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.