage options and premium assistance available to Texans losing job-based coverage. These changes, which require no General Revenue, will help keep more Texans covered through the private market instead of joining the growing ranks of the uninsured.

Unemployment Insurance (UI) helps keep Texas families and the state economy afloat in tough times. This public structure is weaker than it should be. The legislature can make modest improvements in the system to help more Texans remain active participants in the economy when they lose their jobs. Texans need this public structure more than ever, with state unemployment up 49 percent since the beginning of the recession. This presentation details the challenges facing our unemployment insurance system and the opportunity presented by the federal recovery law to strengthen and improve our UI system.

Texas’ broken eligibility and enrollment system cannot handle current demand, much less growing needs with rising unemployment. The Legislature can solve this crisis. First, it must fund the Health and Human Services Commission’s request for $134 million in additional general revenue for the staff needed to improve eligibility system performance. Second, it should adopt 12-months continuous coverage for children on Medicaid, which would greatly reduce the current backlogs in application processing and allow the system to operate competently with fewer staff. The federal economic recovery package provides funds to pay for these additional staff and for 12-months continuous eligibility for children’s Medicaid. This paper makes the case for fixing the crisis in our eligibility system and suggests steps you can take to ensure these priorities are funded in the 2010-11 budget.

With more than $16 billion in federal recovery spending coming to Texas through state agencies, the Center for Public Policy Priorities urged state policymakers to invest in programs that will give struggling low-income families and unemployed workers new opportunities to succeed economically. CPPP also called on the state to ensure that recovery money helps stabilize the economy and benefits those hurt most by the recession. Spending should be done openly, efficiently and with accountability.

The Legislature must fully fund HHSC Exceptional Items 2 and 3 to provide additional staff for the eligibility system. The demand for services is already on the rise and will only increase as the full effects of the recession hit Texas. Without adequate staff, HHSC cannot provide timely and accurate benefits to eligible families. The delay or inappropriate denial or termination of benefits not only causes great hardship to needy Texans; it also causes the state to lose out on critical federal funds for Food Stamps and Medicaid that boost our state and local economies. The Legislature should also use a portion of the biennial balance in TANF block grant funds to increase cash assistance to extremely poor families and help them weather the economic recession. The American Recovery and Reinvestment Act (ARRA) includes an Emergency Contingency Fund that would reimburse Texas for 80% of this increased TANF spending.

The Center for Public Policy Priorities today urged state policymakers to draw down available funds for unemployment insurance (UI) benefits in the federal recovery law. The center highlighted an exchange yesterday between Federal Reserve Chairman Ben Bernanke and U.S. Senator Jack Reed (D-RI) regarding the counterproductive effects of states forgoing money for UI:

BERNANKE: If unemployment benefits are not distributed to the unemployed, then they won't spend them and it won't have that particular element of stimulus.

SEN. JACK REED (D-RI): So if this was done on a wide basis, it would be counterproductive, not productive?

BERNANKE: It would reduce the stimulus effect of the package, yes.

Last session, HB 4062 directed TDA to study the National School Breakfast Program and make recommendations to the 81st Legislature for increasing participation in the program. Numerous studies before TDA’s have explored the importance of eating breakfast at school. This research has shown that school breakfast improves academic performance, decreases behavioral problems, and improves children’s nutritional health. Despite its documented value, only a little over half of all low-income students in Texas public schools eat school breakfast, when compared to those who eat lunch. Based on its study, TDA has recommended ways to increase school breakfast participation. The Legislature should help TDA implement these recommendations by funding school breakfast expansion initiatives.

The American Recovery & Reinvestment Act (ARRA) includes more than $555 Million for Texas to modernize its Unemployment Insurance (UI) eligibility rules. To qualify for these funds, the Texas Legislature must make three commonsense policy changes that would save jobs, increase economic activity, and limit demand on other social services programs. This testimony not only explains what Texas must do to get funding under the Unemployment Insurance Modernization Act (UIMA), but also lays out specific reforms to address chronic insolvency of the Unemployment Compensation Trust Fund.

