in Houston, Texas
Price tag says $115 billion, study authors find Medicaid expansion in Texas ‘affordable’
Monday, Jan 28, 2013, 04:45PM CST
By Mark Lisheron

With the unveiling today of a new report on the cost of expanding Medicaid under Obamacare, we are confident we have now heard the last three words on the subject: Smart, Affordable and Fair.

The Kaiser Commission on Medicaid and the Uninsured said pretty much the same thing in a lot more words with its study released back in November.

By affordable, the Kaiser Commission meant $1.03 trillion with the cooperation of all 50 states from this year through 2022.

The cost for Texas to be smart, affordable and fair is about $115 billion during the same decade, according to the new report by Billy Hamilton Consulting for Texas Impact, a grassroots religious non-profit based in Austin.

This figure is considerably less than the $150 billion the conservative Texas Public Policy Foundation estimated in its study, as much as $38 billion of it to comply with the Patient Protection and Affordable Care Act.

What this flurry of studies is selling, particularly in states like Texas with recalcitrant political leaders, is that all this expanding isn’t just affordable but practically free. And by free these analysts mean paid for by the magic money machine in that far off land where all dreams come true: Washington, D.C.

Of that trillion in the Kaiser study, why, only $76 billion would come from the states. And of the $115 billion only $15 billion would come from Texans, according to the Hamilton study.

What’s more, in the best tradition of John Maynard Keynes, all this free federal money will multiply itself in a direct and indirect boon to the Texas economy, $27.5 billion yielding $67.9 billion during the fiscal years 2014 through 2017, the study says.

Should you like to believe all that we’ve said here about the money being free and multiplying like fishes and loaves, feel free to ignore those marginalized cranks like this one suggesting all of Medicaid is paid for by taxpayers.

Next thing these folks will have you believing is that we are running national debt of $16 trillion.

Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

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Photo by flickr user Lance McCord, used via a Creative Commons license.

Bid for secrecy? Travis County hospital district sets up nonprofit
Monday, Jan 07, 2013, 11:38AM CST
By Mark Lisheron

Having endured those galling laws requiring tax increases be voted on in public, the Travis County hospital district would like to get down to the business of spending your $54 million without your help, thank you.

The district might have preferred not to tell you how they plan to do it had the Austin American-Statesman not made its usual, irksome inquiries.

You see, rather than distribute your property tax increase and as much as $76 million more in matching federal tax money a year through its own board, subject to the nettlesome state Open Meetings Act, the district established a nonprofit Central Health Collaborative, the Statesman is reporting.

Such a nonprofit is not subject to the Open Meetings Act because it isn’t a government body, according to Beth Devery, who offered her opinion as an attorney for the taxpayer-supported government body known as Travis County.

Devery is also the lawyer for the Central Health Collaborative.

Travis County taxpayers might not have gotten mixed up in all this secret medical business had county voters in November not handily passed Proposition 1.

Ostensibly a referendum on establishing a new medical school for the University of Texas in Austin, voters also were agreeing to nearly triple for the average homeowner taxes to support health care for the indigent in 2014.

That tax increase makes Travis County eligible for as much as $76 million a year in more-than-matching federal funds.

This funding is a small tributary to a roiling pool of medical and medical school funding with sources that had to be wrenched out of the University of Texas System by open records requests this past summer.

Creating and running the medical school is estimated to cost $4.1 billion in the first 12 years. The university system expected $420 million of that total to come from Central Health Collaborative.

The Collaborative is supposed to assist Seton Healthcare Family, the local hospital group pledging $1.9 billion over 12 years for the medical school, in finding a location for a new teaching hospital. And later, enter into a contract for health care services through the medical school.

Just how the Collaborative will spend your money might or might not be a matter of public record. The Collaborative hasn’t yet decided whether to hold its meetings in public or in secret, Christie Garbe, vice president of planning and communications, told the Statesman.

The hospital district board spent almost half of its meeting time last year in secret, the paper reports.

Joseph Larsen, a Houston lawyer and Freedom of Information Foundation of Texas board member, told the Statesman the nonprofit would be better off operating more publicly.

Buck Wood, an Austin lawyer who worked on the the current open meetings laws when they were drafted in the 1970s, said had he known the Collaborative’s meetings would be secret he would not have voted for Proposition 1.

“We are basically contracting away the right to information that the public ought to have,” Wood told the paper. “If you’re spending that kind of money, we want to know everything about it.”

Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

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Rift at Texas’ cancer institute widens as more scientists defect
Monday, Oct 15, 2012, 11:44AM CST
By Steve Miller
cancer cells

If there are people involved, it’s going to get political. And if it’s government-run, ah, see the first point times 100.

The Associated Press writes of the Cancer Prevention and Research Institute of Texas, a taxpayer-funded program, after filing an open records request for letters of resignation from key advisors to the agency.

It found that seven advisors resigned last week, claiming “suspicion of favoritism” in doling out grants and warning that the program is becoming subject to abuse.

“You may find that it was not worth subverting the entire scientific enterprise — and my understanding was that the intended goal of CPRIT was to fund the best cancer research in Texas — on account of this ostensibly new, politically driven, commercialization-based mission,” wrote advisor Dr. Bryan Dynlacht in his resignation letter, cited by the AP.

Another letter, from Tyler Jacks, director of the Koch Institute for Integrative Cancer Research in Cambridge, Mass., said the program “was tainted by baseless accusations by members of the CPRIT Oversight Committee that our review of a series of multi-investigator grants in the spring was influenced by regional or institutional bias and the consequent failure to advance these grants for funding consideration in that cycle.”

Records show the agency spent 83 percent of its funds on grants in 2011, or $50 million out of $60 million in spending. The share dropped in 2012, to 41 percent, with the agency doing out $42 million in grants out of $102 million.

The agency was accused earlier in the year of awarding a grant based on commercial potential – the grand Texas tradition of making a buck – rather than scientific merits.

Weeks before that, the chief scientific officer for the agency, Alfred Gilman, said he was asked to step down by the agency’s executive director.

The Cancer Prevention and Research Institute of Texas was created by statewide voter approval in 2007, sold as a means of research and prevention and put on the ballot by the state legislature. The measure authorized the issuance of $300 million in bonds that would be paid by taxpayers.

As it moved through both chambers of the statehouse, there were several objections, including that of state Sen. Kevin Eltife, who said, “I cast a "no" vote on HJR 90 because while I support Senator [Jane] Nelson’s efforts to ’ fund cancer research, I prefer spending general revenue for this effort rather than borrowing money.”

Among those testifying for the bill was Lance Armstrong, the dubious king of bike racing. His Livestrong foundation received a grant from the state agency in 2010.

The recent controversy has prompted calls for reform. Rep. Garnet Coleman, D-Houston, told the Houston Chronicle he will file legislation to put more funding emphasis on prevention.

The board of the Cancer Prevention and Research Institute of Texas includes comptroller Susan Combs and Attorney General Greg Abbott.

Contact Steve Miller at 832-303-9420 or

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Photo of prostate cancer cells via the National Cancer Institute.

Overweight? Smoke? Uncle Sam wants to help. Wellness programs started under 2009 federal stimulus persist, getting fatter with $1 billion in health care law
Monday, Sep 17, 2012, 10:29AM CST
By Mark Lisheron

Months after the grant that brought it to life ran out, Live Tobacco-Free Austin lives on.

Like many of the wellness programs started with $372.8 million in stimulus funding, Live Tobacco-Free Austin secured a new federal grant before the old one had run out and retained most of the staff hired to run the program.

Contrary to the billing of the $862 billion American Recovery and Reinvestment Act as a one-time infusion, the smoking and obesity programs branded Communities Putting Prevention to Work were never meant to be orphaned.

While hundreds of new hires were spending hundreds of millions in advance of a March 2012 spending deadline, advocates were busy embedding promises for billions more in something called the Prevention and Public Health Fund created with the passage of the Patient Protection and Affordable Care Act, Obamacare.

The fund is expected to spread $1 billion around to wellness programs this year and increasing every year after to $2 billion by 2016.

To augment that, the Centers for Disease Control and Prevention began the Community Transformation Grant program, pouring $103 million into wellness programs, several, including $1 million for Austin’s smoking program, started through Communities Putting Prevention to Work.

The Texas Department of State Health Services received a $10 million Transformation Grant for its wellness programs.

Michael MarlowMichael Marlow

Michael Marlow, a California Polytechnic State University economics professor who has written critically on obesity and smoking crusades for the Cato Institute, says this sort of government paternalism is meant to be self-perpetuating.

“You have a one-size-fits-all approach to multi-faceted problems,” Marlow says. “There is no such thing as a temporary solution, just more money for more solutions.”

In the early part of 2010, about a year after the stimulus bill was passed, the Austin/Travis County Health and Human Services Department filed two of what would be 263 applications for Putting Prevention to Work through the Centers for Disease Control.

