A glint of hope. That’s how Austin American-Statesman reporter Andrea Ball described the slow, gradual progress Texas has achieved in eight years to improve the state’s 13 supported living centers for people with developmental disabilities.
It’s an adequate description. As Ball’s recent investigation showed, all 13 centers report improvements in medical care, fewer resident injuries, and fewer cases of abuse and neglect. However, substandard medical care and safety remain a problem in some centers.
Texas’ 3,000 supported living center residents are among the most severely disabled and hardest to place because they require a level of care and security that can only be provided in an institutional setting.
As such, officials need to continue to push for improvements until each institution delivers the care and protection owed to this vulnerable population.
Sadly, Texas had for decades failed to comply with demands for better medical, dental and psychiatric care for state living center residents. On more than one occasion, Texas promised to do better. Each time, state leaders failed to deliver.
Until now, I hope.
The wheel of change began to move after a 2008 Justice Department investigation found a long list of medical care failings at state living centers, including the deaths in a single year of at least 114 residents, 53 of those from preventable conditions. The Justice Department required the state to overhaul the services the centers provide, the way they perform them and the way they measure success.
Since 2009, the state has spent $233 million to hire, train and monitor new employees. Texas has spent another $24 million for Justice Department-required, independent monitoring teams to evaluate all centers on a regular basis, and $12 million for consultants.
As expected, change has come slowly.
According to Ball’s reporting:
From 2010 to 2016, a 35 percent decrease in confirmed cases of abuse, from 429 to 277.
Between 2014 and 2017, a 25 percent decrease in reported injuries to residents, from 42,673 to 32,166.
Of injuries reported, 298 were considered serious, down from 516 in 2014.
Since 2014, a 32 percent decrease in reported injuries to center employees by aggressive residents, from 1,624 to 1,111.
Any progress made so far helps, but when Medicaid officials threatened to halt the flow of federal money to nine centers a total of 25 times in the last year over concerns of resident safety and substandard medical care, it’s a loud signal that there’s still plenty of work to be done.
State officials are on the right track. A change in how the Justice Department and state measure progress, by focusing more on individual outcomes instead of processes, should put centers on a faster track to meeting the federal expectations, according to officials. Officials must seize this opportunity to move the needle for meaningful change further and faster.
For most residents, their profound disabilities make them dependent on these institutions. It’s important that officials get it right for them. In doing so, maybe, officials help redeem the word of Texas.
Early Friday morning, in the well of the U.S. Senate, President Donald Trump and his band of playground bullies finally met their match: Two women and a real man.
The trio, Sens. Susan Collins of Maine, Lisa Murkowski of Alaska and John McCain of Arizona, all Republicans, joined a unified Democratic opposition to kill the so-called “skinny repeal” of Obamacare, 51-48.
For now and perhaps for good, in one of the most dramatic votes witnessed in recent years, the seven-year push by the GOP to repeal and replace or simply repeal the Affordable Care Act has collapsed.
The failed effort paves the way for something incredible to happen that Americans have been clamoring for in their government: A bipartisan approach to fixing the nation’s healthcare system. As we said in previous editorials, Obamacare needs to be shored up, stabilizing insurance markets that have in some places abandoned consumers or left them with few insurers to choose from. Premiums for middle- or upper-income earners also need to be curbed.
The GOP’s skinny repeal, orchestrated in secret by Senate Majority Leader Mitch McConnell, was anything but skinny: As it was laid out, it would have caused chaos in the health insurance markets and premiums to soar, mostly by eliminating the mandate for Americans to buy or get health insurance, but also by wiping out the medical device tax.
Without mandates and penalties to back them up, many people, and particularly younger and healthier Americans, likely would forego health insurance or buy scaled down insurance. Such a system defies the basic principles of insurance that spreads risk among all – young, old and healthy and sick – to keep premiums and costs manageable.
In all, 16 million additional people would be without health insurance by 2026, according to an analysis by the nonpartisan Congressional Budget Office. The CBO also estimated that premiums in the individual market would increase by 20 percent compared to current law in all years between 2018 and 2026.
Without a true fix, the GOP led by Trump had to resort to masquerade plans that were dressed up to look like something they weren’t. Desperate to keep promises made over seven years, including by Trump on the campaign trail, they threw anything out. But in the end, nothing stuck to the Senate wall.
All of the proposals Republicans forwarded would have resulted in tens of millions of Americans losing coverage with the working poor, disabled, and folks with preexisting conditions and middle-aged — who are too young for Medicare and too rich for Medicaid — bearing the loss. That should have been unacceptable to McConnell and House Speaker Paul Ryan.
