Texas Refuses Federal Government Help, Goes It Alone on Health Care
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Texas Refuses Federal Government Help, Goes It Alone on Health Care


TEXAS - January 14, 2019

Legislators in Texas are among the first looking for a way to change government work during Trump’s shutdown. The health sector is among the worst affected. Department employees were sent on forced leave, but about half of the civil servants continue to work. 800,000 people should have been paid on Friday.

The present shutdown is the longest in U.S. history, at 24 days. The previous was 21 days under Clinton.

Returning to the new living conditions that have been established in Texas, the legislators first touched upon the issue seeking to end the Affordable Care Act, known as Obamacare, arguing the law is no longer constitutional.

The state also has the highest uninsured rate among adults in the country and the largest number of children without health insurance. But amid uncertainty about the federal health law, state legislators will tackle a variety of issues during the session, from abortion to mental health to opioids to funding for Medicaid.

Looking at the situation from all sides, the joint federal-state health insurance program for the poor and disabled continues to disappoint Texas legislators, doctors, patients, and lawyers.

According to experts, the program costs will grow due to the aggravation of the situation in the federal government, and this will mean the emergence of many disputes during the allocation of budgetary funds, which are not even on wages or on the provision of work of the States. As long as Texas is a relatively independent state with a large amount of domestic cash reserves, disputes will not arise so violently. On the other hand, now in order to save the maximum regional funds, Texas plans to eliminate all "unnecessary" government programs.

It will also be important to watch if and how legislators overhaul the state’s Medicaid managed care program. The program has been scrutinized in recent months after the Dallas Morning News reported on how private companies running the program have failed to care for vulnerable Texans and put that money toward paying lobbyists and executives’ bonuses. In addition, doctors are again pushing for higher reimbursement rates under the program, which they say would likely encourage more physicians to participate. Another issue is if Texas legislators will give Medicaid expansion one more look. The state has previously resisted expanding coverage for low-income Texans but advocates are making the case again citing the potential financial savings and how it would help hospitals who treat uninsured people.

Because of the current crisis, lawmakers approved $12,000 in increases for protective services caseworkers up to the 2017 session. However, now due to the more difficult situation, Adult Protective Services, the agency responsible for older adults and disabled people who have been abused or neglected, is also experiencing high caseworker turnover and caseloads. That's why the agency is hoping legislators will approve its $17.8 million request for caseworker raises. If approved, 517 staffers would receive a $12,000 annual salary increase. But it’s unclear if APS will get the same level of priority as CPS did. Even Kezeli Wold, associate commissioner for APS, admits that the agency doesn’t always “get enough attention” from the legislature, media or community.

Another important issue of the 2019 session was motherhood and abortion. If earlier in the work of state programs, legislators did not touch deeply on this issue, now on the agenda was the problem of assistance and care for pregnant women, postnatal care and other assistance, including in the case of drug or alcohol dependence.

The state’s Task Force on Maternal Mortality and Morbidity found in its most recent report that 118 women died in 2012 within a year of giving birth. Among the deaths reviewed, heart and cardiovascular problems, hemorrhaging and infection/sepsis were top culprits. Black mothers were most likely to die from complications.

Despite the data, health advocates have said that last year's figure fell sharply compared to previous ones, so the issue can be resolved without the involvement of Federal funds for hospitals and women's care.

And now advocates are particularly hoping legislators will heed the task force’s recommendation to extend full Medicaid benefits for low-income mothers to a year after they deliver instead of only two months.

As for abortions, the situation was very different from the rest, as the issue was being decided by the highest authorities, namely the Supreme Court, where Brett Kavanaugh, who had replaced Anthony Kennedy, had now become a judge.

Now anti-abortion groups have expressed hope that abortion bills passed into law in Texas and elsewhere face lawsuits that may ultimately move up to the Supreme Court and trigger the justices to reexamine Roe v. Wade. One Texas Senate bill would prepare for the demise of Roe v. Wade with a state constitutional amendment prohibiting abortions in the state if the Supreme Court overturns it. The tone was arguably set the day before session started when state attorneys and lawyers representing reproductive rights groups argued in federal court about whether a lawsuit challenging more than 60 Texas abortion regulations would continue.

According to experts and legislators themselves, the most acute problem in Texas remains a high opioid crisis and substance abuse. According to the national spotlight in the opioid crisis, nearly 3,000 Texans died from drug overdoses in 2017; the figure rose 1.5 percent in 2018. According to the center representatives, Federal funds constrain overdoses growth due to the constant provision of specialized centers for drug control, medicines and recruitment of employees. In 2017, the solution to the problem cost the state $931.1 million. In 2018, they spent more than $1000 million. Now that the issue is back on the agenda. Legislators are proposing to introduce a grant system to address this, to provide the same support and create individual help centers.

The issue is expected to be considered in the near future. A kind of law on "good Samaritans" should set an example to others and separate itself from dependence on Federal funds, according to legislators.

With regard to mental health, Texas lawmakers took care of this issue two years ago, making major investments during the 2017 and 2018 sessions, for launching a community grant program for mental health services and addressing how health insurance companies offer mental health benefits and funding to renovate state mental health hospitals.

This year, the only issue that will have to be discussed is how legislators will focus on vulnerable populations that need access to care including children in K-12 grades, people with intellectual and developmental disabilities, pregnant women and prisoners.

Other key issues are suicide prevention; funding for mental health services; if legislators will further mental health benefit protections for insurance; and whether legislators will give salary increases to state hospital workers.

Entrepreneurs and legislators have, regardless of the decision of the federal government and specifically President Donald Trump, chosen their way to help those in need through grants.

In addition, public health experts are continuing to fight an uphill battle as outbreaks of diseases of the past like measles, mumps and whooping cough have resurfaced nationwide among people who are unvaccinated. Texas is one of 25 states that experienced a measles outbreak in 2018, according to the federal Center for Disease Control and Prevention. The public health community has also expressed concern about the growing number of Texas children with conscientious vaccine exemptions.

There were 56,738 Texas students from K-12 with such exemptions, according to the Texas Department of State Health Services. Another issue to watch is whether anti-vaxxer families will pursue legislation that would require child care providers to accept children who haven’t been vaccinated. In addition, while bills related to requirements for vaccines and immunization data will be important to watch, amendments during heated floor debates will also matter.

Author: USA Really