San Antonio Express-News. Jan. 31, 2014.
Texas’ real gap: Between heart, politics
The facts are pretty basic: About 1 million Texans - 115,000 in Bexar County - could be eligible for insurance coverage under the Affordable Care Act, but won’t be able to get it.
Because they live in Texas.
Because Texas won’t allow it.
Because they fall into that group of the state’s uninsured residents who don’t make enough money to qualify for tax credits and too much to be eligible for Medicaid. Where they fall has a name: the “coverage gap.”
Under the ACA, they’d be eligible if the state opted to expand Medicaid eligibility up to 138 percent of the federal poverty level. Texas, of course, is among those states that have opted not to expand Medicaid. The same Supreme Court ruling that upheld ACA’s constitutionality also gave states an out on expansion.
The Express-News reported on a report by the Kaiser Family Foundation on this coverage gap recently. Another Express-News article a week earlier put faces to those in the gap.
Among them is Irma Aguilar, who earns $19,200 a year ($9 an hour) as an assistant manager at a pizza restaurant. Her four children are covered by Medicaid. But she is one of those adults who will be uninsured without Medicaid expansion.
So, Aguilar, 28, separated from a husband who also falls into the gap, basically just worries, about her high blood pressure and what happens to her without comprehensive care. She has racked up $80,000 in emergency room care in the past two years.
The 1 million Texans in this gap represent 17 percent of the state’s uninsured. The good news in this report is that 14 percent of the state’s uninsured - nearly 86 percent of these children - will qualify through Medicaid or the Children’s Health Insurance Program. And 28 percent of uninsured Texans younger than 65 will qualify for the tax credits if they enroll in the federal marketplace. Already, 118,532 have signed up through the marketplace.
But although Texas eased up on some obstacles it erected to block navigators who are supposed to be guiding these Texans to coverage in the marketplace, there remain largely unnecessary state training and conditions. Texas is also among those states that have elected not to set up their own marketplaces.
An additional 1.2 million undocumented immigrants will be ineligible, according to the report. Because their treatment of first and last resort will be emergency rooms, this should be a real concern. The ban on undocumented immigrants getting public benefits has been around for a while, however. There is no credible rationale for a state denying insurance to Texas residents who have no such residency status issues.
The federal government will pay all costs for Medicaid expansion for the first three years, capping the state’s costs to 10 percent after that.
Gov. Rick Perry and others slam Medicaid as a failed program rife with fraud and waste. There’s also a claim that not enough doctors in Texas now accept Medicaid patients. Expanding Medicaid, they say, would further overwhelm emergency rooms.
But Texas has among the lowest Medicaid reimbursement rates in the country, so the state is part of that problem. And, yes, fraud does occur, but the ACA installs more safeguards to prevent this.
The answers lie in those safeguards, not in denying help to those in need. This fear-of-fraud argument strikes us as too convenient, in any case, coming from folks who consistently slam safety net programs generally. And not expanding Medicaid means lack of the comprehensive, preventive care that will keep people out of ERs.
But if the state actually cared, it would have a viable alternative to Medicaid expansion to help Texas’ uninsured. Tellingly, little by way of alternatives has been forthcoming.
So, Texas will be left with this “coverage gap.” We suggest that this is related to another longstanding gap hereabouts - the one between what a state should do as a matter of reason and compassion and what it won’t do as a matter of ideological pique.
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Corpus Christi Caller-Times. Jan. 28, 2014.
The business of health will work its way around the politics
Bravo, local hospital systems, for taking the initiative to help patients sign up for health insurance through the Affordable Care Act. Cheering initiative for doing what the initiators had no choice to do is awkward but, in this case, appropriate.
The Caller-Times recently described efforts by Christus Spohn and Corpus Christi Medical Center to provide information and one-on-one counseling to patients on how to obtain insurance and payment assistance through ACA. Yes, of course, it’s in their best interest. CC Medical Center is out to make a profit and Spohn, which treats a large population of uninsured, is out to limit its charity-care expenses.
Shame on them? Hardly. Not only is their best interest non-nefarious, it’s also in the best interest of the already insured. Those premium-paying taxpayers are where the final bill ends up. The more patients insured because of the hospital groups’ efforts, the smaller that bill.
The hospital systems are navigating the numerous obstacles posed both by the government’s error-laden rollout of the program and the continued attempts by political opponents to sabotage the ACA. Gov. Rick Perry has instigated or abetted Texas’ sabotage effort, in effect cutting off Texas taxpayers’ noses to spite President Obama’s face. And yet, the re-elected president holds his ground. Fancy that.
