Health Care Reform in Texas: Political Theater Spreads Misinformation


Texas is thinking of abandoning Medicaid, reports the New York Times, reprinting a story from the Texas Tribune, a colorful piece that omits one central fact about Medicaid expansion under the Affordable Care Act (ACA).

Apparently the state’s conservatives are unhappy that reform legislation will open Medicaid’s doors to millions of Texas. Today, in the Lone Star state, parents qualify for Medicaid only if their family income is below $5,720. The legislation would set a new national standard for Medicaid eligibility at about $28,000—or $33,000 for a family.

“Dropping out of Medicaid is worth considering,” State Senator Jane Nelson, who heads the state’s Senate Public Health Committee, told the Tribune. “Currently, the Texas program costs $40 billion for a period of two years, with the federal government paying 60 percent of the bill,” but “as a result of federal health care changes, millions of additional Texans will be eligible for Medicaid. I want to know whether our current Medicaid enrollees, and there certainly could be millions more by 2014, could be served more cost efficiently and see better outcomes in a state run program.” 

According to the Tribune, “Far-right conservatives are offering that possibility in impassioned news conferences. Moderate Republicans are studying it behind closed doors.”

The story also quotes State Representative Warren Chisum, Republican of Pampa, “the veteran conservative lawmaker” who recently entered the race for speaker of the House: “With Obamacare mandates coming down, we have a situation where we cannot reduce benefits or change eligibility” to cut costs. “This system is bankrupting our state. We need to get out of it. And with the budget shortfall we’re anticipating, we may have to act this year.”

Always ready to be of help, “the Heritage Foundation, a conservative research organization, estimates Texas could save $60 billion from 2013 to 2019 by opting out of Medicaid and the Children’s Health Insurance Program, dropping coverage for acute care but continuing to finance long-term care services.”  The Texas Health and Human Services Commission, which has 3.6 million children, people with disabilities and impoverished Texans enrolled in Medicaid and CHIP, will release its own study on the effect of ending the state’s participation in the federal match program at some point between now and January.”

The Huffington Post picked up the story from the Times as did numerous blogs (Washington MonthlyMilitant LibertarianHands Off Our Medicare ,and Texas on the Potomac.

                                  What the Stories Don’t Mention

Under the Affordable Care Act, it is true that the ranks of those eligible for Medicaid will swell, beginning in 2014. But for the first few years, the federal government will pay 100% of the cost of covering new enrollees. Granted, beginning in 2020, Washington pares back its help– but still pays 90% of the bill.

As Austin Frakt, who blogs as The Incidental Economist observes, “to blame Obamacare for the cost of new eligibility now and in the next few years is completely wrong.”

Do the State Senators and Representatives who are quoted really not know that the federal government is picking up the tab?

In fact, Texas will benefit more than most states: “States that offer modest coverage today—Alabama, Arkansas, Mississippi, Oklahoma, South Carolina, and Texas—will see very large overall federal” spending, the Urban Institute explains, accompanied by “relatively small increases in their own spending, both because they are low‐income states and thus have higher than average matching rates on their current eligibles, but also because of the very favorable matching rate on new eligibles.”

Texas can expect to see Medicaid enrollment rise by 46 percent while state spending on Medicaid rises by about 3 percent. Meanwhile, Federal spending in Texas is expected to increase by 39 percent. And as more Texans join Medicaid, the state’s hospitals will no longer be forced to “eat” so many unpaid bills. Granted, Medicaid reimbursements are low, but some payment is better than no payment.  Moreover, under the Affordable Care Act, reimbursement for primary care will rise to Medicare levels.

Across the nation, the Urban Institute reports, the federal government will pay a very high share of new Medicaid costs. Overall, federal spending on Medicaid will rise to $443.5 billion while state spending increases by $21.1 billion between 2014 and 2019. Thus about 95 percent of all new spending would be by the federal government.

                             Why Not Correct the Story?

What I cannot entirely understand is why the New York Times featured the piece without comment. I realize that the idea of Texas dropping Medicaid and SCHIP provides a sensational headline on a slow Saturday. And I know that newspapers—including the Times—are under enormous financial pressure. This is why they need stories from other sources.

