Quote:
Originally Posted by jthig32
Yeah, I've just never heard someone essentially blame a state for people not having healthcare coverage. I've always assumed that decisions on who is eligible for government funded healthcare were made at the federal level. So I was struck by the accusation of Texas being "stingy" when it came to healthcare.
And I'm still pretty confident that you need a much, much more detailed analysis of WHY a state has a large percentage of residents without healthcare before you blame the state for it.
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Jthig, two words: Medicaid.
I don't know if you're thinking about Medicaid being a form of healthcare coverage or not, and I don't know how much you know about Medicaid--what it is, or how it's funded or how it's administered. From your question, it seems like you might be unfamiliar with it. And to be fair, I don't know how old I was before I even understood what it was--probably sometime in the last 10 years. And even then, it was more about understanding what it was intellectually than having any practical experience with it. So, I try not to assume that anyone really delves into the subject just for the fun of it.
Medicaid is co-funded by both federal and state governments, but administered by the state governments. Individual eligibility is based on assets/income--i.e., it's a program for people without the means to pay for healthcare coverage--and eligibility requirements vary from state to state. Texas has generally had more restrictive eligibility criteria than other states (i.e. "stingier"), covered fewer services, and re-imbursed physicians and hospitals at lower rates. Lower re-imbursement means fewer physicians/hospitals will accept Medicaid patients, which in turn, effectively restricts healthcare access to lower income/lower asset people.
I think I remember reading recently that ~4million people in Texas (out of a population of ~25 million) are covered by Medicaid, and about 2/3 of that population are children. However, about 2/3 of the expenditures for Medicaid are spent on people with disabilites and long-term healthcare for the elderly (i.e. nursing homes). Also remember reading that ~70% of stays for nursing home residents are paid for by Medicaid (one source said 80%, another 67%).
So when Texas legislators talk about reducing expenditures for healthcare in lieu of enacting any tax increases to maintain funding at current levels (or opting out of Medicaid altogether), they are talking about cutting back services to what is already the neediest, most vulnerable segment of the population, in order to keep tax dollars in the pockets of the relatively wealthier. They are also talking about foregoing ~$1.5 in federal contributions for every dollar in state expenditures reductions (kind of a reverse NBA luxury tax, if you will). The cuts will hit deep.
Calling that "stingy" might be considered by some to be a charitable characterization. A demagogue would probably go with something more along the lines of Republican Death Panels.
But yeah, long story short, funding for Medicaid is a state-level decision, and thus healthcare coverage for people (infants, children, elderly) without means is a state-level decision. Beyond that, healthcare coverage isn't an individual choice for children, for people who can't afford it, or indeed not even necessarily for people who become unemployed and lose access to healthcare coverage. And the NEED for healthcare itself (not just insurance) isn't really a CHOICE for anyone. When a person needs healthcare, they need it. Insurance or not.
Some people in Texas seem to think that Texas got off without really suffering the effects of the recession, or at least that's the lie that a politican like Perry will tell. Rightly or wrongly, other people are beginning to wonder if the full effects of the recession won't just be felt later in Texas, and whether the shortsightedness, self-satisfaction and complacency of Texas legislators won't make things a lot worse than they have to be.
I have long had the sense that Texas (far from showing 'em how it's done) is at least 20 years behind the more progressive parts of the country, and that the problems that places like CA, NY and IL were experiencing would just reverberate down in Texas a little later. Time will tell. But that budget deficit didn't just come out of nowhere.