Giving Texas the Care it Needs: Why growing Medicaid makes sense

This commentary, submitted by Mimi Garcia, Cheasty Anderson, Eileen Garcia, and Laura Guerra-Cardus, all representatives of the Texas Well and Healthy Campaign, appeared in the Austin American-Statesman, on Sunday, August 5: Lately when state leaders talk about health care, one thing that almost never comes up is health. Every generation wants for the next one to have a longer, better life and the one before to meet dignity in aging. Medicaid does that for 3.5 million Texans.

The vast majority of them are children, able to get preventive care and treatments they need by seeing a doctor in a doctor's office, so they grow up healthier. Medicaid also helps Texans with lifelong disabilities receive support in their communities and gives expectant mothers who otherwise couldn't afford prenatal care an opportunity to have healthier babies. Vulnerable seniors, including 7 out of 10 Texans in nursing homes, count on Medicaid every day.

For these patients and their families, Medicaid truly is a lifeline, one overwhelmingly favored in polls of American voters. What's not popular is the idea of restructuring Medicaid as a block grant, as some in our state have proposed. One 2011 survey found 60 percent of voters grasped what our Texas leaders miss: A Medicaid block grant would do what it sounds like-- block many people from getting needed health care because, by giving states more control of how the money is spent, it would open the door to more restrictions on coverage.

Causing patients to lose the coverage they have today and ignoring the needs of millions who have none at all: This is what's at stake in the choices our state is considering about Medicaid. The nation's health care law gives Texas a cost-effective way to cover nearly 2 million more low-income, currently uninsured Texans beginning in 2014. Gov. Rick Perry says he's not interested, even though those additional folks won't cost Texas a dime before 2017. The federal government picks up 100 percent of the cost of growing Medicaid over the first three years, and no less than 90 percent after that.

Perry and others talk about Texas's finances, and we'll come back to that. But what about the difference this could make for people's health? Two recent studies of Medicaid's impact by separate research teams at Harvard University provide clues. They found:

• Having Medicaid means better options. A rigorous study in Oregon allowed researchers, for the first time, to compare two truly alike groups, with the only real difference being that one qualified for Medicaid. Those enrolled became significantly more likely to say they felt healthy and were more likely to get screenings, medications and primary care. Researchers saw big jumps in the overall well-being of the group with health care.

• Having Medicaid reduces strain. In the same study, the Oregon residents with Medicaid were found less likely to face depression. They experienced significant improvements in peace of mind, with fewer medical bills sent to collection agencies. When a doctor recommended a follow-up, they were more likely to get it.
• Having Medicaid might well save lives. In a separate study, researchers looked at Medicaid expansion efforts, like the one in the nation's health care law, for three states: Arizona, Maine and New York. Comparing those states with similar places without a Medicaid expansion, the researchers noticed a 6 percent decline in deaths in the states that extended Medicaid to more people.

To put that in perspective, if that trend carried over here and each of the uninsured adults newly eligible for Medicaid in 2014 could receive it, Texas could save roughly 10,000 lives. That's the equivalent of preventing a year's worth of fatalities from accidents.

The value of improving so many lives should go without saying. Yet our state's Health and Human Services commissioner suggested recently that Medicaid is so problematic that Texas should contain it, rather than see it grow.

Luckily, actions speak louder than words here. Commissioner Tom Suehs has spent three years making Medicaid stronger and more effective, so more children eligible for coverage actually get it. Before Suehs' tenure, it was fair to characterize enrollment systems in the state's coverage program for poor children as deeply challenged, but not today. In the past few years, even as parents lost jobs that provided health care for their children, the rate of uninsured Texas kids plummeted by 22 percent -- that's 200,000 more children with health care, mostly thanks to the Children's Health Insurance Program and Medicaid.

Even when it comes to costs (often state leaders' preferred measure of success), Medicaid outperforms Medicare and private insurance. The average price of Medicaid for each enrolled Texan is lower today than a decade ago. It is true that Texas spends -- and gets back from the feds -- more today than it did a decade ago, but that is because Medicaid is helping more people. It's also because we finally started to get serious about covering uninsured children. More work remains, but let's be proud that more kids have coverage today than at any time in history.

Medicaid works not only for those it serves, but for all Texans. According to separate analyses from Texas economist Ray Perryman and Families USA, having Medicaid for Texans means more money in Texas taxpayers' pockets.

Here's why. When people can't afford health care, they see a doctor in the most expensive place: the ER. If patients can't foot the emergency room bill, hospitals must make up that cost. They do so through higher local taxes and price hikes on what they charge private insurers.

Texas hospitals have to cover more costs related to the uninsured in a single year than Texas would spend over five years extending Medicaid to more low-income Texans under the Affordable Care Act. Either way, our communities, all of us, carry those costs. To anyone who's not a state official, it should be obvious that the larger-local-tax-plus-premium-hike scenario costs Texans more in the end.

Enrolling eligible Texans in Medicaid will not only take the pressure off hospitals, it will bring $100 billion in federal funds to Texas over a decade. That money would flow into our local economies and health systems, creating jobs along the way.

And, yes, some of that funding comes from federal taxes that Texans pay on medical industry products, tanning and very high income. Is Perry truly suggesting that Texans forfeit benefits for their own community, while potentially donating tax contributions to the hospitals, doctors and patients of California and New York?

The Affordable Care Act isn't perfect, but it moves in the direction state leaders often say they want: It takes steps toward changing the bad incentives in the current medical payment system. Without passing new burdens to patients, health reform experiments with paying providers not based on the number of tests and procedures they run but how effectively they treat their patients. In this regard, both health reform and Texas's current hospital Medicaid waiver could reduce costs while making patients safer, too.

What's right for Texans' health and pocketbooks is embracing the Affordable Care Act, especially a Medicaid solution that will improve millions of Texans' lives.