In a box that accompanies this piece, the Times explains its new relationship with the Texas Tribune:  “Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization.” Going forward, the Tribune will be working with the Times to produce in-depth Texas coverage. The twice-weekly features will be known as “The Texas Report” and will appear on a “dedicated” New York Times page. Some suggest that by working with non-profit news organizations like the Tribune, the “mainstream media” may “rehabilitate” its partisan image. According to critics of the mainstream press, “the perceived or real bias comes . . . from the pervasive liberal outlook of the writers and editors producing the content” at newspapers such as the Times. Presumably, if the Times had mentioned the fact that state spending on Medicaid will climb by only 3 percent—while federal Medicaid dollars pouring into the state will rise by 39 percent—the paper would have been accused of putting a “liberal spin” on the story.

Whatever value the Tribune may add to the NYT’s Texas coverage, facts are facts. It would have been helpful if the Times had added an editor’s note to the piece—or called the reporter, and suggested a revision.

Instead, the Times is helping to broadcast the misinformation that Texas conservatives are putting out there. And in the blogosphere, the suggestion that reform legislation will bankrupt the states spreads.

           Bogus Story Serves to Confuse the Public

Conservatives like to bluster. But in truth, it would make absolutely no sense for Texas to shed Medicaid. Even if a state program proved to be miraculously more efficient than a federal program, and even if Texas slashed Medicaid benefits, it could never save enough to make up for the loss of federal aid which covers 60% to 100% of costs.

As Frakt observes:  “Those who talk about dropping out of Medicaid also seem to have forgotten that for all their complaining, hospitals and physicians do accept a fair amount of money from Medicaid. That would all disappear . . .  Let’s not ignore the fact that Texas already has the highest rate of uninsurance in the country. Think this will help?”  It would devastate the health and well-being of that already disadvantaged population.”  (Over 26% of Texans have no insurance.)

He admits worrying that “they may be serious” (we are, after all, talking about Texas), but in the end sounds pretty sure that all of the talk is “just posturing and saber-rattling.”

This is why Frakt titles his post: “Is This Story for Real?” By contrast, the Times ran the piece as a straight news story headlined: “Texas Considers Medicaid Withdrawal.” 

But if you read the article closely, you will find that the Texas Tribune itself hints that this is all political theater. In the second half of a sentence buried at the end of a paragraph, the paper reports: “The party’s advisers on health care policy say [that dropping out of Medicaid] is being discussed more seriously than ever, though they admit it may be as much a huge in-your-face to Washington as anything else.”

Exactly. Texas politicians are blowing smoke. But they have a serious purpose. By spreading the rumor that moderates are meeting behind closed doors to discuss dropping out of Medicaid and SCHIP, they gain a wide audience—and a unique opportunity to  spread another Big Lie about the Affordable Care Act. (I don’t believe, for a minute, that the Texas legislators who were quoted don’t know that Washington will be picking up the tab for new enrollees.

Expect more stories like this one. In Congress, and across the nation, those who oppose reform will use whatever platform they can find to issue threats and stir fears of “unintended consequences.” There is not much that they can do to stop the Affordable Care Act over the next two years. But they will continue the attack, grandstanding, and using the media as a stage where they can blur the facts

The public doesn’t have the time to read the bill. Journalists and bloggers will have to be dogged, correcting the half-truths and outright lies that we will be hearing on cable, in the blogosphere—and even in Congressional hearings.

It is tragic that, at such an important moment for the nation, so many newspapers and magazines don’t have the resources to stay on top of the story—and that so many talented, experienced, truth-telling reporters have joined the ranks of the unemployed.

13 thoughts on “Health Care Reform in Texas: Political Theater Spreads Misinformation

  1. Typical. I’m sure bloggers on my local news will be all over the Texas “report,” citing it as “proof” that the ACA is a disaster.
    Unhappily for them, I will be there to correct the misinformation. My local conservatives really hate me: they rarely can refute my arguments since all they know are sound bytes and headlines.

  2. I wonder if any real debates occur on these blogs. It seems they all generally have a narraive that they keep to. It could be that they don’t debate you but simply ignore you. I think you have lots of valid things to say.

  3. Panacea & Joe Says
    Pancea– Good for you!
    Joe Says-
    Thank you
    On the last post on this blog there is a very good thread –with excellent debate–including people who defnitely don’t agree with me.
    I respond to virtually everyone who offers a reasoned argument and evidence– even if I don’t agree with the argument.
    When someone offers a personal opinion (‘this is what I believe’) without evidence, there’s not much I can say.

  4. Joe Says:
    The personal invective thrown my way tells me I am not ignored on my local blogs ;P It’s designed to get me to respond in kind, which I manage not to do (most of the time–I am human).
    Blogs like Maggies are helpful because they provide me with information, and sources of information, that help me debate the issues intelligently. Fortunately for me, there are some folks in my area who are willing to have an open and honest debate, and that truly is a pleasure to do.

