Issues: Health Issues

Ellis on TDI’s Proposed Navigator Rules

(Austin, TX) // Senator Rodney Ellis (D-Houston) today released the following statement and letter to the Texas Department of Insurance (TDI) regarding TDI’s proposed new rule concerning the regulation of navigators for Health Benefit Exchanges:

“As written, TDI’s proposed navigator rules should not be implemented, as they will impose excessive fees and unnecessary training requirements. While I share TDI’s concern about protecting Texas consumers’ privacy and data, these rules would go well beyond the requirements for others doing similar work. If the impetus for these rules is truly about protecting consumers, then why doesn’t TDI seek to place the same restrictions and requirements on everyone with access to personal information needed for health insurance enrollment?”

“If these onerous restrictions and excessive training requirements are imposed on navigators, TDI should take steps to implement equivalent rules to ensure that consumers are protected regardless of who is providing them with enrollment assistance. Otherwise, these proposed rules appear to be about more than privacy.”

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Letter to TDI Commissioner Rathgeber:

January 6, 2014

Ms. Julia Rathgeber, Commissioner

Texas Department of Insurance

P.O. Box 149104
Austin, TX 78714

Re: Proposed new 28 TAC Chapter 19, Subchapter W, §§19.4001 – 19.4018, concerning Regulation of Navigators for Health Benefit Exchanges, in the December 6, 2013, issue of the Texas Register (38 TexReg 8769).

Dear Commissioner Rathgeber,

I understand that the Texas Department of Insurance (TDI) is moving forward with proposed rules to implement additional restrictions and requirements for navigators.

While I share your concern for the need to protect Texas consumers’ privacy and data, these proposed rules go well beyond the requirements for those doing similar work and singles out navigators.  These proposed rules would impose excessive fees and unnecessary training requirements and put in place restrictions that will prevent navigators from completing their core responsibility of providing consumers with the information they need to make informed decisions about what health plans will be best for them.  These proposed rules go past consumer protection and will hinder Texans from receiving assistance and information about health care options available to them.

As you know, Texas has the highest uninsured rate in the nation and stands to benefit greatly from the implementation of the Affordable Care Act.  One of the key components of the law is the implementation of a health care marketplace, a resource for individuals to shop for and compare quality, affordable health insurance coverage.  For vulnerable and underserved populations, navigators are a critical resource for enrollment assistance.  They are trusted resources for information in their communities and are able to use these connections to inform consumers about health insurance and financial assistance options available through the marketplace.

Furthermore, navigators are only one entity assisting consumers with enrolling in plans; insurance agents and health insurance companies are also helping with enrollment and are exposed to the same private personal data as navigators.  They collect or have access to confidential information including birth dates, social security numbers, and financial information.  While navigators are helping consumers enroll with this information, insurance agents and health insurance companies maintain files with this private personal data.  However, insurance agents and health insurance companies were specifically excluded from the rule making authority in SB 1795, but the need for insurance agents and health insurance companies to be conscientious and accountable when accessing this confidential information still remains.

If the impetus for implementing these new rules is truly about protecting consumer privacy, then why doesn’t TDI seek to place the same restrictions and requirements on all entities that gain access to and maintain files with private personal information necessary for health insurance enrollment? Also, if ensuring all those that have access to such information is a legitimate concern, why have similar restrictions not been proposed in the past?

If these onerous proposed restrictions and training requirements are imposed on navigators, TDI should take steps to implement rules to ensure that personal data is not only protected and secure when in the hands of non-profit and community organizations, but also when in the hand of those who benefit financially from helping consumers like health insurance agents and companies.  TDI should also require that these entities receive the same training as navigators on privacy, ethics, and Texas Medicaid so that they can conscientiously assist Texas consumers with selecting a health plan that meets their needs.

Should equivalent requirements already be in place, please provide information regarding the statutory or rule requirements for health insurance agents and health insurance companies as they relate to registration requirements, background check and finger print requirements, and training requirements including the number of hours devoted to Texas Medicaid, privacy and ethics specifically.