The CDC made 44 awards, including $7.5 million for a smoking program for Austin, rejecting its application for an equal amount for an obesity program. The San Antonio Metropolitan Health District was the only other Texas agency to get a grant, $15.6 million to combat obesity.

Los Angeles County got the largest grants, for smoking and obesity programs, $32.1 million; New York City got $31.1 million; Seattle/King County got $25.5 million; and Philadelphia, $25.4 million.

Cassandra Deleon had been working for the Texas Department of Health and Human Services when she applied for and was hired, along with eight others, to manage the Austin smoking program.

The grant was the largest of its kind secured by Austin/Travis County, and Deleon says staff saw in it a tremendous opportunity to change the social norms around smoking.

There was one problem. For years tobacco was a potent political issue in Austin, but with the passage of what was, in 2005, one of the strongest local anti-smoking ordinances in the country a kind of exhaustion set in.

Austin spent about $1 million incorporating tobacco use data into the medical records of its hospital and clinic partners, Deleon says.The program set up the Live Tobacco-Free Austin website. The Ash Trailer - a vintage Airstream covered entirely with ash trays - was designed for public service appearances, she says.

Most of the funding, about $3 million, went into a radio, television and billboard campaign touting the benefits of living tobacco-free.

Deleon says she is pleased with how they deployed the grant money. The community transformation grant is testimony to the commitment to fight smoking, she says.

But this kind of program, she says, resists efforts to correlate spending with fewer people using tobacco. “We’re in the process of collecting data and, of course, were hoping for a reduction in tobacco use across the board,” Deleon says. “It’s more like that what we’ll be able to track is awareness of our live tobacco-free message.”

This is an example of the diminishing return on the money spent getting people to give up tobacco, Marlow says. After billions in federal, state and local subsidies, hundreds of thousands of tobacco-related deaths, punitive ordinances and prohibitive taxes on cigarettes, more than 45 million adults choose to continue to smoke, according to CDC figures.

“After all that’s been done, people who smoke know it’s unhealthy,” Marlow says. “Continuing to tell them that is not giving them any new information. But that isn’t going to stop the paternalists from spending money on what is no longer effective.”

There is evidence that smoking cessation programs will have to fight for funding with obesity, the new darling of federal wellness. The CDC made $230 million in obesity grants, compared to $142.8 million for smoking through the Communities Putting Prevention to Work program.

San Antonio, which has found itself on several of those much anticipated lists of the nation’s fattest cities, was an ideal candidate for its obesity grant, by far the largest single grant ever awarded to the Health Department, Christine Rutherford-Stuart, assistant director for the Community Health Division, says.

Unlike Austin, San Antonio’s bid for a Community Transformation grant was turned down. After an extension runs out and the $15.6 million is spent, the last of 13 people hired through the stimulus will be let go, Rutherford-Stuart says.

Assuming the one-time windfall wouldn’t come again, San Antonio spent nearly half of its money on bike and walking lanes and outdoor fitness equipment for parks and libraries, infrastructure that could be maintained in the future by other municipal departments, she says.

A full quarter of the funding went to physical activity programs. Among them is Siclovia, an annual bicycling event modeled after a popular rally in Bogotá, Columbia. More than 15,000 people participated in the first Siclovia, 40,000 last year and 60,000 people are expected on Oct. 7, Rutherford-Stuart says.

Another 20 percent of the grant went into nutrition and health plans, including the installation of salad bars in 108 public and charter schools in the city.

Rutherford-Stuart says the YMCA, its partner for Siclovia, has agreed to continue funding the event in coming years. The Health Department is relying on partnerships to continue exercise, fitness and nutrition programs in the absence of the stimulus money, she says,

Having put all of this in place, Rutherford-Stuart says her department will be hard pressed to find proof of actual improvement in public health. Through questionnaires the department hopes it might be able to track changes in behavior.

“We’re happy for the opportunity to use the grant money, but it will be a huge challenge going forward.,” she says. “It took decades to get where we are in San Antonio and in this country with obesity. It’s going to take decades to alleviate the problem.”

obesity by stateSource: CDC

Data from the CDC suggests what has been done at the federal level since the turn of this century has not worked. The current obesity rate of 35 percent - meaning nearly 110 million Americans are obese - is the nation’s highest ever.

In 2000, no state had an obesity rate greater than 25 percent. Today, two dozen have rates between 25 and 30 percent and a dozen top 30 percent, the CDC says. In 2000, 27 states could claim obesity rates of less than 20 percent. In 2010, none could make the claim.