  5. With the sweaping change in House and nearly the Senate. It appears from analysis that employers nationwide wide that GRANDFATHERED their health plan stand a better chance to weather whatever the Republicans can repeal in employer burden with health care reform. It is still likely that employers will still incure a penalty for every full time employee that refuses coverage. The penalty being $2,000. If you can GRANDFATHER your renewals this January you should do so to protect your backside.

  6. Hi Maggie!
    Getting ready to answer Congress Mike Rogers of Michigan and his misinformation also. Angry Bear makes a nice format for such.

  7. This is much ado about nothing. A whole lot of Chicken Little, if you ask me. What folks outside Texas don’t understand is that the people to whom this nefarious plot is being attributed in fact are great humanitarians (as well as accomplished mathematicians)who will end up only booting hundreds of thousands of kids off the CHIP rolls, making further cuts in provider reimbursement to make sure all those wretched Medicaid enrollees can’t find care even if they make their way through the gauntlet of the state’s Rube Goldberg eligibility system, and being short of memory, probably taking another run at foreclosing on grandma’s home. Sound far-fetched? Go back to 2003, the last great burning at the stake of Texas health and human services. Facts didn’t stop the flames from licking the Texas skies then, either.
    But being by nature an optimist, I think that the business communities in Texas — maybe not the Texas Association of Business, but the business people themselves — when armed with the facts in the end will stand up to this kind of demagoguery and insist on the only rational business proposition: keep Medicaid and press forward with reforming the larger health care “system” in the state of which Medicaid is an integral part.

  8. Some states having Medicaid and some states not would be a nightmare in other ways. I live next door in New Mexico, and our Medicaid program is strapped, too. I doubt we could handle an influx of Texans looking for health care.

  9. Thanks for this post. Being from Texas, I also like the Chicken Little comment. Aside from the usual media hoes that pee their pants every time you want to help the poor, it doesn’t take a genius to know that expanding Medicaid has to be a good idea. Texas will have a state ran insurance pool. Some folks still won’t be able to afford to participate in the pool or pay the penalty. If more people qualify for Medicaid, it will probably be those that can’t even afford the pool rates. Those that say that they don’t want to be forced to “give” somebody healthcare that they didn’t earn are missing the point. They may already be getting it. Every time a hospital or doctor has an uncollectable debt, it trickles up to those that can pay. This situation is an integral part of today’s inflated healthcare costs. Taking a nickel from Medicaid is better than hiring a collection agency to get blood out of that turnip. The only thing that worries me is where are the Feds really going to get the money from?

  10. I do wonder though if more medicare tax $$ flows out of Texas employees and employers than flows back in from the Feds.
    Does anyone know the actual fact on that?

  11. Mike, run 75441, Jason, Chris, Windy, Joe Says
    Mike– Thanks for the info about grandfathering. That’s one part of the legislation that I haven’t looked into deeply, but what you say makes sense.
    run– Good to hear from you. I’ll take a look at Angry Bear
    Jason–yes, yes and yes
    I miss Molly Ivens.
    Chris– You’re entirely right. If Texas, or any state, pulled out of Medicaid, many poor people would move to a neighboring state, even if they had to wait a while before qualifying.
    This is one of many reasons why Medicaid should be a federal program.
    Welcome to HealthBeat.
    I agree. We can either “give” the poor haphazard care, often too late, or we can try to help them manage the chronic disesases that afflict so many of them.
    Joe SAys– I don’t know the answer to your question. I’m not sure if anyone keeps track of how much employers and emplyees contribute to Medicare by state.

  12. “I’m not sure if anyone keeps track of how much employers and emplyees contribute to Medicare by state.” — If not, that would be an astounding lack of basic accounting practices. So astounding in fact that it defies believability. Perhaps we don’t need to know that certain states are getting a raw deal and visa versa.

  13. Joe–
    We do knwo that some states are getting much less in Medicare funds than others– because in some states doctors practice more conservative medicine and don’t overtreat. The good news (for their patients) is that their outcomes are at least as goo–often better–and they don’t undergo all fo the unncessary surgeries, hospitalizations, tests, etc. that seniors in Miami, NYC, L.A., New Jersey etc.undergo.
    (or just Google “Dartmouth Atlas” and “overtreatment” and “Medicare”)