Thank you in advance for considering my comments, and I look forward to your response in writing.  I hope we can continue to work together to ensure consumers are protected and that those who need it have access to affordable health care.

Sincerely,

Rodney Ellis

CC: Sara Waitt, General Counsel, Texas Department of Insurance

Jamie Walker, Associate Commissioner, Licensing Services Section, Texas Department of

Insurance

PDF: Ellis – TDI Navigator Rules Letter

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Ellis reacts to HB 2 ruling

(Austin, Texas) – Senator Rodney Ellis (D-Houston) today released the following statement regarding the U.S. District Court’s ruling that portions of House Bill 2 are unconstitutional and will not go into effect: Continue Reading »

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Ellis: “I am proud to Stand with Wendy for Texas Women”

(Austin, TX)Senator Rodney Ellis (D-Houston) today released the following statement regarding Senator Wendy Davis’ filibuster of SB 5, omnibus legislation dramatically reducing reproductive freedom in Texas. 

 “I could not be more proud of my friend and colleague, Senator Wendy Davis’ filibuster of SB 5.  I and tens of thousands of Texans stood with her in her heroic battle for women’s health and choice.  It was an incredible, awe-inspiring moment of passionate citizen action meeting incredible personal will and strength.

“Senate Bill 5 was an unprecedented, unreasonable and unconscionable attack on women’s health.  It would have eliminated access to reproductive services in all but 4 of Texas’ 254 counties in Texas and all but eradicated Texas women’s ability to receive health care services they are constitutionally protected to receive.  Opponents of reproductive freedom want to make it virtually impossible for Texas women to seek safe, legal health care without facing the political consequences of trying to ban all abortions.  It is a cynical, destructive but, sadly, effective strategy.

“Rather than taking up issues that hard-working Texans want us to address, we are instead continuing the war on women by decreasing Texas women’s access to health care.  Senate Bill 5 would enact some of the most restrictive limitations on reproductive freedom in the nation. They bring Big Government into what should be a very personal and private matter between a woman, her doctor and her faith, all under the Orwellian talking point of ‘protecting women’s health.’

“Texas women deserve better.

“During the debate in the Senate, members in favor of this legislation spoke eloquently about caring for the unborn, noting that these measures will increase the quality and standard of care.   They, somewhat incredulously, argued that this anti-choice legislation has nothing to do with restricting a Texas woman’s right to control her own body.  But let’s suspend disbelief for a moment and give proponents of further erosion of reproductive rights the benefit of the doubt and say they truly are concerned about women’s health.  If that is sincerely the case, then the answer is shockingly simple: expand access to health insurance under Obamacare.

“Yet they refused to accept an amendment that I offered which would truly improve the quality of life and health of Texas women and families.

“This amendment would have made these anti-choice bills effective only if Texas expands Medicaid under the Affordable Care Act.  With approximately one in four Texans lacking insurance and about 16 percent of Texas children uninsured, this amendment could have provided health insurance to approximately 1.5 million additional Texans, including resources to improve access to quality care for women, infants and children.

“Lack of adequate health insurance coverage makes it hard for Texas families to get the health care they need, and if and when they do it leaves them with large medical bills.  In fact, study after study has shown that one of the best ways to protect and improve the health of women and babies – born and unborn — is by expanding access to quality health insurance.  Having health insurance contributes to healthier mothers, healthier children, and significantly reduces infant mortality. In fact, women who lack insurance are more likely to have inadequate care, receive a significantly lower standard of care and are more likely to postpone or skip entirely needed care because they lack the money to pay for it.  This has a serious impact on all Texans, especially our children.

“According to the 2012 Texas KIDS COUNT report, almost 40 percent of Texas mothers received little or no prenatal care and one in seven babies were born premature. It also noted that only 58 percent of kids without insurance are considered healthy, while 90 percent of insured kids are healthy.  Patients with health insurance are more likely to visit a doctor regularly and obtain routine exams that lead to early detection and treatment.