The federal response to this failure is to redouble its efforts and its funding, making it clear to what were once pilot Communities Putting Prevention to Work programs that money will be made available to do further battle with fatty foods.

After exhausting its stimulus grant, Los Angeles County got another $9.8 million from the Community Transformation fund. San Diego County spent its $16.1million stimulus grant on obesity and got another $3 million in transformational funds. Philadelphia, too, got another $1.5 million after spending $15 million on obesity and $10.4 million on smoking.

Amanda Dudley, spokesman for the CDC’s National Center for Chronic Disease Prevention and Health Promotion, says the CDC has no intention of continuing the Communities Putting Prevention to Work as a national program.

The agency, however, refers to the grant money available through the Affordable Care Act as CPPW Phase Two funding.

And although one of the primary goals of all stimulus programs was to create or retain jobs, Dudley was unable to say how many of those jobs CPPW created or retained or offer a generalized assessment of the impact the program had on government hiring.

Trying to count the jobs, she said, would be misleading because of the way, the stimulus website tracking spending and job creation, collected the data.

Having also failed to negotiate, Texas Watchdog contacted the recipients of the 10 largest CPPW smoking and obesity grants. Los Angeles County flatly declined to answer questions. Philadelphia officials said they were still analyzing what they had done with their grants. Four agencies did not respond to our inquiry.

What is clear from the four that responded - the Miami-Dade County Health Department, San Diego Health & Human Services Agency, the Seattle – King County Department of Public Health and the Southern Nevada Health District - was a commitment to continue on as long as the funding continued to come in.

Although almost all of its grant had been spent by July of this year, San Diego County hung onto all 13.7 full time equivalent positions, spokesman Michael Workman says.

A package of Community Transformation, Supplemental Nutrition Assistance Program Education and other grants and some county money has kept 6.7 jobs alive in a program that has been renamed Healthy Works.

“The program is considered a cornerstone of the County of San Diego’s Live Well, San Diego!, a 10-year initiative to improve the lives of San Diegans through healthy, safe, and thriving communities,” Workman says.

The other seven CPPW employees were re-assigned to other jobs on the county payroll, Workman says.

By Seattle-King County’s calculation, its grant paid the salaries for 134 jobs in the Public Health Department and with the community partners who participated in the obesity and smoking programs, spokeswoman Kathryn Ross says.

Roughly two-thirds of the Public Health employees brought on with CPPW money are staying, Ross says, through a combination of federal grants, some foundation funds and the reallocation of money in the department budget.

A good share of the work will involve developing a plan to make the one-time grant program sustainable, she says.

Of the 12 people hired by the Miami-Dade County Health Department funding had been found to hold onto more employees, although spokeswoman Rosa Oses-Prealoni says they are hoping to find more funding to keep several others.

The work will continue through other entities funded at least in part through federal, state and local taxes, Miami-Dade County, the Miami-Dade County School Board, the City of Miami, and the City of North Miami and the Consortium for a Healthier Miami-Dade.

Only in the Southern Nevada Health District, which kept its hiring to one person, was there an effort to make sure the CPPW money was spent on programs carried out largely by people already on staff, according to spokeswoman Jennifer Sizemore.

Regardless of the inability to account for or measure the effectiveness of these federal programs, which Marlow insists is dubious, the perception of crisis, in smoking and in obesity, creates an inertia difficult to halt.

“It’s a bottomless pit,” Marlow says, “and it will never stop.”

Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

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Fraud in Texas’ Medicaid dental program followed spending boom
Monday, Aug 20, 2012, 12:36PM CST
By Mark Lisheron

Texas has yet to get a handle on millions of dollars in fraud, an unintended consequence of a fourfold increase in spending on dental services provided by the state’s Medicaid program.

The state Department of Health and Human Services has denied $8.2 million in Medicaid claims made by 26 dentists and orthodontists across the state under suspicion of fraudulent billing for procedures like cosmetic braces not normally covered by Medicaid or unnecessary root canals, the Wall Street Journal reports.

An audit of the 600 reimbursement requests done at the state’s request by Christine Ellis, a Dallas orthodontist, found in more than 90 percent of the cases the dental work was not covered by Medicaid.

"The fraud is statewide,” Ellis told the Journal, “and has reached the hundreds of millions of dollars.”

The crackdown on reimbursement and fraud, however, has caused some dental practices to stop taking Medicaid patients, while other dental practices have closed up altogether, the story says.

