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Travis Commissioners encourage legislators to expand Medicaid

Wednesday, February 20, 2013 by Elizabeth Pagano

Despite some misgivings among the ranks, the Travis County Commissioners Court moved forward in declaring support for Medicaid expansion on Tuesday.


The court voted unanimously to approve a resolution “strongly encouraging” the Texas Legislature to expand coverage in accordance with the provisions of the federal Affordable Care Act of 2010. They voted 3-0 to approve the resolution, with Commissioners Ron Davis and Margaret Gomez absent.


“I’m aware of the situation at the state, and those legislators have to vote as they have to vote. But I think as a local elected official, my responsibility is to let them know what I think,” said County Judge Sam Biscoe. “They’re not shy about giving us advice, so I tend not to be shy about giving them advice.”


“Local dollar supplementation can get to be real, real painful,” said Biscoe. “My guess is that we do, probably, more than any other urban county in Texas when it comes to assisting uninsured and under-insured individuals. But still the numbers left uninsured and under-insured are huge.”


In 2011, Texas had an uninsured rate of about 23 percent, which is the highest in the nation. An estimated 209,348 of those people were Travis county residents.


Several Austin Interfaith leaders expressed thanks to the commissioners court for their action, as did Pamela Baggett from the National Alliance on Mental Illness in Austin. 


“Bottom line, it just makes economic sense,” said Baggett. “The former state comptrollers’ office has said that Texas counties could see $23 billion in federal aid.” In addition to increased funding, Baggett noted that costs associated with police, courts, jails, and prison systems would also decrease.


According to the resolution, the expansion would add $224.1 million in annual Medicaid funds to Travis County. It would also reduce the current $1.8 billion in annual private charity costs, which have typically been passed on in the form of health insurance costs.


The resolution also states “each dollar spent expanding Medicaid in Texas would result in a $1.29 increase in state revenue, a 51 cent increase in local government revenue, and a savings to local governments of $1.21 for investments in uncompensated care.”


Commissioner Sarah Eckhardt said even the more conservative representatives on the Council of Urban Counties were “struggling between the political issues of an expanding federal government and the local issues of an increasingly burdened property tax.”


“There is a sense that when the state restricts coverage to the poor and the middle class, either through restricting specific services or foregoing federal match, it almost inevitably pushes cost down on to the property taxes of those locals that are willing to provide services to those in need,” said Eckhardt.


After some debate, Commissioner Gerald Daugherty ultimately voted in support, saying it was, “the right thing to do.”


“I am also going to be very, very cognizant of this thing being a little bit of something that scares an awful lot of people in this country,” said Daugherty, the court’s lone Republican.  “I think this is Obamacare, and I don’t agree with Obamacare.”


Though he said that he agreed there was a need for more funding for care, especially for mental illness, Daugherty said that he feared the resolution would lead to the county spending “a lot more money,” and ultimately, the socialization of health care in the United States.


“You are using the term Obamacare as a negative, not a positive,” said Baggett. “From that perspective, you are incorrect.”


Despite initially stating he could not vote in favor of the resolution, Daugherty softened his stance after some discussion. He said he was concerned some of the language in the resolution could provoke pushback in the legislature, even from people who are otherwise sympathetic to the need for more funding.


“It’s not like anyone is so inhumane that they don’t want to help people that really need help,” said Daugherty. “I think that Obamacare is very controversial in this country, but that’s not to say that all of the things that are in Obamacare aren’t really important. And I think they do need to be addressed.”


Austin Interfaith plans to hold a noon rally today at the Capitol in support of the Medicaid expansion. The rally is part of a statewide effort by clergy across Texas to work with counties to pass resolutions in support of Medicaid expansion. Dallas and El Paso Counties have already passed resolutions and similar efforts are underway in San Antonio, Houston, Fort Worth and the Rio Grande Valley.


Next week, the Commissioners Court will reconsider Medicaid expansion as a legislative item, which will give Daugherty time to hammer out the details that continue to make him uncomfortable. He told In Fact Daily he was concerned about some of the word choices in the resolution, but he was sure they could be settled by next week.


“I found very few things that I wasn’t supportive of, from a concept standpoint,” said Daugherty.

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