The Legislature must fully fund HHSC Exceptional Items #2 and 3# to provide additional staff for the eligibility system. The demand for services is already on the rise and will only increase as the full effects of the recession hit Texas. Without adequate staff, HHSC cannot provide timely and accurate benefits to eligible families. The delay or inappropriate denial or termination of benefits not only causes great hardship to needy Texans. It also causes the state to lose out on critical federal funds for Food Stamps and Medicaid that boost our state and local economies.

Today, Congress released the details of the American Recovery and Reinvestment Act (ARRA), which provides $789 billion to stimulate the economy. Many of these measures will also help protect vulnerable Texans during this economic downturn. To take full advantage of the benefits in the recovery package and set our economy on the road to recovery, Texas must plan immediately. We applaud Speaker Joe Straus for appointing the Select Committee on Federal Economic Stabilization Funding, charged with monitoring federal action and suggesting to standing committees needed steps to qualify for federal economic recovery funds. This paper summarizes the portions of the bill that affect the state budget.

As the national recession deepens, Texas must look for ways to generate needed revenue for vital programs like Medicaid that low- and moderate-income Texas families rely on when they need it most. Implementing a hospital quality assurance fee (QAFs) in Texas could generate nearly a billion dollars in state and federal funding that could be used to increase payment to Medicaid providers and expand coverage to the uninsured.

As reported in our alert dated January 13, 2009, Congress is moving quickly on federal legislation to address the deepening economic downturn, and in separate legislation to reauthorize the funding for the state children’s health insurance program, known in Texas as CHIP. Taken together, these bills include provisions that will make large amounts of additional federal funding available for Texas Medicaid and CHIP. Some of this funding will come to our state without any new action by the Texas Legislature, but substantial proposed health care funds will only be gained if our state passes new laws. This alert describes the major funding proposals, estimated funding benefits to Texas where available, new options requiring state action, and the expected legislative schedules for consideration of the legislation.

The Center for Public Policy Priorities today highlighted a national report on school breakfast programs that showed Texas ranks higher than most states in providing school breakfast to low-income students, but still fails to reach many students. This caused Texas to lose out on more than $30 million in related federal funds. According to the Food Research and Action Center’s (FRAC) School Breakfast Scorecard, Texas ranks 5th among the states in missed federal dollars tied to the school breakfast program.

Congress is expected to pass a reauthorization of the State Child Health Insurance Program (SCHIP) block grant this week to make it available for the new president’s signature as one of his first acts (this block grant provides the federal share of the Texas Children’s Health Insurance Program, or CHIP). Meanwhile, Congress and the incoming administration are also developing and negotiating a sweeping economic recovery package, now expected to be debated in February. The stimulus package is now expected to include $80 to $100 billion in enhanced Medicaid funding for states over two years. As a result, Texas may receive several billion dollars in additional Medicaid funds for the 2010-2011 state budget. Our Legislature will then decide whether�"or not�"a portion of those funds is devoted to improving our struggling Medicaid program at a time when families need help more than ever.

Senate Bill 6 in 2005 directed HHSC to create a new health care delivery model to provide foster children with comprehensive services, a “medical home,” and coordinated access to care. HHSC worked with the DFPS to develop STAR Health, a new Medicaid managed-care model for foster children, which was implemented on April 1, 2008. This report explores the initial implementation of the program and STAR Health’s potential to improve health outcomes for foster children.

A Child Alone and Without Papers, released today by the Center for Public Policy Priorities (CPPP), reveals what happens to more than 43,000 undocumented, unaccompanied children removed annually from the United States and repatriated to their home countries. Policy analysis and interviews with adults and children in the system revealed the U.S. often compromises children’s rights, safety, and well-being, contrary to international law and U.S. child welfare standards.

For more information, including a two-page summary, backgrounders and appendices, visit www.cppp.org/repatriation.

CPPP's new report provides an update on major actions on health care access in the 2007 legislative session and the important issues and challenges that remain as we approach the 2009 session.