In January the state Attorney General began an investigation into the billing practices of 31 orthodontists in the state. In June the state sued All Smiles Dental Professionals P.C., alleging the company billed Medicaid for dental work that was not necessary and, in some cases, not done. The state clampdown follows an extensive investigation by WFAA News 8 in Dallas.

All Smiles has since closed 13 orthodontic offices in the Dallas area, the Journal says.

The explosion of fraud grew out of the settlement in 2007 of a 14-year-old class action lawsuit filed by parents who said the state was negligent in providing preventative dental care for children enrolled in Medicaid.

In that year the Legislature approved spending $1.8 billion to expand Medicaid dental services for children. Payments to orthodontists and dentists have since increased by four times, to $1.4 billion in 2011, more than any other state in the country.

In 2007 1.1 million or 38.5 percent of Texas children on Medicaid got dental service through the program. By 2010 that number jumped to 1.6 million or 51.6 percent of all children on Medicaid, according to a report given in January to the state House Committee on Public Health by Health and Human Services. (Please see pages 24-31 of the report here.)

Orthodontic care claims alone increased from $102 million to $185 million between 2008 and 2010, the report says.

The problem with fraud in Texas has made its way into a report in April by the U.S. House of Representatives Committee on Oversight and Government Reform. (Please see pages 16-19, here.)

Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

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Proposed UT medical school would carry 12-year price tag of $4.1 billion, could bring tax increase
Monday, Aug 06, 2012, 09:40AM CST
By Mark Lisheron

Leave it to nosy reporters to sully the noble notion of building a world-class medical school here in Austin.

For nearly a year, Austin’s own state Sen. Kirk Watson has been stumping for such a school, with a research center, a teaching hospital and associated neighborhood clinics. The University of Texas, the community, the state, the nation and the world would benefit.

Just as our hearts had swelled to near bursting, along comes the Austin American-Statesman to tell us that all of this medicine, education and all-around good feeling will cost $4.1 billion over the next 12 years.

The taxpayers of Travis County would pay $420 million of the total through a taxing authority called Central Health, which provides low-income health care services. With the numbers out of the bag, Central Health is now thinking it might be a good idea to calculate the potential property tax increase and put it to a vote in November, the story says.

This isn’t to suggest a medical school of this scale isn’t worth every nickel of that $4.1 billion. The money quite obviously wasn’t the issue for Watson, or the American-Statesman wouldn’t have had to file an open records request to compel the UT System to release spreadsheets of estimates that had been developed.

To avoid other, similar deflations of public pride, system officials have asked state Attorney General Greg Abbott for an opinion that would allow them to keep other records pertaining to the medical school secret.

According to the spreadsheets $233 million in debt would be financed to get started, building the needed classrooms, administrative and research buildings and adequately outfitting them.

The annual budget in the first year is estimated at $23 million. In 12 years that figure will have grown to $510 million.

Seton Hospital, which had originally made plans for a $250 million teaching hospital project, is now penciled in for $1.9 billion through 2024 for a share of the cost of operating a University of Texas medical school.

Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

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Photo of surgery by flickr user VishalKapoorMD, used via a Creative Commons license.

A doctor who served in the Texas legislature taking over the state Health and Human Services Commission
Monday, Jul 30, 2012, 03:07PM CST
By Mark Lisheron

Gov. Rick Perry has appointed Kyle Janek, a doctor and former Texas legislator, executive commissioner of the Texas Health and Human Services Commission, replacing retiring commissioner Tom Suehs.

Suehs, who launched health care reforms passed by the Legislature in its 2011 session announced in June he would step down effective Aug. 31. His annual salary was $210,000 through 2011.


Perry also named Chris Traylor, commissioner of the Texas Department of Aging and Disability Services to serve as Janek’s chief deputy commissioner, according to a press release issued a few minutes ago.


Janek, who starts Sept. 1, is the director of anesthesia services at Lakeway Regional Medical Center. He served as a Republican senator from 2002 to 2008 and representative in the House from 1995 to 2002.


Traylor was part of a management team that in 2004 consolidated 15 state health and human services agencies into the current five that comprise the Department of Health and Human Services.

The department employs more than 55,000 people, with a combined budget of more than $30 billion a year.

“Texas, like the rest of the country, is headed into a period of the most significant changes in health care in our history,” Perry said in the release. “This new leadership team, with Kyle and Chris at the helm, combines unparalleled experience and expertise to ensure Texans continue to have access to the health care they need while implementing fiscal policies that are mindful that it’s taxpayer money they are spending.”

Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

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Photo a doctor from the US HHS.

Gov. Rick Perry announces Texas will not expand Medicaid -- a program benefiting 1 in 6 Texans in 2009
Monday, Jul 09, 2012, 03:31PM CST
By Mike Cronin

Gov. Rick Perry sent a letter today to U.S. Health and Human Services Secretary Kathleen Sebelius announcing that Texas would defy two planks of President Obama’s health care law.

Though the U.S. Supreme Court declared the Affordable Care Act constitutional last month, Perry wrote Sebelius that Texas would not create the insurance exchanges “Obamacare” mandates. For states that choose not to set up exchanges --- one-stop sites for comparing health insurance options --- the federal government has indicated it will do so.

Texas also would not expand Medicaid, Perry wrote.

The Supreme Court’s June ruling also allowed states to legally decline to add to their Medicaid rolls.

That is a big deal, reports Elspeth Reeve today in The Atlantic Wire because:

Medicaid expansion was one of the primary mechanisms that Obamacare was going to be able to achieve its primary goal: increasing the number of people with health care coverage. And Texas, which is the second largest state by population, also has the highest rate of uninsured people in the country at 25 percent.

The governor used two primary arguments to explain his stance.

First, “both represent brazen intrusions into the sovereignty of our state,” Perry said in the letter. “In short, it essentially treats the states like subcontractors through which the federal government can control the insurance markets and pursue federal priorities rather than those of the individual states.”

And second, Perry described Medicaid as “a broken system that is already financially unsustainable.” One that “would threaten even Texas
with financial ruin,” Perry said.

Turns out this is not mere hyperbole to many Texas health-care experts, Medicaid advocates and doctors, as Texas Watchdog’s Mark Lisheron reported last year.By 2009, the Medicaid hunger in Texas had grown by nearly four times to $24.6 billion, gobbling up a little more than one in every four dollars in the state budget,” Lisheron reported. The story showed that one in six Texans receive Medicaid, the costs of which in Texas are projected to grow $3 billion every year.

Those developments occurred due to Congress passing many laws during the 1980s that expanded Medicaid coverage beyond its original scope, the story showed:

  • In 1984, Medicaid would now cover children whose low-income families did not receive direct federal cash assistance. Pregnant women and their infants would get covered.
  • In 1986, undocumented immigrants and the homeless would get emergency care through Medicaid.
  • In 1987, the federal government mandated sweeping nursing home reform.
  • In 1988, Congress passed the Medicare Catastrophic Coverage Act, an expansion of Medicaid to cover long-term care for the elderly and disabled not already covered by Medicare

The health care law raised the income requirement for Medicaid to 133 percent of poverty level -- or $30,657 for a family of four.

Contact Mike Cronin at or 713-228-2850. Follow him on Twitter at@michaelccronin or @texaswatchdog.

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Photo of surgery via the US Department of Defense.

Supreme Court upholds health care law, and, according to Texas Gov. Rick Perry, 'has abandoned us'
Thursday, Jun 28, 2012, 01:20PM CST
By Mark Lisheron
Supreme Court

Stunning partisans on the left and the right, the Supreme Court this morning upheld the Patient Protection and Affordable Care Act by a vote of 5 to 4.

Chief Justice John Roberts wrote the decision for the majority comprised of Stephen Breyer, Ruth Bader Ginsburg, Elena Kagan and Sonia Sotomayor. Justices Samuel Alito, Anthony Kennedy, Antonin Scalia and Clarence Thomas were in the minority.

The Supreme Court majority came to its conclusion by deciding that the individual mandate in the 2,000-page Affordable Care Act, requiring citizens who chose not to buy health insurance to pay a penalty was, instead, a tax.

The court also ruled unconstitutional the authority of the federal government in the so-called ObamaCare bill to withhold federal funds from states refusing to cooperate in the expansion of the Medicaid program.

Gov. Rick Perry today said the “Court utterly failed in its duty to uphold the Constitutional limits placed on Washington,” in a statement issued to the press. “Now that the Supreme Court has abandoned us, we citizens must take action at every level of government and demand real reform, done with respect for our Constitution and our liberty.

“Freedom was frontally attacked by passage of this monstrosity. Obamacare is bad for the economy, bad for health care, bad for freedom. Americans have made clear their overwhelming opposition to its convoluted, burdensome and overreaching mandates.”