“Too many hard-working Texans fall into the current gap where they make too much money to qualify for the current Medicaid system but too little to be able to purchase insurance in the private market.  For these individuals eligible for the expansion, Medicaid will mean the opportunity to have a primary doctor and continuity in care thereby reducing their reliance on the expensive care currently provided in emergency rooms.

“This expansion will also give previously uninsured women access to the tools necessary to make them healthier, including family planning services and contraception, which will reduce unintended pregnancies, improve birth outcomes, and reduce infant mortality.

“If proponents of draconian anti-choice laws are serious about helping Texas women, they should be fighting equally hard to expand access to health insurance, not trying to pass bills that will decrease access, increase complications and harm women.  They should fight for measures that will truly protect our most vulnerable and increase access to quality care for women and families, not do all they can to obstruct those efforts.

“The sad truth is that Texas is failing our mothers, failing our children and failing to focus on solutions that help all Texans, rather than narrow partisan interests.  Texas women and families deserve better.”

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Ellis: “I oppose unprecedented, unreasonable and unconscionable attack on women’s health

(Austin, TX)Senator Rodney Ellis (D-Houston) today released the following statement regarding the SB 5, omnibus legislation dramatically reducing reproductive freedom in Texas. 

 

“I am voting against suspending any rule to bring up for debate SB 5, because I oppose this unprecedented, unreasonable and unconscionable attack on women’s health.  Once it is eligible for debate, I will stand shoulder to shoulder with any and every one opposed to this draconian legislation.

 

“There are 254 counties in Texas; under SB 5, women would have access to these critical services in exactly four of them.  The clear goal of this legislation is to eradicate Texas women’s ability to receive health care services they are constitutionally protected to receive.  Opponents of reproductive freedom want to make it virtually impossible for Texas women to seek safe, legal health care without facing the political consequences of trying to ban all abortions.  It is a cynical, destructive but, sadly, effective strategy.

 

“Rather than taking up issues that hard-working Texans want us to address, we are instead continuing the war on women by decreasing Texas women’s access to health care.  Senate Bill 5 would enact some of the most restrictive limitations on reproductive freedom in the nation. They bring Big Government into what should be a very personal and private matter between a woman, her doctor and her faith, all under the Orwellian talking point of ‘protecting women’s health.’

 

“Texas women deserve better.

 

“As the father of three daughters, these are not the types of private, personal decisions I want the Legislature making for them. All of these bills are masked in the cover of making women safer and healthier, when in reality these are political issues that seek to take away a woman’s choice. They restrict the practice of medicine and weaken standards of care and patient safety, which will have devastating consequences when a woman is experiencing medical complications.

 

“During the debate in the Senate, members in favor of this legislation spoke eloquently about caring for the unborn, noting that these measures will increase the quality and standard of care.   They, somewhat incredulously, argued that this anti-choice legislation has nothing to do with restricting a Texas woman’s right to control her own body.  But let’s suspend disbelief for a moment and give proponents of further erosion of reproductive rights the benefit of the doubt and say they truly are concerned about women’s health.  If that is sincerely the case, then the answer is shockingly simple: expand access to health insurance under Obamacare.

 

“Yet they refused to accept an amendment that I offered which would truly improve the quality of life and health of Texas women and families.

 

“This amendment would have made these anti-choice bills effective only if Texas expands Medicaid under the Affordable Care Act.  With approximately one in four Texans lacking insurance and about 16 percent of Texas children uninsured, this amendment could have provided health insurance to approximately 1.5 million additional Texans, including resources to improve access to quality care for women, infants and children.

 

“Lack of adequate health insurance coverage makes it hard for Texas families to get the health care they need, and if and when they do it leaves them with large medical bills.  In fact, study after study has shown that one of the best ways to protect and improve the health of women and babies – born and unborn — is by expanding access to quality health insurance.  Having health insurance contributes to healthier mothers, healthier children, and significantly reduces infant mortality. In fact, women who lack insurance are more likely to have inadequate care, receive a significantly lower standard of care and are more likely to postpone or skip entirely needed care because they lack the money to pay for it.  This has a serious impact on all Texans, especially our children.

