HOUSTON - Gov. Perry has said he'll oppose expanded Medicaid in Texas, but the next legislature will also have a say. Meanwhile, a growing chorus of social service advocates, health care providers and local officials are making it clear: They want to tap the billions of new federal dollars that would enable more low-income Texans to get health coverage under the Affordable Care Act.

Physician Laura Guerra-Cardus, associate director of the Children's Defense Fund of Texas, says accepting the money would go a long way toward improving the state's worst-in-the-nation uninsured rate - largely by increasing coverage among low-income 19- to 64-year-olds.

"There are 3.6 million in that group, and 2 million of them are uninsured. That's 57 percent. That's the very group we are potentially denying affordable health care coverage."

The figures are based on data released Wednesday by the U.S. Census Bureau, which has posted an online tool for tracking county-by-county coverage. Under the new health care legislation, adults who earn below 138 percent of the federal poverty level would be covered by expanded Medicaid. State health officials have estimated that Texas would cut its uninsured rate in half - from 24 percent to 12 percent - if the state embraces the plan.

Opponents argue that the federal aid comes with too many federal strings, and that state contribution levels might rise in the future. However, some of the largest Texas counties are exploring alternative ways to participate in the Medicaid expansion, even though it is not yet clear if the federal government would approve of local plans without state buy-in.

Guerra-Cardus says it's the counties that most bear the burden of the costs associated with the uninsured.

"They are being passed on to all taxpayers through hidden taxes on health insurance premiums and higher hospital district taxes."

A recent study published in the New England Journal of Medicine shows a significant decline in the adult death rate in states that have already expanded Medicaid on their own. Guerra-Cardus thinks that's the kind of statistic that will eventually lead states like Texas to reverse their opposition. She points out that the current Medicaid program, which is also optional, was eventually embraced by every state.

"There is good reason to hope that, in time, every state will adopt the new options. And the deal we're getting for this expanded Medicaid for adults is far better than the deal we got with original Medicaid."

States now pick up about 40 percent of their Medicaid expenses. The federal government would pay 100 percent of the expansion for the first three years, after which states would have to contribute up to 10 percent. The expansion was a key component of the Affordable Care Act, but the Supreme Court ruled that states had the right to reject it.

U.S. Census coverage estimates are at http://1.usa.gov/rUfEu. The NEJM study is available at http://bit.ly/Oa2iVI.




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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.