But they rolled over for Trump and his minions who took to Twitter with intimidating tweets to Collins and Murkowski, challenges to duels (I wish I were making that up) and threats of holding up federal aid or economic initiatives to Alaska to punish Murkowski for her steadfast opposition to GOP plans.
The ladies demonstrated the kind of leadership the nation needs – and has longed for — to deal with complex issues, particularly in fixing the nation’s healthcare system. Their leadership was a huge contrast with Trump’s governance by intimidation, browbeating and humiliation.
Vice President Mike Pence, who evermore takes on the presence of a sycophant for Trump, showed up in the Senate on Friday to break the tie. But his vote was unnecessary. Collins and Murkowski cast their votes as voting began at 1:24 a.m. McCain in high drama kept his vote under wraps from the public until 1:29 a.m., when he walked on the Senate floor, approached the Senate clerk and gave a thumbs down.
Few pieces of legislation in recent years have generated as much intense national debate in recent memory as the Patient Protection and Affordable Care Act, known to many Americans as Obamacare.
An overhaul of the U.S. health care system, it was signed into law by President Barack Obama in 2010. Republicans have long vowed to repeal and replace the law, and on March 6 GOP lawmakers unveiled a House bill called the American Health Care Act, which would change how health care is financed for people who do not have insurance coverage through their work and eliminate the mandate requiring most Americans to have health insurance.
We asked Viewpoints readers to share their ACA experience with us. The following are some of their letters and photos:
In 2013, I was in good health but my doctor had me on four meds for cholesterol and high blood pressure. No big deal — in fact, three of these were on the $4 list at Wal-Mart Pharmacy. So, then I decided to buy an individual health insurance policy. Aetna, Blue Cross and other insurers declined to cover me for any price because of the number of meds I took to stay healthy. When the Affordable Care Act became effective in 2014, I had a choice of insurers through the health insurance exchange. So even though I didn’t qualify for subsidy, the ACA made it possible for me to finally buy health insurance because insurers are no longer permitted to cherry pick customers by excluding pre-existing conditions. — Howard Porter, Austin
I was diagnosed with breast cancer at age 31 in 2015. With no family history, it was a terrible surprise nine months before my wedding. But I was lucky that the cancer had not spread, although my oncologist still recommended surgery, chemo and radiation. Again, I was lucky — I had health insurance, which picked up the $280,000 tab for my treatments. I didn’t need Obamacare for myself, but I cannot imagine what it would have been like to receive this diagnosis without insurance. It would have destroyed my dreams for the future. I know that before the ACA, this happened to Americans constantly. Repealing Obamacare will directly impact me — specifically, repealing the pre-existing conditions clause. Even though I no longer have cancer, I will forever be considered either uninsurable or gouged for health insurance without this provision. It isn’t my fault I got cancer, but if Obamacare is repealed, I will keep paying for it. — Tiffany Gilman, Austin
Never mind the lines: “If you like your doctor, you can keep your doctor,” or “If you like your policy, you can keep your policy.” At this time of the year, the biggest issue with the ACA really hits home. This is tax time; I am again preparing to include my 1095-C form with my return — you know, that nagging little mandatory document that must be included to prove to the IRS that you had ACA-approved coverage for the year or you get to pay a big, fat penalty. I really get tired of seeing all the numbers that are insured under the ACA. Of course there are big numbers of insured Americans; they have no choice. Instead of the previous lies, the statement should have been: “You will purchase a policy that is approved by the ACA with whatever doctors they provide, or face a stiff penalty.” — Jeff Popnoe, Round Rock
For about a year, due to pre-existing conditions, my husband, Ken, received his health insurance through the Texas High Risk Pool. When the Affordable Care Act debuted, he was glad to be able to choose a policy. Subsequently, due to a fall at home that resulted in a broken hip, he had surgery and was working on his rehabilitation in the hospital when we received devastating news: Although he had no outward symptoms, Ken had stage 4 pancreatic cancer. As we began to plan for his care, one of his doctors said, “I don’t know what you think of Obamacare, but be thankful that because of it. You are not looking at a cap on care.” Shockingly, Ken passed away only 12 days after the diagnosis. In the midst of such grief, I was very thankful for the coverage he had. There was no “Mickey Mouse” with the insurance company — as often seemed to happen before the ACA. I knew exactly what my financial responsibility was and there were no surprises. In a time of such sadness, with my brain feeling as if I was in a fog, Obamacare is something I will always be grateful for. — Robin Durr, Austin
To help pay for ACA, the cost for Medicare B went up. In 2013, I paid $98 per month for Medicare B. In 2014, it went up to $140 per month. In 2015, it went up to $280 per month, so I dropped Medicare B. — Clyde Claggett, Georgetown
