Liveblog: Reform or Bust?

We liveblogged this morning from the Austin Club, where the subject of today's TribLive was health care: the costs — and solutions — for Medicaid, payment reform in Texas vs. the federal health overhaul, and what kind of hit Texas' neediest patients will take.

We liveblogged this morning from the Austin Club, where the subject of today's TribLive was health care: Reform or Bust?

CEO and Editor-in-Chief Evan Smith quizzed some of Texas' top health care thinkers — State Rep. John Zerwas, R-Simonton; Texas Academy of Family Physicians Chief Tom Banning; and Anne Dunkelberg, associate director of the Center for Public Policy Priorities.

The topics of conversation? The costs — and solutions — for Medicaid, payment reform in Texas vs. the federal health overhaul in Washington, and what kind of hit budget cuts will take on Texas' neediest patients. 

Zerwas made a little of his own news, suggesting that Texans should get to vote on legalizing gambling, and that the state should carefully balance the beneficial role that women's health providers — read Planned Parenthood — play in some communities. He also said publicly that Texas should nearly deplete the Rainy Day Fund, or else he'd face a "spanking" in his district.  

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Liveblog

by Emily Ramshaw
We're starting Triblive a couple of minutes early here. Glad I rolled out of bed on time.
by Emily Ramshaw
Evan launches in: Do we have a health crisis? In cost or in care?
by Emily Ramshaw
Dunkelberg: I probably would never have chosen the word crisis myself... I definitely think we are lacking both on the care and the cost control side. It's not a state issue. It's totally on a national level.
by Emily Ramshaw
Zerwas: We still have a system, however it has evolved... that still leaves a lot of people with the inability to access the greatest health care in the world. (He blamed it on skyrocketing costs.)
by Emily Ramshaw
Zerwas suggests there are aspects of federal reform that are good — that the mission was good — but that the execution was not.
by Emily Ramshaw
Banning: It's a matter of the non-system we have. Every industrialized country has got some sort of foundation based on primary care, where they try to keep people from getting sick. Frankly, our incentives in this system are misaligned. We pay for treatments... after people become sick.
by Emily Ramshaw
Banning says his members support the ideas behind Dewhurst's payment reform plan.
by Emily Ramshaw
Smith mentions Rep. Garnet Coleman's trip to Washington this week, with the mission of expanding enhanced FMAP funding. Is asking whether that's the right strategy.
by Emily Ramshaw
Zerwas says he does support an enhanced FMAP, "but not for the same reason." He says the formula for determining FMAP is flawed, because it doesn't take into consideration Texas' poverty burden. "Here we carry 10 percent of the poverty burden, but we only get 7 percent" of the federal dollars.
by Emily Ramshaw
Zerwas: Extension of the FMAP could have some huge repercussions... in a positive way.
by Emily Ramshaw
Smith asking about UPL and managed care.
by Emily Ramshaw
Zerwas: UPL is critically important to the survival of our safety net hospitals... It's a very very important priority for us.
by Emily Ramshaw
Zerwas: Rep. Coleman and I are on the same page on a lot of things. On most things related to health care policy, Rep. Coleman and I are on the same page.
by Emily Ramshaw
Smith asks about the TPPF/Kolkhorst/Dewhurst presser yesterday on seeking Medicaid waivers, or block grants.
by Emily Ramshaw
Dunkelberg: "In my line of work, you're always suspicious when you hear the word flexibility... There's a huge philosophical divide between the notion we should give people whatever care X percent of their income will buy" versus giving them some minimum standard of care.
by Emily Ramshaw
Dunkelberg: She says Medicaid spending hasn't been growing any faster than private care spending. "The only reason we have this special different attitude toward Medicaid is because the state Legislature has to pay for Medicaid."
by Emily Ramshaw
Smith asks whether block grants are a good solution.
by Emily Ramshaw
Dunkelberg says Congress has not kept block grants up with anything remotely related to population. "You would not want that to be the model for your funding stream" for people with disabilities, or in nursing homes. "Our existing block grant model is not a good one."
by Emily Ramshaw
Banning: One of the most critically important things that gets lost in this debate... is EMTALA, which guarantees universal access to health care. In terms of flexibility, let's say we determine something we're covering now is not needed. Does that mean the need goes away for that patient? No. It just means that patient will now go to the emergency room... because we're not paying for it.
by Emily Ramshaw
Zerwas acknowledges that health care costs must be reigned in, but suggests that the public "still has to have skin in the game."
by Emily Ramshaw
Zerwas: Suggests that LASIK is a great example of something that's not paid for with insurance — it's out there in the private market, and people pay for the quality.
by Emily Ramshaw
Banning says within the individual and small group market, "there is an utter lack of oversight over the insurers."
by Emily Ramshaw
Smith asking about Obama's health care reform — the substance. What do you like, what don't you like?
by Emily Ramshaw
Zerwas says he likes pieces of it that emphasize quality care. "What I clearly don't like about it is, what it is going to do is explode the Medicaid population. That is going to be a burden do the state we are not going to be able to sustain." He said that money will come out of education, infrastructure, public safety.
by Emily Ramshaw
Dunkelberg: Says no matter how many court rulings on health care reform there are, no one will know until the Supreme Court decides. That likely won't be until 2012, she said.

