Be a #HealthCareVoter: Texas Candidate Question Guide

Everywhere across the state of Texas, candidates for state and federal office are campaigning for election in November 2018. Each candidate has “pet” issues they care about and on which they’re running. But Texans have said loud and clear that health care is the number one issue on the ballot this year.

Candidates will be working to convince and turn out voters until the very last minute on November 6. Now is the time to check in with your candidates and ask them about their positions on the critical health care issues facing our state. You have the opportunity to ask them the hard questions, to educate them on the issues, and to let them know why you are a #HealthCareVoter in 2018.

We’ve put together a set of questions and some background material on the issues that state and federal candidates need to address this year. As you research the candidates on your ballot, look for their positions on these issues. If you don’t find a satisfactory answer, reach out to the candidate’s campaign, ask questions on social media, or better yet — go to a public campaign event and get your candidates on the record.

The questions in this guide can be used for statewide candidates, such as Governor, Lt. Governor, and Attorney General, as well as state House and Senate candidates. We also have a section for Congressional candidates.

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Upcoming Election Dates:

• Last Day to Register to Vote: October 9, 2018

• Early Voting: October 22 – November 2, 2018

• Election Day: November 6, 2018

Questions for Statewide and Texas Legislature Candidates

Expanding Health Care to All Texans

Why it matters: Texas has the highest rate and largest number of uninsured people in the country. 17.3 percent of Texans are uninsured. That translates to 4.8 million people, or twice the population of the San Antonio metro area. Over 830,000 children lack health insurance. The high rate of uninsured people limits our ability to address dozens of urgent health problems that our state is grappling with including maternal mortality rates, the lack of access to substance use and opioid treatment services, mental health services, and access to rural health care and hospitals.

What Lawmakers Could Do: Texas lawmakers could expand Medicaid to low-income adults. Texas has consistently rejected Medicaid expansion funding, and in the 2017 legislative session there wasn’t a single hearing on Medicaid expansion. Expanding Medicaid would bring $6-10 billion a year that Texans pay in federal taxes back to our state. Beyond the obvious benefit of covering more people, expanding Medicaid has proven to be financially wise for the 34 states that have already done so.

How It Would Help: About 1.3 million now-uninsured Texans are projected to gain coverage if Texas accepted federal funds to cover working poor and near-poor adults. Out of those, close to 700,000 Texans currently have no access to health insurance because they make too much money to qualify for our current Medicaid program (family of three can earn no more than $320 per month), but they make too little to qualify for discounted coverage through the Affordable Care Act Marketplace (which starts at incomes of $2,300 a month for a family of three). These Texans are in the “coverage gap” and have no affordable health insurance options. People who lack health insurance miss important health screenings, forego primary care, and have serious health conditions that may go untreated until they become critical and risk financial ruin because of health issues. Insuring more Texans makes individuals, families, and communities healthier.

What to Ask: What will you do to ensure that everyone in Texas has access to high-quality health insurance coverage, regardless of their income?

How will you ensure that none of your constituents are left behind and in the coverage gap created by Texas’s refusal to expand Medicaid?

Protecting New Mothers and Babies

Why it matters: Texas has a high rate of maternal deaths — deaths of mothers during pregnancy, childbirth, or within a year of giving birth. Also, severe pregnancy complications — like hemorrhage, critically high blood pressure, and seizures — are about 50 times more common than maternal death and can be very damaging to the mother and infant. While many complex factors play a role, women can die or experience severe pregnancy complications because they don’t have access to health insurance (one in four Texas women of reproductive age do not have health insurance). That means that too many Texas women lack access to preventive care, chronic disease management, birth control, mental health care, substance use treatment, and other services that could help them have healthier pregnancies. Health care access throughout a woman's life is critical for healthy moms and healthy babies.

What Lawmakers Could Do: With few exceptions, under policies established by the state Legislature, low-income Texas women can only apply for Medicaid once they know they are pregnant, and then they lose their insurance two months after delivery. The Texas Maternal Mortality and Morbidity Task Force issued a report this summer outlining policy recommendations lawmakers could implement to reduce the number of childbirth-related deaths. The first policy recommendation the Task Force made is to extend health care coverage (Medicaid for Pregnant Women) from two months to 12 months following delivery. The Task Force recommends access to health care during the year after pregnancy and between pregnancies to improve the health of women. Because Black women are at much greater risk for maternal mortality and complications regardless of income, education, marital status, or other health factors, the Task Force also recommended additional support to address racial disparities in health care that contribute to a higher likelihood of death for Black mothers. Expanding Medicaid for all eligible Texans would ensure more women of childbearing age have health care before they become pregnant.