My husband, Andy, and I own a small business together. I was able to make the decision to join him and leave behind the 9-to-5 world the year the ACA was rolled out. Being able to purchase reasonably priced health insurance that would allow us to have a baby was the boost we needed to make that move confidently. As the gig economy and self-employment gains a greater share of the overall economy, it’s vital to have a health insurance marketplace that is inclusive to a broad spectrum of people — especially those who have to be able to provide for themselves and their families. I suspect that the health insurance marketplace and the expansion of the gig and sharing economy and reduced unemployment are all interconnected. — Faith Sams, Austin
In 2014, my husband, Jeff, and I had insurance with Blue Cross Blue Shield with a monthly premium of $941.43. We didn’t qualify for an ACA subsidy. That policy had a $6,000 deductible per person. In November of that year, I had to have carpal tunnel surgery on both hands. In December, my husband had to have knee surgery. In summary, in 2014, we paid $23,297.16 in out-of-pocket expenses — monthly premiums plus deductibles — before Blue Cross Blue Shield ever paid a penny on our behalf. Not to mention, since the knee surgery was performed at the end of December and his physical therapy didn’t start until January, our deductible started over and we immediately started having out-of- pocket expenses again. Lastly, our monthly premium of $941.43 has now gone up to $1,457.15 starting this January. — Pam Hammonds, Burnet
My story is simple: I’m 61-years-old with two serious pre-existing conditions. I’m self-employed. If anyone would insure me, it would not be “affordable.” I’ve relied on the ACA from its beginning — and it has literally been a life-saver. I also happen to know several Republicans within my age bracket who have pre-existing conditions and also avail themselves to the program. Once they looked beyond the popular misconceptions, myths and blatant lies about the ACA, they figured out that it works pretty well for those of us who are not yet eligible for Medicare. Yes, costs have gone up while the program has worked out its early flaws, but I’ve yet to see or hear about any real alternatives that won’t cut services and raise costs even more. My biggest fear is that a bunch of grand-standing congressmen who have their own insurance are going to take mine away, leaving me — and millions of others — at risk until I reach 65. — Jeff Brown, Austin
Though my brother Alan Arms worked as a contractor for many years, none of his employers offered health insurance. In November 2013, he was coughing up blood and went to an internist who ordered him immediately to a hospital. There, he was diagnosed with terminal liver cancer and faced a bill over $50,000. In January 2014, the ACA went into effect — and despite his pre-existing condition, Alan was able to buy health insurance for around $550 a month. When he died in May 2014, the sole reason he left a small estate — and not a smoking crater of medical bills — was the ACA covered his pre-existing condition and paid most of his bills. Though initially he had problems finding a plan with a network that covered his doctors, eventually he found one. Had he died indigent, the hospitals and doctors would have been forced to eat the payments for his treatment. Because of the ACA, they were paid. — David Arms, Austin
The ACA was life-changing for me. I am a 44-year-old published novelist and teacher. Before Obamacare, the only option I had for health insurance was through the Author’s Guild. An HMO plan was $1,200 a month; a PPO was $1,600 a month. I have had a pre-existing condition since I was 21” a blood-clotting disorder that rarely effects my life. I was elated when I could get a decent plan for less than $500 a month. I was able to start an Austin organization called Girls With Pens because I didn’t have to worry about getting health insurance through my job. Now all that could all be taken away. Do you want me teaching your children how to love writing, or do you want me serving coffee at Starbucks for the insurance? The ACA isn’t perfect, but each and every one of us deserves affordable health care, no matter our fitness, class or working status. — Carolyn Cohagan, Austin
In 2010, my wife lost her job and we lost our health insurance. I worked for a small hardware store, where the health insurance they offered would have cost me $450 a month with a $5,000 deductible. I was making $10 an hour, so that was not an option. Then, we were able to get insurance through the ACA. For about $100 a month, we were both covered with excellent medical benefits, which included prescription benefits, preventative care and doctor visits with a $10 co-pay. Later I found out I had high cholesterol and went on medication for that. Both of these conditions are under control now. Without health care, I may not have even known I was at risk for either a stroke or heart attack. Even when the cost of our insurance went up to about $120 a month, it was still very affordable. If the ACA is repealed, my health will be in danger. — Rick Koepcke, Austin