by Emily Ramshaw
Dunkelberg says federal health care reform is a success because for the first time, everyone has a guaranteed minimum standard of health care.
by Emily Ramshaw
Dunkelberg on the costs and benefits to Texas from federal health reform and the expansion of Medicaid: "The great news is we're finally changing Texas from being a donor state. The bad news is we have to pay our 5 percent in 2017."
by Emily Ramshaw
Banning: "When you look at the underpinnings of what's in the" federal health care reform, he says, it models what Republicans put forth to oppose Hillary Clinton's health care plan.
by Emily Ramshaw
Zerwas: "It's OK to give subsidies. But let them go out there and buy it on the private market."
by Emily Ramshaw
Zerwas: "But what we're doing is just feeding the beast. The beast is going to continue to grow."
by Emily Ramshaw
Smith asks about "Zerwascare..." his introduction of health insurance exchange legislation.
by Emily Ramshaw
Zerwas on a health insurance exchange: "If we didn't do it, we cede that exchange, that management, to the federal government."
by Emily Ramshaw
Zerwas: "I think we'll have the votes. The question is... will it get through the governor."
by Emily Ramshaw
Banning: Dewhurst filed his bills last session, before federal reform was even written. "You could make the argument the feds took some good ideas from the state."
by Emily Ramshaw
Smith asks about poll results that show Texans don't want to cut funding for health care programs.
by Emily Ramshaw
Zerwas on budget cuts, 10 percent provider rate cuts: "I'm concerned about what's going to happen to the safety net provider network out there. That 10 percent — I believe we're going to see the safety net fracture."
by Emily Ramshaw
Dunkelberg: Everything the state of Texas does is looking at being cut back 25 percent if we don't add some revenue to this equation.
by Emily Ramshaw
Dunkelberg: "The amount of money we can save by implementing every best practice in the world... isn't going to deal with a gap the size of $7.6 billion (in Medicaid)."
by Emily Ramshaw
Zerwas: Says he's absolutely for using at least some of the Rainy Day Fund. "You can dull the edge of this [budget] a little bit."
by Emily Ramshaw
Zerwas said he'd come close — maybe within $1 billion — of depleting the Rainy Day Fund. "It's raining."
If he goes home with a budget that looks like this, and $5 billion in the bank, he said, "I'm going to get a spanking."
by Emily Ramshaw
Opening it up for questions.
by Emily Ramshaw
Question about preexisting conditions. Zerwas says if the law says we're going to take people on with preexisting conditions, "let's accept the fact there's going to be an increased cost to that."
by Emily Ramshaw
Question about TT poll — as people look at budget cutting, they're reluctant to talk about new revenue until they see the reality. Will that happen at the lege? Zerwas says discussions going on include people talking about whether margins tax should be reformed, particular loopholes.
by Emily Ramshaw
Zerwas on gambling: We as a state need to have that debate and dialogue. I do support taking that to the voters as a referendum.
by Emily Ramshaw
Dunkelberg: If you take cuts too deeply, does it cripple your recovery?
by Emily Ramshaw
Question about women's reproductive health, Planned Parenthood.
by Emily Ramshaw
Smith asks about Planned Parenthood and AG opinion allowing HHSC to defund them.
Zerwas: I'm a very pro-life individual. There are a lot of good health care services that are provided in some of these other venues. I think we need to be sure we don't lose the ability to deliver those quality services that are out there. I'm not somebody who wants to see us promote, or be associated with abortions... But where you have a need for something... most people would agree that's a reasonable thing we should look at. I think we should try to disconnect those things. Let's look at some of the very valuable women's health services that are provided.
by Emily Ramshaw
And that's a wrap.

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