 

“According to the 2012 Texas KIDS COUNT report, almost 40 percent of Texas mothers received little or no prenatal care and one in seven babies were born premature. It also noted that only 58 percent of kids without insurance are considered healthy, while 90 percent of insured kids are healthy.  Patients with health insurance are more likely to visit a doctor regularly and obtain routine exams that lead to early detection and treatment.

 

“Too many hard-working Texans fall into the current gap where they make too much money to qualify for the current Medicaid system but too little to be able to purchase insurance in the private market.  For these individuals eligible for the expansion, Medicaid will mean the opportunity to have a primary doctor and continuity in care thereby reducing their reliance on the expensive care currently provided in emergency rooms.

 

“This expansion will also give previously uninsured women access to the tools necessary to make them healthier, including family planning services and contraception, which will reduce unintended pregnancies, improve birth outcomes, and reduce infant mortality.

 

“If proponents of draconian anti-choice laws are serious about helping Texas women, they should be fighting equally hard to expand access to health insurance, not trying to pass bills that will decrease access, increase complications and harm women.  They should fight for measures that will truly protect our most vulnerable and increase access to quality care for women and families, not do all they can to obstruct those efforts.

 

“The sad truth is that Texas is failing our mothers, failing our children and failing to focus on solutions that help all Texans, rather than narrow partisan interests.  Texas women and families deserve better.”

 

 

 

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Ellis Rips Senate’s War on Texas Women’s Right to Choose

(Austin, TX)Senator Rodney Ellis (D-Houston) today released the following statement regarding the continuing attack on Texas women’s right to choose.   

“The war on women is apparently alive and well in Texas.  Just days after Governor Perry vetoed legislation requiring equal pay for equal work for women, the Texas Senate has decided to dramatically decrease access to health care and harm Texas women.   Texas Women deserve better treatment than they are getting from their government.

“None of these bills passed the Senate during the regular legislative session, demonstrating the lack of support for these issues by the body.  Now in special session under new rules we will be forcing a woman to allow government into what should be a very personal and private matter between her, her family, and her doctor.

“There are 254 counties in Texas; Under SB 5, women would have access to these critical services in exactly five of them.  Anti-choice advocates are simply eradicating Texas women’s ability to receive health care services they are constitutionally protected to receive.  They want to make it virtually impossible for Texas women to seek safe, legal health care without facing the political consequences of trying to ban all abortion.  It is a cynical, destructive but, sadly, effective strategy.

“All of these bills are masked in the cover of making women safer and healthier, when in reality these are political issues that seek to take away a women’s choice.   They restrict the practice of medicine and weaken standards of care and patient safety.  These plans will have devastating consequences when a woman is experiencing medical complications.

“As a father of three daughters, these are not the types of private, personal decisions I want the Legislature making for them.

“We all saw the effects of these very same rash political decisions, with the cuts to family planning last session, which gained points with certain political parties but served no real purpose to make the lives of every day Texans better and in fact had devastating consequences for access to care for many.

“Thankfully with bipartisan support, some of the cuts to funding were restored.  It is disappointing and insulting that after the cooperative regular legislative session we just completed that these partisan issues were added to the call.

“I hope members realize that these bills will decrease access, increase complications and harm women.”

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Ellis: Expand Special Session Agenda to include Priorities Texans Care About

(Austin, TX)Senator Rodney Ellis (D-Houston) today sent the following letter to Governor Rick Perry asking him to add reviewing tax loopholes, Medicaid expansion and college costs to the special session agenda:

June 11, 2013

Governor Rick Perry
Office of the Governor
P.O. Box 12428
Austin, Texas 78711

Dear Governor Perry:

The 83rd Legislative Session closed with work still left to be done on several important issues beyond just redistricting. As you consider adding additional subjects to the special session agenda, I hope you will keep an open mind and ask the legislature to find solutions on cataloging and reigning in wasteful tax expenditures, expanding access to affordable health insurance, and making college more affordable to Texas families.