Obamacare isn’t affordable. The plan’s premiums are going up 25 to 116 percent nationwide this year. Health insurance companies are dropping the exchanges, which forces customers in 70 percent of the U.S. counties to buy insurance from one or two companies. Republicans promised to repeal and replace Obamacare and voted over 60 times to repeal part of the law. Congress began the process in January by passing the fiscal year 2017 “shell” budget resolution — S.Con.Res.3 — which instructed the committees about how to write the repeal law. The language has existed in a bill passed in 2015. They’ve not met their self-imposed deadline — and repeal timeline is slipping. Millions will be negatively impacted by these exchanges. We’re so close to making this last chance a reality. Contact your congressional members. Tell them we want a full repeal of ACA and to replace it with a new, workable health plan. No more excuses. — Wanda Whitney, Georgetown
I am concerned about efforts to repeal the Affordable Care Act. For many millions of Americans, this act is very far from being a disaster, as some have glibly claimed. In fact, for some of us, it has been a life-saver. Without Obamacare, I could never have afforded to pay for a costly heart-valve replacement that may have saved my life. What will those with pre-existing conditions do without the guarantees of health care eligibility promised in the Affordable Care Act? Caring for the least among us is part of who we are as Americans. If we smash affordable health care, we shatter the fragile bonds that preserve our sense of unity. — Charles Rand, Austin
As a 62-year-old breast cancer survivor who’s losing employer-based health insurance this year, I’m terrified that without Obamacare I may be forced to choose between bankruptcy and life-saving treatment. We’ve needed the Affordable Care Act before. Our 23-year-old daughter died of a rare illness 16 months ago. The ACA allowed her to stay on my husband’s employer-based insurance and not worry about lifetime expenditure caps. Were it not for the ACA, we would have been bankrupt in addition to losing our daughter Hallie. I can’t sleep at night wondering if I’ll have ACA insurance to treat my breast cancer. Or will we again face the prospect of bankruptcy? — Abby Brody, Georgetown
First, do no harm. We learn this in medical school, carrying it with us throughout our careers. In the U.S., access to affordable health insurance is a necessity for obtaining the best possible care. Shouldn’t our elected representatives share in this goal? Unfortunately, our new administration is pressing forward with repealing the law that puts insurance in reach for most. A survey in the New England Journal of Medicine found that 85 percent of family practice doctors are against repeal of the ACA. The president of the American Academy of Family Physicians, Dr. John Meigs Jr., says “too much is at stake to make significant changes to ACA.” Every day, primary care physicians see the struggles our patience face because of lack of insurance. Why isn’t our government listening to us? I hope they will join us in doing no harm — and keep the ACA. — Christine Mann, Leander
I had really good health insurance through my employers. When I went to work for myself, I had to buy insurance on my own. Though it was expensive and not very good, I knew that if I let it lapse it would be even harder to get back into the system later — and that I would have the issue of a pre-existing condition. I found the cheapest policy I could find and hoped that I wouldn’t get sick. The ACA changed everything. For the last two years, I’ve had good, affordable coverage thanks to the government subsidy. My prescriptions are just $5 — and ACA covered a large percentage of my carpal tunnel surgeries. Without that subsidy, I could not have afforded a good enough policy to cover my health care needs. Without the marketplace, I would not have had so many choices for a plan that works well for me. — Rona Distenfeld, Austin
I had my pancreas removed 16 years ago due to a rare form of pancreatic cancer. I work at home under contract and have no option for work-related coverage. When my work coverage was discontinued, I tried to get insurance to cover my needs for medication, an insulin pump and other supplies — but was told “no way” by numerous insurance companies. Once the ACA was introduced, I was finally able to get coverage that was somewhat expensive but went a long way toward keeping me alive. Many of us need it. — Rob Sanford, Fredericksburg
The debate over the merits of the Affordable Care Act highlights the highly partisan environment of our times. “Repeal and replace” has been the mantra of many Republicans elected to national office — President Trump included. However, the evidence is clear that our country’s rate of uninsured is at a historic low of nearly 9 percent. As someone who purchased insurance through the health insurance marketplace, of course I would like a more affordable monthly premium. I am hopeful that a Republican-controlled Congress can help deliver this. I am also hopeful that other pieces of Obamacare that aim to improve our nation’s health care will continue to be embraced, such as efforts to expand primary care medicine and efforts to improve quality of care. As an entering medical student, these pieces have inspired me to advocate for improving and embracing — rather than repealing and replacing — Obamacare. — Mark Smith, Austin
My wife, Linda, is a beneficiary of Obamacare. Prior to its enactment, she was covered by the Texas High Risk Pool. Due to her pre-existing type 2 diabetes, she could not get coverage from standard insurance carriers. My wife was 62 when the law was enacted — too young for Medicare. Her premiums went down with Obamacare — not up — with no subsidies. The good news is her premiums will go down again next year when she gets on Medicare. The bottom line is that Obamacare is flawed because it didn’t go far enough. Everyone should be on Medicare — and we should find a way to pay for it. Though Americans pay more for health care than any other developed country, our quality of care is not any greater. Americans should ask our congressmen and senators why. — Randy and Linda Johnson, Georgetown