The reasoning for upholding the Affordable Care Act as a tax rather than a mandate is certain to be the subject of furious legal argument.

The court’s decision refers to the mandate as a “shared responsibility payment” to the federal government. Failure to make such a payment results in a penalty collected by the Internal Revenue Service in the same way as a tax, the ruling says.

The majority made clear that an individual mandate as outlined in the Affordable Care Act would illegitimately force individuals to engage in commerce by buying health insurance.

John RobertsJohn Roberts

“Construing the Commerce Clause to permit Congress to regulate individuals precisely because they are doing nothing would open a new and potentially vast domain to congressional authority,” the Roberts decision says. “Congress already possesses expansive power to regulate what people do. Upholding the Affordable Care Act under the Commerce Clause would give Congress the same license to regulate what people do not do. The Framers knew the difference between doing something and doing nothing. They gave Congress the power to regulate commerce, not to compel it. Ignoring that distinction would undermine the principle.”

Instead, the decision does what Congress failed to do in drafting the bill: find the reasoning for its health insurance requirement on the grounds that Congress possesses the power to “lay and collect taxes.”

Texas’ Greg Abbott, one of the 12 original attorneys general to sign on to the ObamaCare lawsuit, took note of what he called “a novel application of the facts” in a statement he issued today from Washington, D.C.

“The Court did what Congress was afraid to do--called ObamaCare a tax on all Americans,” Abbott wrote. “This is particularly ironic since President Obama, himself, insisted this was not a tax.”

In addition to its clearest delineation of the Commerce Clause in more than 15 years, the Court said the federal government would be in violation of the Constitution if it cut off funding to states that refused to expand Medicaid in the ways outlined in the Affordable Care Act.

Justices Breyer and Kagan joined Roberts in the opinion that Congress has no constitutional power to withhold existing federal grants as a way of compelling participation in expanding a program.

Along with the individual mandate, the forced expansion of Medicaid was the impetus for the lawsuit filed March 23, 2010, by the state of Florida against the U.S. Department of Health and Human Services.

Eventually, 26 states would sign onto the suit decided by the court today.

The 11th Circuit Court of Appeals had ruled with the states and against the individual mandate and against the state and Congress’ right to force the states to expand Medicaid.

“The threatened loss of over 10 percent of a State’s overall budget is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion,” today’s ruling says.

The ruling goes on to repudiate the government’s claim “that the expansion is properly viewed as only a modification of the existing program, and that this modification is permissible because Congress reserved the ‘right to alter, amend, or repeal any provision’ of Medicaid.”

Greg AbbottGreg Abbott

"This is an historic victory for individual liberty, states’ rights, and limited government,” Abbott said. “Today the Supreme Court made crystal clear that the federal government is more restrained than yesterday. The Court also agreed that States are individual sovereigns that cannot be commandeered by the federal government. In this instance, by forcing States to expand Medicaid, the federal government tried to hold States hostage.”

Brooke Rollins, president of the Texas Public Policy Foundation called the Medicaid portion of the ruling a silver lining. “This,” she said in a statement, “at least protects, to some extent, the prerogatives of the states under the Tenth Amendment.”

To say that those following ObamaCare to the nation’s highest court were surprised by the decision would be a Grand Canyon-sized understatement.

Liberal legal experts and pundits were all but throwing themselves off of metaphorical bridges on Wednesday. Politico’s Roger Simon concluded before today’s decision that the High Court has lost its honor, that it was accountable to no one in America.

Conservative groups like the Heritage Foundation had already laid the groundwork for market based reforms, assuming the court would invalidate at least the individual mandate.

After the ruling, roles were reversed. Peter Suderman, senior editor for the libertarian Reason magazine and website, noted how different the outcome was in comparison to expectations.

“Although the overall ruling is a victory for supporters of ObamaCare, the particulars of the Supreme Court’s decision today are almost exactly the opposite of what most observers expected. It’s like a ruling from Bizarro World.”

Patrick Gaspard, executive director of the Democratic National Committee was more succinct when he tweeted, “it’s constitutional. Bitches.”

A short time later he followed with, “I let my scotus (Supreme Court of the United States) excitement get the better of me. In all seriousness this is an important moment in improving the lives of all Americans.”

However surprised, the ruling today changed few minds. President Obama praised the court and reiterated the justness of the Affordable Care Act in spite of it political divisiveness.

Republican presidential candidate Mitt Romney, who hoped for a repeal by the court, said the responsibility for the repeal falls now to the people.

