"Obamacare" on Center Stage

The drama over the Women’s Health Program — and the fight between the state and the feds over Planned Parenthood funding — has dominated the health care headlines in recent weeks. But it’s not over yet. Gov. Rick Perry has directed Texas’ Health and Human Services Commission (HHSC) to find money in that agency’s budget — up to $40 million a year — to run the contraception and cancer-screening program without federal help.

Without new revenue or raiding the Rainy Day Fund, and with an already hefty Medicaid shortfall, that money will have to be made up in unexpected savings or siphoned from other programs, which could be politically difficult. Perry staffers are expecting a proposal from HHSC within a few weeks.

After that, the agency will write a transition plan — from a joint state-federal program to a purely state-run one — and the Obama administration will have to sign off on it. That plan is due to the Centers for Medicare and Medicaid Services by April 16.

Other health care developments to watch during the next month: 

• On Monday, the U.S. Supreme Court will begin an extraordinary three-day review of federal health care reform — known not so lovingly by Republicans as "Obamacare." Texas Attorney General Greg Abbott, who’s on the litigation team's executive committee, will be in attendance, but he won't be arguing before the high court. Meanwhile, Texas-based supporters of the law have launched their own media blitz, suggesting that the state — where more than a quarter of the population is uninsured — has been one of the biggest winners under the reforms.  
• Physician groups are beating the drum to try to reverse state cuts to co-payments for patients eligible for both Medicaid and Medicare. Doctors who treat them — many of them in impoverished communities along the Texas-Mexico border — have been hit particularly hard. The Texas Medical Association is taking a lead role, hosting rallies and town hall meetings around the state.
• The Texas Higher Education Coordinating Board is preparing to release a report lawmakers commissioned last session on the state’s graduate medical education. The study is expected to confirm that by 2014, Texas will have too few residency slots for the medical students graduating from its schools, a troubling trend given the state’s current physician shortfall.
• HHSC is in the midst of a robust statewide tour to lay out the details of the so-called 1115 waiver, a federal agreement that allows Texas to expand managed care throughout the state and form regional health care partnerships to seek efficiency and cost savings. A meeting in Austin is set for today; there’s another in Harlingen on Wednesday. But behind the scenes, a hospital fight is brewing. Private hospitals say the regional health care partnerships are going to give a major financial advantage to the public hospitals that anchor them. And they’re worried that a new funding mechanism to cover uncompensated care will end up benefiting public hospitals at the expense of private ones.