AUSTIN, Texas – Funcionarios federales concedieron a Texas una prórroga de 15 meses sobre su programa de condonación “Sección 1115”, el cual aporta fondos para reembolsos a los hospitales por la atención que brindan sin cargo para los pacientes. Pero este programa está siendo suspendido, y los funcionarios electos de Texas –quienes hasta ahora se han negado a expandir el programa Medicare bajo la “Affordable Care Act” (Ley de Atención Asequible)– podrían tener que reconsiderar esos costos.

La Legislatura de Texas se ha negado hasta ahora a expandir su programa Madicaid bajo la Ley de Atención Asequible (ACA, por sus siglas en inglés), pero el estado todavía recibe del gobierno federal billones de dólares para atención de la salud.

Los funcionarios federales recién extendieron la condonación de la “Sección 11-15” del Estado, la cual reembolsa a los hospitales por la atención que brindan sin compensación, pero el dinero de ese programa pronto desaparecerá a menos que el estado lo sustituya con Medicaid.

Joan Alker, directora del “Georgetown University Center for Children and Families” (Centro de la Universidad Georgetown para los Niños y las Familias), dice que las estadísticas muestran que los hospitales tienen muchos más pacientes que pagan cuando los estados amplían la cobertura de Medicaid.

“Así que ya hay mucha información que muestra que los estados que han ampliado Medicaid están viendo reducciones mucho, mucho mayores en la estadía de pacientes hospitalarios no asegurados.”

Las condonaciones de la Sección 1115 consisten en programas temporales para ayudar a los estados a pagar por atención no remunerada y para impulsar la innovación en la prestación de servicios de salud.

Bajo esta figura, Texas ha recibido unos seis billones de dólares anuales durante los últimos cinco años.

Pero sin la ampliación de Medicaid, cerca de un millón de tejanos siguen estando en un “vacío de cobertura”, sin poder tener un seguro médico accesible a sus bolsillos.

La condonación fue programada para expirar en septiembre, pero esta semana los funcionarios federales otorgaron a Texas una prórroga de 15 meses.

Anne Dunkelberg, directora asociada del “Center for Public Policy Priorities” (Centro de Prioridades de Políticas Públicas), afirma que los funcionarios federales están en proceso de programar los pagos por la atención no remunerada (conocida como “UC”, siglas de “uncompensated care”), cuando un paciente es elegible para Medicaid o alguna otra cobertura de salud.

“Ese dinero de atención no remunerada se irá a partir de 2018 de cualquier manera, y la pregunta es si tenemos o no listo un plan de cobertura con fondos federales diseñado para Texas que reduzca el número de no asegurados y traiga unos 6 billones de dólares."

Bajo la Ley de Atención Asequible (ACA), el gobierno federal aporta fondos para la expansión de Medicaid. De cualquier manera, los estados comenzarán a pagar una pequeña fracción a partir de 2017, y pagarán no más del 10 por ciento al entrar el año 2020.


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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.