Dallas, TX – Priority one for state lawmakers meeting in Austin next week is to plug a $25 billion budget shortfall. Just how big is that? Well, if you shut down all the prisons, laid off every state trooper, eliminated every service except public education, higher education and health care, you still wouldn't cut $25 billion.
Governor Rick Perry and others have suggested Texas drop out of Medicaid, the federal-state health program for low income children, elderly and the disabled. It's Texas's fastest growing expense.
State Senator Jane Nelson of Flower Mound chairs the Senate's Health and Human Services Committee and says Texas Medicaid costs have grown 170% in the past 11 years.
Nelson: Our Medicaid population is growing so rapidly that if it continues, it will consume our entire budget. There won't be money left for education or transportation or prisons or anything else.
We'll talk further with Senator Nelson about healthcare spending which makes up a third of the state budget.
But first BJ Austin reports that even without future cuts, disabled Texans who qualify for Medicaid services can't get them.
Ramon Williams of Dallas is 30 years old, and spends his days in a wheelchair. He cannot speak or walk. He has cerebral palsy.
For the past nine years, Ramon has been on the state's waiting list for Medicaid Home and Community Services. Those services include in-home help. Doris Williams wants in-home help that would assist with Ramon's feeding, bathing, changing his diaper, interpreting his needs. She has been doing all of that by herself for 30 years -- except when Ramon is in "day-hab", a special daycare for the disabled that operates weekdays.
Williams: The school, the day-hab I have him in now, they've informed me this month that his last day of going to school will be Jan 31st because they're only going to do HCS, which is Home Community Service, which is the list I've been on for 9 years. So now, I've got the task of trying to figure out how I'm going to take care of him, go to work, or stay and home and sink further in poverty.
Williams worries the location of a new "day-hab" may increase her commute and make it impossible to keep her job and take care of Ramon. She says Medicaid Home and Community Services could help with that. But, Williams says the prospect of getting those services has gone from bad to worse. Right now, there are 41 thousand Texans on the waiting list. In Dallas County alone, five to eight people are added to that list each week. And this year, when the state cut the budget, it reduced the number of people served. And now, there's more uncertainty with the prospect of Texas opting out of Medicaid all together.
Williams: I don't know what our lifestyle is going to be now. I lay awake at night.
Metrocare Services has been paying the day care tuition for Ramon. And officials are trying to find a new place for him. But Metrocare is expecting state funding cuts of up to 18%, and is making cuts of its own. Executive Director Dr. James Baker says the budget cuts have a serious impact on families.
Baker: That's a very painful situation to tell somebody the services they were expecting to get aren't going to be coming their way.
Dr. Baker says opting OUT of Medicaid would have widespread consequences.
Baker: It's a shift in the cost burden from the state to local governments and local hospitals. It wouldn't be just Parkland. It would be private hospitals in the community as well. It's a shift from being paid for by state tax dollars to being paid by your local taxes and thru your insurance. If people are going to emergency rooms for care that don't have any insurance, the way that cost gets paid is through insurance premiums of everybody paying at their jobs.
Ramon's mother, Doris has a message for lawmakers.
Williams: Individuals with disabilities should not be the first ones on the chopping block.
Kofler: Unfortunately State Senator Jane Nelson expects the Medicaid waiting list to grow. And Nelson says Texas can't afford to opt out of Medicaid because it would lose millions in federal matching money.
Nelson: We would lose the quality of care that people are getting right now and we would lose 70 percent of the funding and so how would we make up for that? I just don’t think it would make sense. Now I do think that we should continue to pursue requesting that the federal government allow us to do some things differently, even some minor things like requiring a co-pay for our Medicaid patients. Especially our emergency room care is so expensive and there are individuals who are going into the emergency room who shouldn’t be there, they should be in a clinic and a doctor’s office. And if the federal government would allow us to require a co-pay, that would help. That’s one small example of a lot of things I think we could do to get this back under control.
Kofler: In the Medicaid Report, a lot of the cost for Medicaid in the emergency room was pregnant women, many of whom are undocumented. The report recommended that 100 percent of Medicaid for undocumented people be paid for by the federal government. I can only assume you wish that were the case.
Nelson: Oh boy do I wish that were the case, yes. And I think if the federal government is going to mandate that we have to treat all individuals, then they can help pay for it.
Kofler: If they don’t put up the money, can you imagine the state of Texas, the lawmakers saying we’re not going to pay Medicaid costs in the emergency room for undocumented women?
Nelson: Can I imagine that happening? Yes I can. I mean that’s a hard thing to say but we’ve reached the point where we cannot pay for everything for everybody.
Kofler: Have you identified anything that you think that maybe can be eliminated or cut back?
Nelson: I think we’re going to have to look at some big areas like combining state agencies, eliminating state agencies and I think we’ve got to really examine the number of people who are working at these agencies and see if we wouldn’t be doing the taxpayers a service to put some of those people back out in the private sector. My theme song has been prevention is the solution to our health care woes, but many of those prevention programs could be done without government expenditures. Last year we spent 10 million dollars on tobacco prevention, but smoking cessation is something people could probably do on their own.
Kofler: Is there anything for you that’s off the table, that should not be considered for cuts?
Nelson: Yes. I’m a former teacher and I think that probably the most important investment we make is in our children’s education. Any cut in teacher salary to me is off the table, absolutely off the table. Medical care for people who cannot get that treatment anywhere else and can’t afford it is off the table. I will take care of people who can’t take care of themselves. Immunizations, I would fight to make sure that immunizations for our children are paid for. For those who can’t afford it, don’t have insurance; I can’t imagine eliminating that.