As you proudly point out, Texas continues to grow rapidly, with more and more Americans and businesses choosing to make our state home. But that growth comes at a cost, as more people mean more schools, more roads, more hospitals and more services. Texas is at a budget crossroads; tax increases are ruled out, so each session we struggle to find the revenue to meet our growing needs and to invest in the very things that will continue on our success. With these challenges, it is critical that we know exactly how every tax dollar is used. To this end, I urge you to add review of over $44 billion in state and local tax loopholes to the special session call.

During the session, the Senate unanimously approved just such a study to identify and review Texas’ tax preferences, ensure that they are carrying out their intended purposes, and advance more efficient and effective economic policy. Unfortunately, this provision was removed in the dead of night, protecting these special interest tax subsidies in a cloak of darkness and secrecy while adding hundreds of millions of more tax giveaways to the code. It is time to shine the light on these loopholes, but it will require your assistance and leadership.

Another challenge that will determine Texas’ future success is addressing the staggering health care crisis facing our state. Texas has the highest uninsured rate in the nation, with one in four Texans lacking any health insurance at all and, according to a new report, 54 percent lacking any meaningful coverage. There are more uninsured in Texas – 6,080,000 – than the entire populations of Alaska, Delaware, the District of Columbia, Montana, North Dakota, South Dakota, Vermont and Wyoming combined – 6,021,410. And our Medicaid program currently spends less than the national average per enrollee and also reimburses doctors, hospitals and other providers less than the national average. We can provide insurance to 1.5 million Texans if we act now on the Affordable Care Act, but we must get to work now.

Providing health care access to 1.5 million Texans does not just make moral and social sense, it makes economic sense. Two recent studies show just how good a deal expanding Medicaid would be for Texas. According to an economic analysis by the Perryman Group, Texas would see a return of $1.29 for every $1 spent on Medicaid expansion, and the burden on local governments would be reduced by $1.21 for every dollar the state spent expanding the program. Furthermore, Medicaid expansion would create approximately 300,000 Texas jobs per year for the next decade, and will reduce the $5 billion per year Texas hospitals pay in uncompensated care. These costs are currently passed on to all Texans in the form of higher prices, as well as a direct tax in areas that have hospital districts. I hope you will address this crisis by adding this important issue to the special session call.

Finally, the rising cost of college continues to be a serious challenge to Texas families. Since tuition deregulation was passed in 2003, the cost of tuition and fees at state colleges and universities has increased by 90 percent, and has risen even more at some of our top institutions.

While some of us warned this would be the outcome, those who supported tuition deregulation assured Texans price spikes would not happen. It is past time for the legislature to stop abdicating its responsibility to Texans on higher education and make the tough decisions on tuition. I believe there is more than enough support in the legislature to explore new ideas on college affordability and end tuition deregulation.

I know you believe that tuition deregulation was the right thing to do in 2003, but it has long since outlived its usefulness and has become a significant barrier for Texans trying to afford college. I urge you to add a review of tuition deregulation and college affordability measures to the special session call.

I sincerely hope you will take these important issues into consideration as you deliberate whether to expand the call for the 1st Called Special Session of the 83rd Texas Legislature. Hard-working Texans deserve no less than a full and open debate on these critical matters.

Sincerely,

Rodney Ellis

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Rainy Day Fund OK for Water, Roads & Schools

Last week I told you about SJR 1, legislation to take $6 billion from the Rainy Day Fund and invest it water and transportation projects. I was wary of using the Rainy Day Fund solely on water and transportation and said we had to use money from the fund to restore the disastrous cuts to public education enacted in 2011. Continue Reading »

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Rainy Day Fund OK for Water, Roads & Tax Cuts, But Not Kids & Seniors?

