AUSTIN, Texas -- As states grapple with financial shortfalls due to the coronavirus pandemic, a new study shows just how much Texas could benefit by expanding Medicaid under the Affordable Care Act.
Study lead Laura Dague, associate professor in the Bush School of Government and Public Service at Texas A&M, said at current funding rates, Medicaid expansion in Texas could bring in $5.4 billion in new federal spending and provide health coverage to nearly 1 million Texans, with little cost to the state.
Dague said the unexpected health crisis illustrates how expanding Medicaid could help lower-income Texans.
"Medicaid is the kind of program that can make a big difference in a pandemic - especially as, going forward, where hopefully we'll develop better treatments, and thinking about how people are going to pay for those things," Dague said.
Without health insurance, people typically forgo preventive care, and head to an emergency room when they're sick, creating a financial burden for the state and taxpayers. Research for the study was compiled by the Bush School of Government and Public Service and sponsored by the Episcopal Health Foundation.
Texas is one of 12 states that hasn't expanded Medicaid since becoming eligible to do so with passage of the Affordable Care Act in 2010. As a result, Texas has the nation's highest rate and total number of uninsured individuals.
Dauge said many Texans earning minimum wage are too poor to qualify for an ACA tax credit, but earn too much to qualify for Medicaid under the state's strict eligibility criteria.
"So, we have a really big eligibility gap in Texas that a lot of people in working families can fall into," she said. "And that's one of the reasons we have a high uninsured rate relative to other states."
Dague worries when the COVID-19 vaccine is available, the cost will be out of reach for some Texans.
In 2019, a federal judge in Texas invalidated the Affordable Care Act, although the law remains in effect awaiting a U.S. Supreme Court ruling.
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Health-care professionals say low pay and a worker shortage have led a dramatic number of nursing homes in rural Iowa to close their doors. They hope increased government funding and more focus on rural health care this year will help.
Looking at a graph that shows the number of nursing-home employees between January 2019 and January 2020, the bright red line goes almost straight down. The pandemic was a big reason for that, but Iowa Health Care Association President and CEO Brent Willet said there are other economic factors at work, and the staffing shortages have already resulted in double-digit closures.
"It is alarming," he said. "The latest figures are, we've had 17 nursing homes in Iowa close in the last 12 months. Fifteen of those 17 have been in rural parts of the state."
Willet said nursing homes can't offer competitive wages to people who are willing to take these demanding jobs, especially in rural areas where the population is declining. He said he remains optimistic, though, adding that the Iowa Legislature will reconsider those wages this year, since more than half of nursing-home funding comes from state and federal governments.
Willet said it's also becoming harder for people in rural nursing homes to get the support they need from other medical-service providers in town. He said this adds to the problems already caused by staffing shortages, simply because those services dwindle along with the population.
"Like dialysis, like their primary-care doctor," he said. "As those services become harder and harder to come by, it creates additional challenges pertaining to costs and logistics to care for people in their home community."
The national long-term care facility numbers are also alarming. The Centers for Medicare and Medicaid Services reported recently that 129 nursing homes closed in 2022 - although this year, the numbers are starting to improve.
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Health-care professionals and advocates in Connecticut have said it will take sweeping reforms to bolster the state's flailing public health system.
At the labor union 1199 SEIU's Health-Care Policy Symposium, experts spoke of the system's long-time underfunding and staffing shortages. A union-related group, called Expand Services to Save Lives, wants to see part of the state's multi-billion-dollar surplus used to address the issues - including $30 million to recruit and retain public-health workers.
Rebecca Simonsen, vice president and director of the public division at 1199 SEIU, said the state needs to revitalize this system of critical services.
"State health-care services generally serve the most at-risk, highest need, complex residents," she said. "Often folks without insurance, often folks that have been turned away from the private sector. And we created these services because, as a state, we believe that every resident's life should be valued."
In 2022, the state received a $32 million grant from the Centers for Disease Control and Prevention for public-health workforce development. She added that even if the group gets everything it's seeking from this legislative agenda, it wouldn't be the entire solution.
One area of the staffing crisis to be addressed is retention of nurses, more of whom are leaving the field due to burnout and higher patient limits. The union wants to see a pipeline created for nursing students to prepare them for public-sector jobs.
Brian Williams, an organizer for 1199 SEIU and a certified addiction counselor with the Connecticut Department of Mental Health and Addiction Services, said it's time to commit to action instead of acknowledging the problem.
"We cannot continue to say, 'Hey, you know, we have a nursing crisis, we have a nursing crisis.' We have to create incentives to actually expand the pool of nurses," he said. "And this is one of the proposals that we have that we believe will have an impact."
The group also proposed a $12 million investment to add workers to the department to address what was described at the conference as an ongoing mental-health crisis.
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Iowa lawmakers are considering a bill which would dramatically reduce the use of cellphones in vehicles.
Right now, it is illegal in Iowa to send or read text messages while driving, but drivers can use a cellphone for navigation, which often takes more attention than texting. Senate Bill 60 would tighten the rules further, prohibiting drivers from operating a phone if it takes more than a single touch to activate or deactivate it.
Sen. Claire Celsi, D-West Des Moines, said she is personally motivated by the measure after attending the wake of a constituent's 12-year-old child who was killed by a distracted driver.
"It really affected me," Celsi recounted. "The dad just said, 'Please, please, please make this illegal. Please help people like us never to have to go through a loss like this.' So, that's what really spurred me to join onto the bill this year. It's a Republican bill, but I completely support it."
The Iowa Department of Public Safety said drivers who use handheld devices are four times more likely to be in a collision causing injuries than those who are not using their phones. The bill is headed to a Senate committee.
Celsi acknowledged she used to oppose hands-free cell phone measures, because she felt the costs were prohibitive, but she said technology has caught up, and prices have come down.
"You can buy something at Walmart for $20 that can help you go hands free in your car," Celsi pointed out. "I think it really demands now that we reexamine the issue and do something about distracted driving in our state."
The Insurance Institute for Highway Safety said about half of states prohibit the handheld use of cellphones when driving, and all but Montana prohibit text-messaging while driving.
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