This is another appropriate occasion to repeat Perry’s costly sabotage efforts because they are what forced the local hospital officials’ hands:
First, Perry refused a Medicaid expansion that would have covered 1.3 million of Texas’ more than 6 million uninsured at no cost to Texas in the first three years and at 10 percent cost afterward. Some prominent Republican county judges tasked with funding indigent health care, including our own Nueces County Judge Loyd Neal, urged Perry to accept the Medicaid expansion, to no avail. The result has been a much bigger burden on Texas taxpayers.
Perry also declined to allow the state to set up its own insurance exchange to help uninsured Texans find the best insurance deals, instead investing all responsibility AND authority in the federal government. Perry ceding Texas authority to the feds would be downright curious behavior absent the sabotage motive as an explanation.
Later, as the ACA rollout approached, Perry instigated onerous regulation of federally approved insurance counselors, known as navigators, through the Texas Department of Insurance. This is another philosophically contrary move by the normally anti-regulation Perry. Under the new Texas rules, the navigators must take 20 additional training hours and are restricted from, among other things, recommending a specific health plan.
The rules aren’t aimed at better insurance counseling so much as at using government to obstruct people from getting work done. Spohn protested these new rules, fearing that they could be used against Spohn’s counselors. We’re guessing that Spohn’s concern is based on both familiarity with human nature and deep experience in the business end of delivering health care. Usually Perry respects an industry’s knowledge of what’s best for itself and backs wa-a-y off - again with the contradictions!
If the ACA fails on its own, so be it. But Perry has been sticking his foot in front of it with every step it takes, in hopes of being able to say he told us so if it trips. So, again, bravo Spohn and CC Medical Center, for endeavoring to navigate over and around the obstructions to deliver health care AND make sure the bills get paid. Along with the obvious financial motive, it’s just the right thing to do.
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Austin American-Statesman. Jan. 31, 2014.
MyEdu: A wise investment it wasn’t
“Much has been written about whether this was a wise investment. Only time will tell.”
So wrote Michael Crosno, CEO of MyEdu, in a November 2011 op-ed published in the American-Statesman. Crosno was writing in response to mounting criticism about the troubling circumstances surrounding the decision by the University of Texas Board of Regents to invest $10 million in his online company.
Time has told. MyEdu was not a wise investment.
Blackboard, an education software company based in Washington, D.C., recently bought MyEdu for an undisclosed amount. The purchase resulted in no financial return for the University of Texas System. Ten million public dollars. And no money to show for it.
MyEdu - the Austin-based company’s name is pronounced “My E-D-U” - compiles publicly available information about courses and professors at universities to help students plan class schedules and manage their course loads. The website allows students to set a path toward graduation and connects them with other students and potential employers.
The unanimous vote by regents in August 2011 to take $10 million from the Permanent University Fund and give it to MyEdu was unusual, if not unprecedented. Investment decisions typically are handled by the University of Texas Investment Management Co. Bruce Zimmerman, UTIMCO’s chief executive officer, had warned regents that putting money in Internet startups was risky and that there was a good chance the $10 million that they wanted to invest in MyEdu would be lost. The chance of a huge gain was considered small, at a time when campus budgets were feeling increased financial pressures.
Regents also did not inform individual UT campuses about the investment. “We didn’t choose to bring this to the campus,” UT President Bill Powers said of the deal in 2011. “It was brought to us.”
Faculty critics called the investment speculative and questioned its necessity. There was little or no evidence or data to support the claim by regents that MyEdu would improve graduation rates.
Reports of a conflict of interest added to the controversy. One of MyEdu’s founders is John Cunningham, the son of Bill Cunningham, a former UT president and UT System chancellor, who also had invested in the company. Cunningham’s stake in his son’s company was news to some regents when they were asked about it, though they were quick to note that no law or sense of obligation required disclosure of Cunningham’s financial interest.
The investment was not a wise one financially, but perhaps its wisdom is found elsewhere. In a story published this week, officials told the American-Statesman’s Ralph Haurwitz and Lori Hawkins that UT campuses received continuing benefits from MyEdu’s support systems for students. UT System Chancellor Francisco Cigarroa, putting a good face on the deal he supported, said he was “very happy with the student success side, although the expectations of a return on this investment didn’t pan out.” Powers also said he was “very happy with MyEdu.”
In July, however, the Daily Texan reported that changes made by MyEdu to its website had made students’ online profiles available to employers and had left some students frustrated and upset. The apparent shift in focus from campus to careers created concern that MyEdu was serving the best interests of potential employers, not of students. Some students called on the regents to end UT’s partnership with the company.
In his 2011 op-ed in the Statesman, Crosno said investors with his company “should like their chances of returning a profit.” There will be no profit for the UT System.
Regents weren’t open about the investment they made in MyEdu and dismissed warnings from those who are paid to know how to best invest the public’s money. In a Nov. 4, 2011, editorial we wondered why, if investing in MyEdu was as good a deal as regents said it was, they had so much trouble being more forthcoming about it.
