Anne Dunkelberg

Heatlhcare policy in Texas will change after the passage of the Affordable Care Act, and panelists Monday focused on uncovering the future of those policies and Medicaid’s place in Texas. 

The panel included Anne Dunkelberg, from the left-leaning Center for Public Policy Priorities and Arlene Wohlgemuth, from the right-leaning Texas Public Policy Foundation’s Center for Health Care Policy. William Sage, law professor and vice provost for health affairs, moderated the talk.

“What we’re looking for as advocates is something that will establish a systematic way to affordable healthcare that will be available to all levels,” Dunkelberg said. “To make any of that work — be affordable, effective — you got to have a system of getting healthcare cost under control.”

Dunkelberg said as of 2011 there were 6.1 million uninsured Texans, a majority of them working-age adults. She said expanding Medicaid would bring $24.1 billion in federal money to Texans and insure 1.5 million more people by 2017, though three million Texans would still be uninsured.

Wohlgemuth said Medicaid needed reform, not expansion. Wohlgemuth said with the Affordable Care Act, younger and healthier people and small employers in Austin will see an increase of 162 percent in insurance premiums by 2014. On the other hand, older and sicker individuals in Austin will see a decrease of 32 percent in premiums.

“I think we have to look very seriously at actual experience rather than projections,” Wohlgemuth said.

Wohlgemuth made reference to two Medicaid expansion examples in Arizona and Maine, both of which failed to decrease the percentage of uninsured and ended up costing hundreds of millions of dollars more than expected.

“We can do better,” Wohlgemuth said. We can do better for the Medicaid patient. We can do better for the taxpayer.”

Wohlgemuth advocated a system where people make their own decisions about what to pay for in healthcare. She said that this will make people more aware of how much healthcare costs.

“The individual in charge of spending the money is going to be the best consumer,” Wohlgemuth said.

Both Dunkelberg and Wohlgemuth agreed that overall there needs to be more transparency for healthcare costs.

Ben DeMarsh, a second-year law student, attended the panel on Monday. DeMarsh is also a member of the Health Law and Bioethics Society, one of the four School of Law clubs that helped host the event.

“There’s bipartisan support for greater healthcare cost transparency,” DeMarsh said. “There’s a need for more consumer-driven medical care.”

DeMarsh said although the speakers disagreed on expanding Medicaid, people should become more actively involved with how their money is spent on medical care.

“I really believe that cost transparency is the most important aspect of anything that we can do with health reform,” DeMarsh said.

Printed on Tuesday, March 19, 2013 as: Panelists debate merits of Medicaid expansion 

This article was corrected after its original posting.

The proposed state budget does not take into consideration investments Texas should make to fund portions of the national health care reform law, said the associate director of a research group. Anne Dunkelberg, associate director the nonpartisan research organization Center for Public Policy Priorities, spoke to nearly 100 people at the First Unitarian Universalist Church of Austin about the need for the state to raise its allotted funding for the 2010 Affordable Care Act. Bonny Gardner, public affairs co-chair at the church, said the church sponsored the event to inform the public about an issue it considers important to everyone. “We see health care issues and health care reform as vitally affecting the lives of everyone in this country,” she said. “We want to correct public misperceptions and misunderstandings.” Facing a budget shortfall of approximately $15 to $27 billion, representatives in the state House proposed a budget that would reduce funding to the Texas Health and Human Services Commission by 24.6 percent, or $49 million. Both Senate and House budgets proposed cutting reimbursement rates to Medicaid providers by 10 percent. Jacqueline Angel, public affairs and sociology professor, said the state will need more Medicaid funding in the future. “Almost one-fifth of the population has a disability, and the number continues to rise,” Angel said. “At the same time, the population is aging and the number of individuals with chronic conditions and limited resources is also increasing.” Public affairs lecturer Sherri Greenberg said cutting Medicaid reimbursement rates would reduce the limited options Medicaid patients have, forcing them to go to the emergency room for uncompensated care. The increasing number of patients who need emergency care would then cause costs to increase for hospitals funded by local property taxes. “There are people who show up in the emergency room who don’t actually need emergency care,” she said. Greenberg said if patients do not find a Medicaid provider, they are more likely to go to the emergency room for routine care. To meet the requirements of national health care reform, Dunkelberg said the state needs to start building an insurance exchange, provide the Texas Department of Insurance with more resources to carry out its broader responsibilities, streamline Medicaid and health insurance exchange enrollment systems and increase the health care workforce. She said legislators also did not take inflation and Texas’s increasing population into account when writing the budget. She suggested using the state’s $9.4-billion Rainy Day Fund, closing tax loopholes and raising taxes to balance the budget rather than simply cutting more in other areas. “There’s no way to say, ‘Don’t cut Health and Human Services, put it on public schools, or don’t cut public schools, put it on the courts,’ because everything in the budget’s cut,” Dunkelburg said.