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Texas Senators Not Sure of Managed Care Rollout

By J. Lyn Carl, GalleryWatch.com

Austin, TX –

The people of Texas will best be served by close examination of the state's proposed planned conversion to managed care for the state's 2.6 million Medicaid recipients, according to Sen. Royce West (D-Dallas).

West and several other members of the Senate held a press conference today to discuss the Health and Human Service Commission's (HHSC) recommendations regarding the implementation of that part of HB 2292 from the 78th Legislature. The proposal is to switch those 2.6 million Texans, many from Texas' urban areas, to a managed care system.

Noting that health care financing is "extremely complicated," West said sometimes decisions made in the U.S. Congress have a direct impact on how health care is funded or not funded at the county level. "As we make decisions, we must look at the long-term consequences to the local taxpayers and the impact on healthcare consumers," he said.

Texas must do a better job of managing its health care costs, admitted West, but the state also needs to look at long-term implications of any plans it is considering. The state must decide "what delivery model will best serve the patients in the state and allow us to maximize federal funds without harming the safety net of public hospitals that already provide a huge amount of uncompensated and indigent care," said the Dallas senator.

West noted a Senate subcommittee will meet later this week to hear details on the proposed rollout, as well as to consider any alternatives being proposed. He outlined how many Texas counties will suffer even greater loss of dollars if the system being considered is put into place. He said he is asking that the HHSC slow the rollout as planned until the legislature can "make certain that all options are thoroughly investigated before decisions are made."

Numbers are always a part of the discussion, said West, but he said it is also important to make certain that all alternatives are exhausted, all funding models are considered and that the state draws down as much in federal aid as possible.

West said figures show than many counties stand to lose hundreds of millions of dollars under the proposal. His home county - Dallas County - estimates a $50 million loss. While figures can differ, he said, "The fact is, counties are telling us they stand to lose millions. We must slow down and look at all the different alternatives" before a decision on a Medicaid rollout.

Representing Harris County, Sen. Jon Lindsay (R-Houston) said that county has been part of a pilot program for the Star Plus program since 1988. He said the county has lost a "significant" amount of money - some $35 million already - and if the program is continued and expanded to the rest of the state, the losses could be an additional $20 million over the next couple of years. While there might be a savings at the state level, and even a "significant savings," the burden is instead passed down to the county level.

"Let's find a way to do what we can to keep the (county) ad valorem tax rate down," said Lindsay, noting this rollout will simply "cause it to go up."

Counties in South Texas cannot afford to lose more money by paying for increased indigent health care, said Sen. Juan Hinojosa (D-McAllen). Counties are struggling now to find money to take care of indigent individuals. "Health care is a necessity, not a luxury," said the senator.

Sen. Eddie Lucio (D-Brownsville) expressed his concern regarding plans for the rapid HMO expansion. He said although some benefits are identified in parts of the state, HHSC analysis shows the Star and Star-Plus programs have had a negative impact in some areas of South Texas. He said the program should "commence slowly and cautiously" in targeted areas rather than a "one size fits all" program to be implemented in all parts of the state.

Representing the County Judges and Commissioner Association, County Judge Van York said the program should be postponed, as it would represent poor policy that would further penalize public hospitals and clinics that are "already under strain due to state cuts." He urged restoration of previous health care programs before the state considers any further changes. Sen. Robert Deuell (R-Greensville) also spoke against the proposal, saying it could cause the people in Dallas County to have even less healthcare available.

"We need to go back to the drawing board," said West, noting that county judges from across the state have told their representatives about the dollars they would lose. "Do we shift the burden once again from the state to the counties?" asked West. "We must maximize all of the funding available for health care in this state."