“As you might imagine I disagree with the Supreme Court decision, and I agree with the dissent,” Politico reports Mitt Romney saying just after the ruling. "Obamacare was bad policy yesterday, it's bad policy today. If we want to replace Obamacare, we have to replace Obama.”

Arlene WohlgemuthArlene Wohlgemuth

Arlene Wohlgemuth, health care specialist for the Public Policy Foundation, said today renaming the health care mandate a tax does not legitimize it.

“Congress now needs to act quickly to repeal this law and take a new approach to health care reform,” Wohlgemuth said.  “But this time, we need to fix health care the right way – with patient-centered reforms that emphasize the patient-doctor relationship and allow them to make more effective and economical health care choices with less interference from insurance companies or government.”

Trevor Burrus, co-author of important amicus briefs filed in the case for the Cato Institute’s Center for Constitutional Studies, warned of irrational exuberance on the day before the ruling.

Burrus, who wrote passionately for the repeal of ObamaCare, cautioned that the Supreme Court was deciding on a single case, neither rolling back nor pushing forward the role of the federal government in the lives of individuals.

Either decision, he said, would continue to be fought in the court of public opinion.

“It’s a big decision, we all know that,” Burrus said. “But contrary to what some have said or written, there is no sky is falling here. What we’ve seen is the expansion of constitutional interpretation to the point that it now matters so much to people who is going to control their health care choices and the choices of their kids.

“That’s the importance of this case.”

Editor's Note: This story was updated at 1:40 p.m. with comments from Gov. Rick Perry, Attorney General Greg Abbott, and Arlene Wohlgemuth, a health care specialist for the Texas Public Policy Foundation. 

Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

Keep up with all the latest news from Texas Watchdog. Fan our page on Facebook, follow us on Twitter and Scribd, and fan us on YouTube. Join our network on, and put our RSS feeds in your newsreader. We're also on MySpace, Digg, FriendFeed, and tumblr.

Follow Texas Health Care Report on Twitter, and fan us on Facebook. Texas Health Care Report is a project of Texas Watchdog.

Photo of Supreme Court building by flickr user methTICALman, used via a Creative Commons license.

Texas health chief Tom Suehs to retire
Thursday, Jun 14, 2012, 04:30PM CST
By Mark Lisheron

Tom Suehs, who put Medicaid at the center of health care reform as executive commissioner of the Texas Department Health and Human Services, is retiring effective Aug. 31.

Suehs follows Billy Millwee, his director of Medicaid and the state’s health insurance programs for children, who in May announced he, too, would retire at the end of August.


Suehs and Millwee were in the midst of carrying out a broad health care reform bill passed by the Legislature in 2011 projected to save Texas taxpayers about $470 million over two years. The plan includes a savings of $300 million by converting to managed health care programs in the Rio Grande Valley.


As recently as February, Suehs had been warning the Legislature the Medicaid program in Texas was going to need at least $15 billion more in 2013 to remain solvent. Several weeks ago, Millwee acknowledged that the legislative reform bill, even if implemented fully, would do little to stave off the growth of Medicaid costs.

Tom SuehsTom Suehs

Suehs, 60, had headed the Department of Health and Human Services since 2009 after service as its deputy commissioner since 2003.

He had been a health care consultant, president of the Texas Health Care Association, deputy commissioner for management and finance for the Texas Department of Mental Health and Mental Retardation and associate commissioner for budget, planning and management in the former Texas Department of Human Services.


“In his more than 25 years of dedicated service to the people of Texas,” Gov. Rick Perry said in a statement issued this afternoon, “Tom Suehs has worked tirelessly to improve the health and well being of families across the state.


“During his tenure as Texas Health and Human Services executive commissioner, Tom helped steer the health and human services enterprise through significant and much-needed reforms, ensuring our taxpayer dollars are used effectively and efficiently to help our most vulnerable Texans. On behalf of all Texans, I thank him for his hard work and service to the state, and wish him the best.”



Contact Mark Lisheron at 512-299-2318 or or on Twitter at @marktxwatchdog.

Keep up with all the latest news from Texas Watchdog. Fan our page on Facebook, follow us on Twitter and Scribd, and fan us on YouTube. Join our network on, and put our RSS feeds in your newsreader. We're also on MySpace, Digg, FriendFeed, and tumblr.

Follow Texas Health Care Report on Twitter, and fan us on Facebook. Texas Health Care Report is a project of Texas Watchdog.

Photo of stethoscope by flickr user chickenlump, used via a Creative Commons license.

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