In December 2013, I was newly pregnant and working long hours as a self-employed consultant at a global law firm. Our COBRA policy was set to expire. My husband, John, was the third employee in a dot-com that offered no benefits. As pregnancy was considered a pre-existing condition, agencies were well within their rights to deny us coverage regardless of our willingness or ability to pay premiums. Through the ACA exchange, we enrolled in a policy and suffered no gap in coverage. That summer, our daughter Elodie was born with a previously undetected, life-threatening birth defect called duodenal atresia. Without this coverage, we would have lost everything to save her life. The bills from her surgery and monthlong neonatal intensive care unit stay totaled upwards of $500,000. We were so fortunate to pay a small fraction, thanks to the ACA. I urge your readers to consider the many hard-working families like ours that rely on the ACA’s protections. — Lisa Federico, Austin
My son was prenatally diagnosed with a congenital heart defect that would leave him with one functioning ventricle and require a series of surgeries over his lifetime — two of them in the first six months of life. Today, my son is a sweet and mischievous 18-month-old toddler, thanks to an incredible medical team. But we have a long road ahead of us, and access to a good health care policy is a top priority in my world. The ACA means my son will have medical coverage for the rest of his life and will not be punished because he has a pre-existing condition. It means he won’t face a cap on his coverage. The idea that lawmakers could repeal Obamacare without a ready replacement is terrifying to families like mine. I guess when you have free health care for life — like our congressional representatives do — the rest of us don’t matter. — Michelle Beebe Nabours, Manchaca
Today is my daughter’s eighth birthday. She was born not long after Obama’s first inauguration. Before I got pregnant, I’d left a teaching job in favor of working with an educational nonprofit, though it offered no health coverage. Wishing to have a child, I stayed on COBRA and paid a $600 monthly premium. Two miscarriages later, a pregnancy stuck. My insurance coverage did not. COBRA terminates after 18 months. Because my pregnancy was deemed a pre-existing condition, I had no other viable option. My daughter’s birth was a 24-hour ordeal that was made harder because I was uninsured. Though my husband and I gained a beautiful child, we watched a down payment for a first home disappear. Our daughter’s middle name is Hope. Our hope for uninsured expectant parents was realized, albeit imperfectly, with the ACA. By repealing it, Republican lawmakers dash dreams and health for countless families, leaving them financially at risk. — Laurie Filipelli, Austin
My family had been waiting for March 15 for five years. It was the day I donated my kidney to my mother — so that she can live her life free of a machine. I remember sitting in the clinic and my donor advocate asking me what my plan is if the ACA is repealed, explaining that a kidney donation will count as a “pre-existing condition.” Without the ACA, health insurers can refuse to cover me. I went through a litany of health tests to even be chosen as a donor and am told I will live an ordinary life after surgery. Now I could be denied coverage at age 26. What about when I want to start a family? What if something else goes wrong? This gift to my mother is now a financial liability. I want to be part of a society that encourages giving life, not one that punishes donors. — Carolyn Blake, Austin
More than 133 million Americans like me have pre-existing conditions. For the first time in America, people with pre-existing conditions cannot be denied health coverage or charged exorbitant rates. The ACA prohibits these things. Now Republicans in Congress want to repeal the ACA, including the individual-responsibility part of the law. I know this is a tough pill to swallow, but maintaining protections for people with pre-existing conditions without requiring individual responsibility would cost millions of us coverage and increase premiums for even more of us. Health care reform is personal. Millions of lives are affected. The ACA allows those of us with pre-existing conditions to live healthier and more-productive lives. It also allows us to change jobs without losing health insurance. As Republicans work to repeal the ACA, I implore them to also follow the physician’s oath to first do no harm. — Janie F. Galko, Austin
With the government push to repeal and replace Obamacare, why not consider a simple solution? Principal criticisms of the ACA are inflexibility and high costs. Tenets of a “replacement” plan are flexible coverage alternatives and interstate insurance options. These objectives could be met by simply amending the existing system. Allow insurance companies to offer alternative plans in addition to the existing four ACA plans. A similar approach has worked in Medicare Part B, where “Advantage Plans” are offered in addition to original “Supplement Plans.” Let the public choose which plan is best for them. Allow access to individual state insurance exchanges from any state. This change would introduce competition and reduce costs. Why subject the nation to the Sturm und Drang of “repeal and replace” when it would be so simple to amend the existing system? An amendment would be a bipartisan, win-win solution — and it would be best for the public. The plan’s name is irrelevant. — David Butler, Georgetown