As you know, last session the $23 billion budget crisis was the biggest challenge to deal with.  To fix that fiscal mess, those in power decided on a “cut first, ask questions later” agenda, slashing funds for Texas schools, health care and seniors.  Some of us disagreed with their approach and offered alternatives to protect Texas schoolchildren and seniors.  Unfortunately, we were ignored at every turn.

The budget lowlights included:

  • cut over $5 billion from Texas schools;
  • shifted another $2 billion in payments to Texas schools into the 2014-15 budget cycle;
  • cut $4.7 billion in Medicaid and cut nursing home reimbursement rates by 3 percent;
  • counted more than $1 billion from unlikely federal waivers and other rosy scenarios;
  • slashed higher education $1.5 billion, a 10 percent cut from current levels and $2 billion below what was needed to maintain than current services;
  • eliminated financial aid for over 43,000 students, including 29,000 students who lost their TEXAS Grant, the state’s largest financial aid program.

Those in power chose to irresponsibly cut vital services for Texas families to the bone.  They chose to sacrifice our children’s educational opportunities and eliminate or reduce vital services for those in need, while continuing multi-million dollar corporate giveaways.

Some of us fought to reduce those draconian cuts.  We said we faced an emergency and should use some the state’s then $10 billion Rainy Day Fund to protect families.  At every turn, those in charge blocked it, saying the fund could only be tapped in the case of some massive natural disaster.  We had to sock money away for an even rainier day.  They set a precedent: the Rainy Day Fund is untouchable, even under the direst fiscal circumstances.  We were told we had to ignore an immediate, obvious crisis just in case another, bigger crisis comes down the road.

That was then, this is now.

In just the last two weeks, those in charge have now called for spending billions from the Rainy Day Fund.  Senate Joint Resolution 1 takes $6 billion from the Rainy Day Fund and spends $2.5billion for water projects and $3.5 billion for transportation projects.  And Governor Perry has called for using $1.6 billion from the fund for tax cuts for businesses.

So the message is the Rainy Day Fund can be used, but only for those priorities important to those in charge of Texas government.  Restore funds to our kids’ schools? Not a priority.  Provide billions of dollars for water infrastructure?  Please proceed!  Provide health care for 1.5 million Texans?  Sorry. Invest billions in roads? You betcha!  Fund tens of thousands of new college scholarships?  Maybe next time.  Give businesses more tax breaks?  But of course!

Rainy Day Fund for Our Schools Should Be Priority #1

Restoring the cuts to our children’s schools must be the top priority for any money coming from the Rainy Day Fund.  As seen in the chart below, the inflation-adjusted budget levels proposed in the budget do not make up for the cuts imposed last session.

For instance, after $594 in cuts per pupil last session, this budget only adds about $20 per pupil to Houston ISD, and per student funding in is lower in FY 2014 ($9,381/$3,921) than it was in FY 2012 ($9,676/$4,132), the first year of the budget cuts.

We need to use the Rainy Day Fund to invest more in our children’s schools.

education funding

(Adjusted to 2013 dollars)
 

Use Rainy Day Fund to Invest in Health Care

Texas has the highest uninsured rate in the nation, and 6.1 million Texans lack real access to health care.  We have one of the chintziest Medicaid programs in the nation, with hundreds of thousands of truly needy Texans left without insurance.

We have a historic opportunity to finally do something about these dismal numbers, but, instead, some choose to stand in the doorway and say ‘no.’

For an investment of $15 billion, we could draw down as much as $100 billion in federal funds and expand health care coverage to 1.5 million low-income Texans over 10 years.  The feds will cover 100 percent of the costs for expansion for the first three years, and then gradually reduce to 90 percent thereafter.

Texas has long had the highest uninsured rate in the nation, and our Medicaid program currently spends less than the national average per enrollee and also reimburses doctors, hospitals and other providers less than the national average.

This is not to diminish the need for investments in water and roads.  I know that Texas faces a severe water shortage as we move deeper in the 21st century, and we have to begin to address this problem.  And I have served on the Senate Transportation Committee for six years, so I fully understand the crisis we have in transportation and support investing more resources to get Texas moving again.  However, considering that just two years ago we were lectured by those in charge that using any of the Rainy Day Fund for just about anything was simply impossible, to now be told that we are going to take $6 billion and not invest it in our children’s educational future is simply beyond reason. 