The question of transparency remains, as does the need for it. Unfortunately, as we now know, the deal wasn’t as good as thought.
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The Dallas Morning News. Jan. 31, 2014.
How to make the most of this opening on immigration reform
Last week was an important one for the future of immigration reform. Tuesday, President Barack Obama made the issue a component of his State of the Union speech - and never mentioned the word comprehensive. Thursday, House Republicans opened their three-day retreat by unveiling a set of immigration principles that could set the foundation for legitimate immigration reform. Suddenly, there seems to be genuine momentum for a solution.
Of course, we’ve heard all this before. But this time, there seems to be a recognition by Republicans that the 11 million who operate outside our laws and institutions somehow need to be brought into the American fold. Democrats seem to be acknowledging that words such as comprehensive and citizenship are no longer sacrosanct.
Stunningly, these appear to be days of compromise. Obama’s omission of comprehensive on Tuesday seemed to signal a willingness by Democrats to abandon their demand that the four pillars of reform - a path to citizenship, border security, guest-worker program and employer sanctions - be enacted simultaneously. Likewise, when Rep. Pete Sessions and Sen. John Cornyn, both Texas Republicans, recently met with us, they did not rule out the possibility of a path to legalization.
This newspaper applauds the willingness of members of both parties to turn their focus to immigration reform. It is long overdue. But success depends on flexibility.
In that spirit of compromise, The News, too, is rethinking its insistence on comprehensive reform. We offer instead a step-by-step solution based on a four-part framework.
First: Congress should pass a pathway to citizenship for DREAM Act kids who were brought to this country by their parents without documentation. As Cornyn said recently, “There seems to be consensus that finding a way to regularize their status is the fair and just thing to do.”
Second: Legislators should simultaneously pass border security and a pathway to legalization. These two aspects of immigration reform are the most contentious, which is why simultaneous implementation is needed. Democrats will not pass a border security measure without a path to either citizenship or legalization. Republicans will not pass a path to anything without border security.
Rep. Paul Ryan, R-Wis., offered an idea of how that could happen: Undocumented immigrants would immediately be granted probationary legal status. There would then be a time frame for border security and workplace benchmarks to be reached. If those benchmarks are reached, those who are family of U.S. citizens or have employee sponsors could begin the path to citizenship. The plan has obvious pitfalls and areas of concern, but it’s a good starting point.
Third: Pass a guest-worker plan that addresses America’s need for both high-skill and low-skill foreign workers.
Fourth: Finally, improve and expand the E-Verify program and beef up employer sanctions.
Even with such a plan, immigration reform may be as long a shot as the Cowboys appearing in next year’s Super Bowl. But think of these days of compromise as early fall, when anything is possible, and you’ve just got to believe.
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The Sentinel of Nacogdoches. Jan. 30, 2015.
President’s retirement savings plan isn’t perfect, but it’s worth something
Details are short on the “myRA” retirement savings plan that President Barack Obama rolled out in his State of the Union speech, but we’re with the president on this one: We need to do something - anything - to get people to save more for their later years.
The president’s plan, which is short for “my Individual Retirement Account,” would encourage (but not force) businesses to automatically enroll employees into a savings plan that would likely put their money in U.S. Treasury bonds at first. As simple as that sounds, the proposal already has its detractors.
“Similar to the concerns with health care, where you’re trying to expand coverage, when you mandate options, you drive people to something that’s not as good as what the private market is offering,” Aliya Wong, head of retirement policy for the U.S. Chamber of Commerce, said in an Associated Press story about the myRA.
She’s right: There are already plenty of good retirement savings options out there, from company 401(k)s to Roth IRAs, and in the long run the stock market has proven to provide a much better return than Treasury bonds (which are currently paying less than 3 percent interest). The problem is, way too many Americans either don’t know how to get started in the existing savings plans or don’t believe they can spare even $25 a month out of their paychecks.
That has led us to the situation in which we find ourselves. Roughly half of Americans have no retirement plan at work, according to the AP story, and study after study shows that most of us in the workplace are not anywhere close to where we should be, as far as our long-term savings are concerned.
The old three-legged retirement stool (Social Security, pensions and personal savings) has lost one of its legs, as few businesses offer pensions anymore, and Social Security cannot be counted upon to make up the difference. That leaves personal savings, but too many people have failed to recognize that problem and are likely to find themselves coming up short when it comes to their retirement income.
For that reason, we believe Congress should get behind the president’s simple first step toward a solution - or come up with something better that he can support. The government already has a forced retirement savings plan in Social Security, but it has become clear that workers must have an active investment plan of their own it we have any hope of maintaining a decent lifestyle in our golden years. MyRAs may not be the best idea, but they’re something.
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