How It Would Help: Increasing access to health care for all Texas women of reproductive age gives women a fighting chance to survive childbirth, have healthy babies, and be healthier for their kids. Expanding Medicaid and increasing supports for Black women who are at a much higher risk for death would help guarantee that women have access to the critical health care they need before, during, and after pregnancy. When women have the regular care they need to manage their health, including chronic conditions, they are healthier when they conceive and when they give birth.

What to Ask: What is your plan to make sure all women have access to affordable health care coverage throughout their lives so fewer women die from childbirth-related conditions and more children are born healthy?

Addressing Untreated Mental Illness and Lack of Access to Care

Why it matters: In a given year about one million¹ Texas adults face mental illness or a substance use disorder without the benefit of health insurance. Just as people shouldn’t have to go without treatment for a heart condition or diabetes, they should not have to go without treatment for mental illness. As a result of the structural lack of services (not enough providers or affordable services for people who are uninsured), county jails and emergency rooms have become the leading providers of mental health treatment in Texas. The largest provider of mental health care in Texas is the Harris County jail system. When Texans can get better mental health treatment in jail than they can outside it, something in our health care system has to change.

What Lawmakers Could Do: The U.S. Department of Health and Human Services reports that if Texas accepted Medicaid expansion funding approximately 400,000 of the one million uninsured Texas adults with mental illness or substance use disorders would be covered by health insurance and become eligible to receive treatment. It would also reduce the pressure on our hospital and jail systems.

How It Would Help: Medicaid expansion in Texas would bring $6-10 billion in federal taxes paid by Texans back to the state each year, meaning that as many as 1.3 million uninsured Texans could get insured. Getting insured is the first step for most Texans to be able to get treatment. Just as people leave other health conditions untreated until they reach a crisis level, they also go without mental health treatment when they have no health insurance.

What to Ask: What will you do to ensure that hundreds of thousands of Texans with mental illness and no access to affordable health insurance get the services they need instead of leaving it to hospitals and jails to be urgent care providers?

Protecting Health Care for Vulnerable Texans

Why it matters: One of the most important responsibilities of the state Legislature is to fully fund critical health programs. Those programs include Medicaid (for people with disabilities and low-income children, pregnant women, and seniors); CHIP (for uninsured children in families earning too much to qualify for Medicaid but too little to purchase insurance); women’s health programs (including health screenings and family planning); and substance use recovery programs (including those that help keep families safely together while serving pregnant women and other parents in need).

What Lawmakers Could Do: In recent sessions, the Texas Legislature continued its practice of underfunding Medicaid and other health programs, putting pressure on the next Legislature to backfill the program or cut services. In 2011 the Legislature cut funding to the Family Planning Program, which served women who don’t have health insurance or Medicaid. Those cuts led to thousands fewer women getting care. While the numbers have rebounded somewhat, the program is still underfunded and inadequate to serve all women in need. Rather than funding piecemeal programs to address the lack of comprehensive health coverage, lawmakers could expand Medicaid, which would cover many of the people receiving care through special programs, while also creating savings in the state budget.

How It Would Help: Fully funding Medicaid, CHIP and women’s health programs would ensure that Texas’s vulnerable populations — women, children, seniors and people with disabilities — would be able to get the care they need.

What to Ask: Will you support fully funding Medicaid, CHIP and other health programs that serve children, women, seniors, and people with disabilities?

Protecting People with Pre-Existing Conditions

Why it matters: With the start of the Affordable Care Act (ACA), insurance companies could no longer raise rates or deny coverage to people with pre-existing conditions. Approximately one-quarter of Texans have a pre-existing condition. In the bad old days, even a moderate case of eczema could cause an insurer to deny coverage, exclude the condition, or raise rates. The ACA banned discrimination based on pre-existing conditions. Despite Congress’ failure to repeal the ACA, threats to pre-existing condition coverage persist, including a federal lawsuit filed by the Texas Attorney General that could end pre-existing coverage protections.

What Lawmakers Could Do: Elected leaders can reject attempts to weaken current standards for coverage of pre-existing conditions and make commitments to uphold them when necessary.

How It Would Help: The outcome of the federal lawsuit is uncertain, and appeals could take many years. The pre-existing condition protection of the ACA is one of its most popular features. Millions of Texans could lose their coverage or be subject to much higher rates if the lawsuit succeeds. Texas lawmakers can protect their constituents by asking the Attorney General to drop his lawsuit and by passing legislation to make pre-existing condition protections part of state law.

What to Ask: How will you ensure that Texans with pre-existing conditions don’t face discrimination in buying and using health insurance?

 Will you support legislation that prevents health insurance companies from discriminating against people with preexisting conditions in any way?

Questions for Congressional Candidates

Ensuring Everyone Has Access to Affordable High-Quality Health Care

Why it matters: Our country has made historic gains on reducing our uninsured rate thanks to the Affordable Care Act, but the work isn't done. Because of both sabotage attempts by the administration and parts of the ACA that have never been fixed (e.g. family glitch), the ACA is not working as well as it could be and prices, especially for the middle class, are not being adequately controlled. We need a commitment to universal coverage. Everyone should have access to good coverage that is affordable for them.