The bottom line is if we are now allowed to use the Rainy Day Fund as intended, we need to put our kids on an equal footing with our cars and our creeks.  My solution: let’s do both. Let’s truly invest in Texas’ future and save our natural resources and our most precious resources.  Let’s restore the cuts to our children’s schools and fulfill our promise to our kids.

We have the money; we just need the will to do it.

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Editorial: Texas’ smoking habit costs us billions

Continue Reading »

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Emmett pushing for Medicaid expansion

Harris County Judge Ed Emmett on Monday called on Gov. Rick Perry to support the expansion of Medicaid under the federal Affordable Care Act, and encouraged state leaders to invest in transportation and mental health care.

Emmett, using the bully pulpit of his sixth annual State of the County speech to the Greater Houston Partnership, drew widespread applause when he said he agrees with recommendations from the Texas Hospital Association, Texas Medical Association and Legislative Budget Board on expanding the federal health care program for the poor.

“While the political debate over the Affordable Care Act continues, poor people will continue to get sick and they’ll continue to need care. Harris County taxpayers should not have to foot the bill while our federal tax dollars are going to other states,” Emmett said. “We are already paying those dollars into the federal government, and for us to say, ‘Well, we don’t want your $4 billion in exchange for $50 million that we put in,’ frankly is just nonsensical.”

Texas could draw down $100 billion in federal funds over 10 years if it puts up $15.5 billion under Medicaid expansion, analyses show. For the 2014-2015 budget cycle, the Legislative Budget Board reports Texas would need to spend $50.4 million to receive $4 billion in federal funds. Texans with incomes up to 133 percent of the federal poverty line would be eligible for Medicaid under the expansion, up from 26 percent of the poverty line now.

Mental health care

Rapidly growing Harris County has a strong balance sheet, Emmett said, praising its hardworking officials, employees and appointed volunteers. However, the speech chiefly was a call for prudent public investment in areas Emmett said would allow continued future growth. He also drew applause by calling for increased funding for mental health care, to divert those in crisis from county jails, and when he called for immigration reform.

Perry spokesman Josh Havens said the governor remains opposed to the expansion of Medicaid, which already makes up a fourth of the state budget.

“If we expand Medicaid, that percentage will drastically increase and eclipse other important priorities like education, infrastructure and public safety,” he said. “The fact of the matter is, Medicaid is unsustainable and it would be irresponsible to add more people to (an) already broken system.”

The Texas Medical Association’s views on expansion also are not clear-cut. Its president, Houston neonatologist Michael Speer, said in a statement Thursday that the program must be reformed to allow a flexible solution that limits red tape and adjusts reimbursement rates to allow more doctors to participate and more patients to be treated.

“We must look beyond the federal government’s expansion solution to design one especially for Texas and for Texans,” Speer said. “The physicians of the Texas Medical Association are confident that state leaders and lawmakers … can design a comprehensive solution that is healthy for patients and taxpayers.”

An appeal to logic

Ron Cookston, executive director of Gateway to Care, a health care education and outreach group, called Emmett’s announcement “oustanding.”

“Leaders in Fort Worth and Bexar County and other counties across Texas are beginning to step up and recognize the importance of moving forward with the expansion,” Cookston said. “That’s just huge in terms of the working poor that would have access to adequate health care resources.”

Emmett, like Perry, a Republican, said after his speech that his address was not meant as an appeal to political moderation, but to logic. No one has accused Republican governors Rick Scott of Florida, John Kasich of Ohio or Jan Brewer of Arizona of being liberals, he said, but each has decided to support Medicaid expansion.

“To me, it is conservative to spend $50 million to get $4 billion,” he said. “When things are going well, that’s when we need to spend money to make sure things keep going well in the future. If I got that across, then I accomplished my purpose.”

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