Texas Is Throwing Away Billions on Bad Health Care. But Legislators Look Paralyzed to Fix It

The ability of the Texas Legislature to turn opportunity into stagnation is second to none.The problem is, the failure to legislate can mean real suffering for Texans who desperately need their lawmakers to get the job done.Here we are talking about the crucial need for reform to the system that sees billions of dollars in public money spent to pay third-party, private health care companies to take care of vulnerable Texans.If you know something about how broken this system is, you probably know it from an extraordinary investigative series that this newspaper’s journalists broke last year.Titled “Pain & Profit”, the stories demonstrated in heartbreaking detail how millions of sick, disabled and extremely poor people get substandard care from health care corporations, even as the state pays those corporations very well to give our people decent treatment.You can fill in the rest -- the companies get rich, the people don’t get adequate care.Lawmakers, both Democrats and Republicans, charged into Austin this session burning to change it. This isn’t a liberal or conservative question. We are spending the money, after all. We just aren’t getting our money’s worth.Now, as the legislative session churns on, the burning fire for reform is turning into smoldering ash. The Managed Care Accountability bill, the most comprehensive of about 20 bills offered to address the system’s flaws, stalled in committee until procedural deadlines for consideration killed it. Now the best hope is that some of the other smaller and narrower reform bills barely alive in the House won’t share the same fate.This issue is too serious to be satisfied with a few tweaks to increase accountability. More to the point, reform must provide the services that Medicaid managed care patients deserve. Failure to fix the system amounts to a dereliction of duty that we’ve seen too often from lawmakers when they have to make tough calls or encounter the deep pockets of lobbyists.Texas and the federal government pay about $22 billion a year to companies and a few nonprofits that act as middlemen. These middlemen decide which doctor bills to pay and which services to approve. Texas pays up front, and companies pocket billions in profit from what they don't spend on patients.The system was supposed to provide better and less expensive care. As a gatekeeper, managed care companies were empowered to reduce so-called unnecessary services and match patients with doctors and specialists. Instead, those companies abused the process, left patients and families of sick and disabled children without coverage, or bogged patients down in endless and mostly fruitless appeals. Authored by Houston Republican Rep. Sarah Davis, the Managed Care Accountability bill attacked the heart of the problem — the lack of competent state oversight that might deter rogue actions.The bill would have required the state health commission to better track denials and identify patterns of companies profiting from improperly denying appropriate and needed services, and generally determine whether companies were delivering the patient services that taxpayers paid for.As is often the case in Austin, righteous reform in the public interest ran up against managed care organizations and their politically connected lobbyists, a toxic alliance that helped create the problem and now is blocking efforts to repair it. As Davis recently told The Dallas Morning News, “We always knew making major reforms was an uphill battle. The [managed care organizations] were fighting us every step of the way."It is inexcusable that lawmakers can turn away from measures that could help thousands of families for whom the state’s privatized Medicaid system is their lifeline. It is a monumental betrayal of trust: First companies didn’t do the right thing, and now lawmakers, having full knowledge of the problems, spent nearly an entire session finding ways to avoid approving a solution.There is still time for lawmakers to step up to their responsibility. But will they?   Continue reading...

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