I am in full support of the Affordable Care Act. I have been able to obtain health insurance since its inception. Prior to ACA, I was paying $587 per month for health care through Blue Cross Blue Shield High Risk. It was a terrible plan and offered nothing beneficial. It was the only insurance I could obtain due to benign thyroid nodules. When ACA started up, I was able to have health care without having to worry about any pre-existing conditions and high monthly premiums. I am currently utilizing Sendero Ideal Care through the ACA. I am very happy with my doctors and the care I receive. — Jo Rae Di Menno, Austin
Just as Martin Niemoller once said, I now say: “First they came after Obamacare, and I did not speak out, because I was not on Obamacare. Then they came after Medicaid, and I did not speak out, because I was not on Medicaid. Then they came after Medicare — and there was no one left to speak for me.” I am an 89-year- old with serious and expensive medical problems. Now, I am scared to death that I will have no medical coverage in my final years as I try to stay alive with some comfort and dignity. — Herman I. Morris, Plano
WHOM TO CONTACT
The following lawmakers represent Central Texas:
John Cornyn: 202-224-2934; 517 Hart Senate Office Bldg., Washington, DC 20510
Ted Cruz: 202-224-5922; Russell Senate Office Bldg 404, Washington, DC 20510
10th District: Michael McCaul (R); 202-225-2401; 2001 Rayburn House Office Building, Washington, DC 20515
17th District: Bill Flores (R); 202-225-6105; 2440 Rayburn House Office Building, Washington, DC 20515
21st District: Lamar S. Smith (R); 202-225-4236; 2409 Rayburn House Office Building, Washington, DC 20515
25th District: Roger Williams (R); 202-225-9896; 1323 Longworth House Office Building, Washington, DC 20515
President Donald Trump and the Republican Congress are preparing to repeal the Affordable Care Act, aka, “Obamacare.” At this point they have not crafted a replacement. We’d like to hear from you about your personal experiences with the Affordable Care Act.
We believe your stories can help inform policymakers on this important topic.
You can submit your story as a Letter to the Editor using our online form or by sending an email to email@example.com (no more than 150 words , please). Don’t forget to include your full name, address and daytime and evening phone numbers.
Our goal is to publish a full page of those stories we receive. Your first-hand accounts will help foster understanding about how Central Texans are using or not using the Affordable Care Act and whether it should be refined, replaced or eliminated.
Texans, Latinos, and yes, Latino Texans. They were every bit present during the Democratic and Republican National Conventions. Their numbers may not have been large, but they made strong appearances, leaving memorable remarks.
DNC had 133 speakers of which 43 percent were women and 44 percent were nonwhite, according to the LA Times. Meanwhile, the RNC had a total of 71 speakers, of which 35 percent were women and 20 percent were nonwhite.
So how many were Texan? Latino? And Texan Latino?
LA Times said six Latinos spoke at the RNC and I found more than 20 took the stage at the DNC. From Austinite Robert Rodriguez (in video above) to Ted Cruz, Latino Texans made for some of the most unforgettable appearances at both conventions.
And while the Los Angeles Times did not have a count of speakers from the Lone Star State, at least five spoke at the DNC and three at the RNC.
There’s no surprise to find the lists lopsided in Latino and minority representation. One need only look to the party platforms to see why. The parties differ on everything from health insurance coverage to college education with most Latinos favoring the Democratic positions. But perhaps the most stark difference is on immigration in which Republican presidential candidate Donald Trump calls for the deportation of 11 million undocumented immigrants and the building of a wall stretching nearly the length of the southern border between Mexico. Hillary Clinton, the Democrats’ candidate, calls for comprehensive immigration reform.
So, who exactly showed up at the conventions? Here’s a list — and links to some of the speeches:
AT THE DEMOCRATIC CONVENTION:
From Texas to the DNC:
U.S. Representative Sheila Jackson Lee (Houston) | Speech
The fallout continues over CommUnityCare’s decision to close two public clinics in Austin last month and shuffle services around at others. It’s worth noting that CommUnityCare receives property tax support from Central Health. The American-Statesman’s Julie Chang reported that although CommUnityCare officials attempted to call and mail all patients information about the closures, the changes have left some of the area’s neediest patients surprised and looking for alternatives.
I reached out to Latino HealthCare Forum president Jill Ramirez via email for her thoughts and further insights into the closings. I’ve also reached out to Central Health officials for their response and hope to post those comments later. Here’s the full text of responses provided by Ramirez:
How does closing these clinics — and sending patients to alternative clinics — improve the service level and quality of healthcare to the community?