There are big racial and income disparities in access to insurance and health care too. Poor outcomes disproportionately affect communities of color, those with low incomes, people with disabilities, and those living in distressed geographic areas.

What Lawmakers Could Do: Lawmakers can undo some of the sabotage Congress and the Trump administration have enacted in their zeal to repeal the Affordable Care Act without having any real plan to replace it. They can also fix parts of the ACA that have created problems for consumers, such as the “family glitch” that makes insurance unaffordable for some families when one spouse has job-based insurance and the other does not. Lawmakers can reinstate the individual requirement to have health insurance, which helps keep the insurance market stable and drives down premiums — especially for the middle class. But we are stuck with some changes that were made through administrative action, like slashing funding for consumer outreach and assistance with enrollment, and allowing the sale of short-term junk insurance plans that have skimpy coverage.

How It Would Help: More than 20 million people who were previously uninsured have gotten health insurance because of the Affordable Care Act. We can’t afford to backtrack on that progress. In Texas 17.3 percent of the population is uninsured — the highest uninsured rate in the nation. Further cuts to the ACA, and further repeal attempts, will cause that number to keep climbing if lawmakers don’t take action.

What to Ask: What will you do to stop the administration from undermining health coverage and increasing health care costs for middle-class families?

What will you do to help ensure everyone in our country has access to high-quality health and health care regardless of their race, income, health status, or geographic location?

Protections for People with Pre-Existing Conditions

Why it matters: With the start of the Affordable Care Act (ACA), insurance companies could no longer raise rates or deny coverage to people with pre-existing conditions. Approximately one-quarter of Texans have a pre-existing condition. In the bad old days, even a moderate case of eczema could cause an insurer to deny coverage, exclude the condition, or raise rates. The ACA banned discrimination based on pre-existing conditions. Congress persists in its threats to repeal the ACA, and a pending federal lawsuit filed by the Texas Attorney General could end pre-existing coverage protections.

What Lawmakers Could Do: Members of Congress must resist any further calls to repeal the Affordable Care Act, or to repeal portions of the ACA. Over the last two years the Trump administration has chipped away at ACA protections and introduced policies that undermine pre-existing condition coverage, such as by allowing short-term junk insurance. Congress should be on guard for these attempts, and consider legislation to make sure all insurance plans offer the comprehensive coverage people have come to expect from their health insurance.

How It Would Help: The pre-existing condition protection of the ACA is one of its most popular features. More than 130 million people nationwide have pre-existing conditions, and today they can afford health insurance that may have been out of reach in the past. People like having health insurance and the peace of mind that comes with it. No one wants to go back to a time when discriminatory and capricious insurance practices were common.

What to Ask: Will you commit to opposing legislation that would have the effect of harming people with pre-existing conditions?

If court decisions or administrative action allow health insurers to discriminate against people with pre-existing conditions, will you support legislation to reinstate all current protections?

Protecting Medicaid

Why it matters: Medicaid is a very important part of our health care system, and it’s constantly under threat from policymakers. Medicaid provides health coverage for nearly four million vulnerable Texans including children, pregnant women, seniors, and people living with a disability. Two-thirds of Medicaid recipients are children. Medicaid covers more than 50 percent of all births, provides health care to more than two out of every five Texas children, covers long-term care and supports for millions of seniors, and pays for 60 percent of all nursing home care. Most adults who live in nursing homes or live with a disability will use Medicaid at some point.

What Lawmakers Could Do: Despite growing more slowly per-capita than Medicare or private insurance, Medicaid was on the chopping block last year when Congressional leaders attempted to gut the program as part of the Affordable Care Act repeal effort. Lawmakers must protect Medicaid, even as some members of Congress and the administration call for massive cuts to health care and other programs to pay for the ballooning deficits created by the tax cuts for the wealthy and corporations passed in 2017.

How It Would Help: Ensuring a strong Medicaid in our community protects the most vulnerable among us and provides a safety net for all of us. Through Medicaid, two out of every five Texas children are able to get the health care they need. Seniors, pregnant women and people living with disabilities are protected. Medicaid is there for all of us. It helps keep our urban and rural hospitals open and is there for all of us should we attain a disability or have a child born with a disability. Medicaid provides funding for special education and health care services for schools.

What to Ask: What will you do to protect Medicaid and ensure that children, people with disabilities, and seniors continue to have coverage?

Will you commit to protecting Medicaid and rejecting legislation that slashes funding for or restructures this vital health care safety net?

¹ https://aspe.hhs.gov/system/files/pdf/190506/BHMedicaidExpansion.pdf