Sur­vey: Tex­ans want more Med­i­caid

About two-thirds of res­i­dents think lead­ers aren’t do­ing enough for poor

Houston Chronicle - - CITY | STATE - By Jenny Deam jenny.deam@chron.com twit­ter.com/jen­ny_deam

About two-thirds of Tex­ans think state law­mak­ers are not do­ing enough to help low-in­come adults get the health care they need, in­clud­ing tack­ling sky­rock­et­ing costs, re­duc­ing the num­ber of ma­ter­nal deaths and boost­ing ac­cess to health in­sur­ance, a new na­tional sur­vey found.

And by the ex­act same per­cent­age, Tex­ans think the so­lu­tion is ex­pand­ing Med­i­caid — a po­si­tion cur­rent state lead­ers and con­ser­va­tive forces have stead­fastly op­posed.

The find­ings, re­leased Thurs­day, come from a sur­vey com­mis­sioned by the Hous­ton-based Epis­co­pal Health Foun­da­tion work­ing in part­ner­ship with the na­tional Kaiser Health Foun­da­tion to mea­sure the at­ti­tudes in a state that leads the na­tion in the num­ber of unin­sured and has long strug­gled with ac­cess to care among its poor and near poor. Be­tween March and May 1, 367 adults in the state were in­ter­viewed by land lines and cell­phones, in both Span­ish and English, about who they hold ac­count­able.

The high­est-ranked pri­or­ity for law­mak­ers to tackle is the cost of health care, fol­lowed by re­duc­ing the num­ber of women who die dur­ing preg­nancy and child­birth. Low­er­ing the cost of pre­scrip­tion drugs and in­creas­ing fund­ing for men­tal health treat­ment were also flagged as pri­or­i­ties.

“The public is telling state lead­ers that they have an im­por­tant role to play. Peo­ple are say­ing: solve the prob­lem,” said Elana Marks, pres­i­dent and CEO of Epis­co­pal Health Foun­da­tion, a $1 bil­lion foun­da­tion fo­cused on im­prov­ing ac­cess to health ser­vices ac­cess in Texas.

‘Re­ally sur­pris­ing’

In a state that prides it­self on a less-is-more phi­los­o­phy when it comes to govern­ment in­volve­ment in peo­ple’s lives, the rev­e­la­tion that 64 per­cent thought the state should ex­pand its Med­i­caid pro­gram is seen as stun­ning.

Un­der the ini­tial ren­der­ing of the Af­ford­able Care Act, all states were to ex­pand the fed­eral safety net pro­gram to scoop up more lower-in­come peo­ple who were unin­sured. But in 2012, the U.S. Supreme Court ruled that in­di­vid­ual states could de­cide whether to ex­pand Med­i­caid. Texas is one of 17 states that said no. In ad­di­tion, the state has one of the tough­est thresh­olds in the na­tion to qual­ify for the pro­gram.

“What is re­ally sur­pris­ing is it’s as high as it is in Texas,” Liz Hamel, direc­tor of public opin­ion and sur­vey re­search at the Wash­ing­ton, D.C.-based Kaiser Fam­ily Foun­da­tion, said about Med­i­caid ex­pan­sion.

Typ­i­cally, the bright red pol­i­tics of Texas come with an as­sump­tion that it will be an out­lier to na­tional at­ti­tudes that fa­vor Med­i­caid ex­pan­sion, she said. “We think of Texas as be­ing very dif­fer­ent, but the sur­vey shows that it is not dis­sim­i­lar.”

One clue to the sup­port: The sur­vey found that seven in 10 Tex­ans re­ported a per­sonal con­nec­tion to Med­i­caid, ei­ther by be­ing per­son­ally as­sisted or as some­one who had a child, other fam­ily mem­ber or close friend who had been cov­ered.

The lat­est two states to ex­pand Med­i­caid are Maine and Vir­ginia.

Still, op­po­si­tion to ex­pan­sion in Texas re­mains strong.

While Dr. Deane Wald­man, direc­tor of the Cen­ter for Health Care Pol­icy at the right-lean­ing Texas Public Pol­icy Foun­da­tion, does not doubt the find­ings of the new sur­vey, he be­lieves those sur­veyed reached the wrong con­clu­sion.

“I’m sure two-thirds of Tex­ans be­lieve those things. Peo­ple who are med­i­cally needy should get the care they need. They think the so­lu­tion to that is to spend more money, and ex­pand Med­i­caid, get more peo­ple in­sured,” the re­tired pe­di­atric car­di­ol­o­gist said.

But he ar­gued that is pre­cisely the wrong way to travel.

He said in­creased Med­i­caid ac­tu­ally de­creases ac­cess to care be­cause it be­comes so ex­pen­sive to ad­min­is­ter that physi­cian re­im­burse­ment rates de­cline and fewer doc­tors ac­cept Med­i­caid pa­tients.

“The an­swer is not to spend more, but to spend what we have more wisely, mean­ing spend more on pa­tient care and less on govern­ment bu­reau­cracy and in­sur­ance prof­its,” he said.

‘Not the only one’

Gov. Greg Ab­bott, who is a staunch op­po­nent of Med­i­caid ex­pan­sion, did not re­ply to a re­quest for com­ment on the sur­vey.

Marks, of the Epis­co­pal Health Foun­da­tion, said the con­ver­sa­tion sur­round­ing Texas health care ac­cess has of­ten been fix­ated on the yea or nay ques­tion of Med­i­caid ex­pan­sion. “Med­i­caid ex­pan­sion is one mech­a­nism to in­crease ac­cess but not the only one,” she said.

The Trump ad­min­is­tra­tion has fa­vored giv­ing in­di­vid­ual states wide lee­way in craft­ing in­di­vid­ual state so­lu­tions, she said, adding that the sur­vey proves Tex­ans are ready for state lead­ers to step up with a plan.

“We haven’t been hav­ing that con­ver­sa­tion in this state,” she said.

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