Closing clinics and sending patients to alternative clinics can be beneficial if these clinics meet service gaps in access and whether the gaps are related to specific populations, specific areas of the community, specific health care services, etc. A community health assessment should be done to help identify those gaps. Once the gaps are identified, the community will be able to determine what model of care will address the community needs. The community must be engaged from the start and be involved in the discussions of service discontinuance and there should be a transition plan. In Central Health’s case, they have not typically engaged the community in services planning. Most of the (negative) issues they have brought on themselves have been the lack of involving the community.
Will transportation be an issue for any of the communities affected by the clinic closings?
Access barriers create discrepancies in the number, type, and timing of health services leading to poorer health status. Transportation is a commonly identified barrier to care but is understudied in terms of the detail needed to address more direct health and transportation policy interventions. Central Health has underestimated the impact of transportation in their service planning (see discussion of closing of Northeast Clinic closing below`). Central Health has not provided any information about the impact of clinic closings, transfer of services in terms of transportation. Typically they draw a linear line and estimate miles driven and don’t incorporate that a large part of the service population use the bus and don’t own cars and are elderly. Studies have shown that barriers such as distance, access to an automobile, and availability of someone to drive them to a clinic are potential major problems. Their lack of business planning with regard of transportation has been consistent.
Aside from transportation, what additional hardships might patients experience because of the closings?
Other barriers include disruption of treatment, loss of providers with which they are familiar, cultural and language issues, and personal experiences. More broadly, non-financial barriers are distributed unequally across the population and are felt in greater extent and depth in the poor, minority and other vulnerable populations. This may be due to not only the amount of care they receive but also the content, quality, and continuity of what care they do receive.
What type of communication did patients and the community as a whole receive prior to the closings? How could communication been improved?
Communication was always non-existent. Central Health has not learned from the best practices used in the development of the Southeast Health and Wellness Center in working with community health leaders that are trusted community members in understanding the service changes and assisting in communicating changes if warranted.
Are there any other clinic closings scheduled? If so, do affected communities know of the planned changes?
As discussed above, Central Health proposes to continue to close clinics, again without any discussion with community stakeholders. The most recent clinic is the Rosewood Zaragosa clinic.
Other thoughts on changes regarding clinic closures:
Central Health has not dealt with the community and neighborhoods in a transparent, collegial and respectful manner. Their track record reflects this:
Intrusion into the Gracywoods neighborhood in the development of the North Braker Lane Health Clinic. Central Health bought the land, initiated re-zoning in an established neighborhood without any prior notice to the neighborhood organization(s) resulting in community strife over a clinic that could have been planned in an effective manner.
While planning the North Braker clinic, Central Health closed the Northeast Health clinic at 7112 Ed Bluestein, the only clinic serving Northeast Austin. Central Health forced many patients to have to travel further north to meet their clinic needs. The closure was also without notice. As a result, the community protested as this created hardship for many patients to make the trek with two to three bus transfers. The Northeast area had been without health clinic services until the recent opening of the Peoples Community Clinic in the Northeast area. But, because there has much growth to the northeast, the area is still underserved.
In 2105, Central Health and CommUnityCare staff announced that they were closing the Rosewood Zaragosa clinic and moving resources (s) to the clinic planned at Huston-Tillotson less than 2 miles away. The staff’s official reason was that the Rosewood Zaragosa clinic required facility improvements. Rosewood Zaragosa is one of a few clinics where community members have access to the clinic’s medical services on one side of the site and access to public health resources on the other side. This is a one-stop for the community where patients can get healthcare and health services in one location. This is the type of best practice that Austin has been striving for and it is already functioning through the Rosewood Zaragosa clinic and center. Last year, the community mobilized when it learned of plans for this closure and sent a strong message. The Central Health Board heard that message loud and clear and the proposal was withdrawn. Yet, the CommUnityCare clinic director continues to plan for this closure and has begun talking about it. It is also important to note that this clinic serves a Latino population.
What a mess. That’s what you get when Texas lawmakers call for millions in cuts, as they did in 2015, to therapy services for disabled children. Now, the courts are left trying to sort out the muddle.
Last session, Texas lawmakers approved a two-year budget that ordered a roughly 25 percent cut to the amount of money some pediatric therapists were paid by Medicaid. The cuts equal $150 million in state funds and $200 million in matching federal funds. Answering to the legislature call, Texas Health and Human Services Commission officials targeted the funding cuts around physical, occupational and speech therapies that affect an estimated 60,000 disabled children, including foster children. With any luck, the courts will find that funding should be restored and see that the commission’s decision to cut these particular funds is short-sighted.
Yes, short-sighted. The services targeted are long-term therapies that help children with limited abilities become more independent and self-sufficient to the best of their abilities. Studies show that greatest results are achieved when therapies begin at a very young age and continue into adulthood, if necessary. To cut or limit those therapies and services dramatically decreases the chances of these children to grow and be productive citizens.
Understandably, a group of in-home therapy providers and families of children with disabilities immediately sued the state in August to prevent the payment cuts from taking effect. Advocates and families argue that payments to providers for Medicaid patients would drop by as much as 28 percent. Such a steep reduction in payment would force some providers out of business and leave many children without much-needed therapies. It should be noted that these arguments were countered last week by a lawyer for one healthcare insurer who said in court that rate reductions could be carried out without a reduction in services.
Still, there has to be a better solution than to take aim at services that benefit the most vulnerable Texans: Children with severe disabilities with no money to pay for the services they need. Yet, the commission refuses to see it that way, even when many have said that state’s proposed cuts are based on faulty information.
The Legislature based the cuts on single independent study from Texas A&M Health Science Center researchers — parts of which state District Judge Tim Sulak, in signing a temporary injunction to the cuts in September, said were “seriously flawed.” Like I said: It’s a mess.
Yet, on Wednesday, during oral arguments in the Texas 3rd Court of Appeals, the attorney for the state’s health commission, Kristofer Monson, said the appropriations bill passed by the Legislature in 2015 mandated the cuts and left the commission with no choice but to carry them out. “The commission followed the rules,” Monson has said.
Numerous letters and comments made by at least 60 legislators, show that the lawmakers don’t agree with Monson.
In fact, Lt. Gov. Dan Patrick and Flower Mound Republican state Sen. Jane Nelson, the chairman of the budget-writing Senate Finance Committee, told Health and Human Services Commissioner Chris Traylor he had “the flexibility to strive for achieving $100 million in savings in Medicaid therapy services while preserving access to services.” The key here is access to care.
No one argues that identifying corruption and pockets of waste is a bad idea — that, after all, was the initial intent for the legislative bill. Looking for ways to make the best of taxpayer money should be a priority. However, what we are dealing with here is not comparable to unnecessary dental services for a healthy kid, but limiting the life-altering therapies of a disabled child. Hopefully, the courts will see on April 25 that the commission was short-sighted in their call for these particular cuts and restore funding for Texas disabled children.
The world of medical bills can be bewildering, even for those of us with good health insurance. The Affordable Care Act, aka ObamaCare, has meant more people are covered in Texas than ever before, but it is not a stretch to say the billing is just as confusing, and depending on the size of your deductible and your paycheck, an unexpected medical expense can still be a substantial hit to the family’s pocketbook.
I know a little something about broken bones and hospital bills, because my two daughters, ages 6 and 8, have managed to have three between them in the last two years (jumping on the bed, bike accident, and falling off a chair.) The last of which happened on Christmas Day and ended in emergency orthopedic surgery. The bills are still coming in on that one, but the total if I were uninsured would be in excess of $25,000. By virtue of the fact that I have pretty reasonable insurance through the Statesman and the fact that my daughter had already maxed out her medical deductible earlier in the year, we will be on the hook for about $1,000 of that cost. We can afford to pay it, but others are not so fortunate.
For those Texans who fall in the Medicaid gap — those whose incomes are below the poverty level but are ineligible for Medicaid and do not qualify for the federal health insurance subsidies — $25,000 might as well be $250,000. That fact alone would explain why unpaid medical bills are considered the No. 1 cause of bankruptcy. Nationally, nearly 3 million people are in the coverage gap; a quarter of those live in Texas, according to the Kaiser Family Foundation.
In my time on the editorial board, I’ve heard various groups attempt to explain that rising medical costs are due to a failure of families to research the costs or an inability to prioritize their spending. But when your child falls and her bone is unmistakably broken, there is no time to go online and compare costs for orthopedic surgery, there is no form to sign to require hospitals to use only “in-network” specialists, and I dare anyone to suggest that perhaps you cut back on the pain medication to cut costs. Saying “Nevermind, let’s not fix this arm today” is not an option.
With the deadline for signing up for health insurance on the federal exchange on Sunday, those who qualify for ACA should absolutely take advantage of it — regardless of how young or healthy you may be. A single, freak accident or unexpected medical diagnosis can be a financial catastrophe.
Republicans in Congress have spent years trying to repeal a law that is needed for American families, although currently imperfect. A family should not have to take on the equivalent of a car loan to fix an 8-year-old’s broken arm.