Chapter 20: Texas and the Affordable Care Act
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Description
In this segment, Dr. Foxhall discusses the Affordable Care Act (ACA) passed on 23 March 2010 and its impact on Texas Health and the activities of MD Anderson. He begins by noting that Texas has the highest rate of uninsured individuals in the nation and that only a limited number of categories of individuals are eligible for Medicaid, with the result that a percentage of individuals who are diagnosed with cancer are uninsured. He explains the hopes that the ACA would provide coverage to the uninsured, to cancer survivors unable to get affordable insurance, and to low income individuals in need of cancer prevention services. He then goes into more detail about the Texas limitations on Medicaid as well as some alternatives under discussion in the Texas Legislature to provide coverage to ineligible individuals.
Identifier
FoxhallLE_05_201405013_C20
Publication Date
5-13-2014
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - The Finances and Business of MD Anderson; MD Anderson and Government; The Healthcare Industry; Politics and Cancer/Science/Care; The Institution and Finances; Growth and/or Change; MD Anderson History; On Texas and Texans
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
All right. We are recording. Today is May 13th, 2014, and today I’m on the nineteenth floor of Pickens Tower in the Office of Health Policy for my fourth [fifth] session with Dr. Foxhall, Vice President for Health Policy.
Tacey Ann Rosolowski, PhD:
So thank you for agreeing to this final and supplementary session about the Affordable Care Act and all the changes that came to healthcare, particularly cancer care, in Texas in 2010. So what would be a good place to start with that? I mean, my first question was what decisions did Texas make about the Affordable Care Act, but maybe there’s a better place to start to give context, so I’ll let you make the decision. I know it’s a very complex situation. (laughs)
Lewis Foxhall, MD:
Sure. Well, the Affordable Care Act and its cohort is really intended to provide insurance coverage for people who had not been able to get it, and in the cancer world, that’s been a significant problem. We have, of course, a very high rate of uninsured here in the State of Texas. 7
Tacey Ann Rosolowski, PhD:
I read it was like 33 percent.
Lewis Foxhall, MD:
Yeah, it’s about 25 in the state, and around 30-plus here in the Houston region, so we certainly have had the highest rate in the country for quite a long time, and nothing much has been able to budge that. We have a significant number of people here in the state who are also low-income, and the Medicaid program that provides federal coverage for the low-income populations is limited in our state to primarily women, pregnant women, and children, and aged, blind, and disabled. So the otherwise adult population is not covered by that. So we wind up with a number of people who get cancer and don’t have any insurance coverage, so we have provided a program, our Financial Assistance Program, to take care of patients in that situation who need our cancer care.
Tacey Ann Rosolowski, PhD:
About what percentage of the cancer patients are uninsured?
Lewis Foxhall, MD:
In our institution?
Tacey Ann Rosolowski, PhD:
Or in general, [unclear] the numbers?
Lewis Foxhall, MD:
In our institution we see around 5 percent or so that are on our charity program, and roughly an equal number on the Medicaid program, so that kind of bounces up and down over time. But this has been a persistent problem for a long time. So at any rate, the Affordable Care Act we were hoping would be a way to provide coverage for those low-income individuals who couldn’t afford care and also for an important group who are primarily cancer survivors, who previously had cancer, who were not able to get insurance because of their history of having had cancer. So it was very difficult for them to get any sort of coverage. There was a state program which provided coverage outside the regular insurance track, but it’s very expensive. So we were hopeful that this would allow us to have better coverage for individuals who get cancer but also provide coverage for cancer prevention services which they’re not able to access. So people without insurance, especially low-income people, get cancer screenings at much lower rates, smoke at higher rates and generally are at higher risk of getting lung cancer. So there were several areas that we were hopeful that this would help us out. The Act, of course, was finally passed. It was done in a very partisan way, but, nonetheless, had different components that address some of these big concerns that we have. So this has gradually been rolled out bit by bit over time.
Tacey Ann Rosolowski, PhD:
Let me just ask before we go on, what is your view of why Texas made the decisions it did vis-à-vis Affordable Care Act?
Lewis Foxhall, MD:
Regarding the Medicaid?
Tacey Ann Rosolowski, PhD:
Mm-hmm.
Lewis Foxhall, MD:
Well, part of the provisions in the Act included an expansion of the Medicaid program to cover low-income people, so this was intended to be paid for primarily but not entirely by the federal government, at least for the first several years, and this is a way to enroll individuals in some coverage that was less expensive than paying for subsidies for an additional low-income group to enroll in commercial insurance or to provide them with Medicare, which would have been another alternative, but, again, that’s more expensive. So this was the low-cost or lower-cost alternative that the federal government had offered up as part of the package. The Supreme Court determined that that was not constitutional to require states to participate in that part of the Act, and it was made optional, and about half the states decided to keep it. The other half decided not to, and Texas was one of those. So there are—
Tacey Ann Rosolowski, PhD:
Why?
Lewis Foxhall, MD:
Well, [unclear]. But there are a number of issues. It’s a political football, still, and there are political considerations, I think, in any of these things, because, as I said, it was really a very partisan vote that passed it. There are certainly considerations regarding the cost to the state. It’s really unknown how much that would be, how many more people would enroll, how much that would cost, and there were concerns about that. So that’s still, I think, under discussion at the state level as far as whether there could be some other solutions besides the straight expansion, perhaps block-grant funding or a way to use that money to provide subsidies for people to get insured through the health exchange marketplace approach, so I think that’s still being discussed, but so far we’re not participating. So that leaves us with a large number of people that are 100 percent [unclear] who don’t have any insurance. We also have a large number of undocumented persons, unauthorized immigrants in the state, who have never been eligible for it and are still without insurance, for the most part. So we will continue to have our challenges going forward. But there’s been some people that have signed up through the marketplace exchanges, so I think we had around 190,000 or so here in the Houston region, and that’s some encouragement. And I think we’ll probably see more of this next year when the penalties are a bit higher, to provide a little more incentive to get people to sign up. So hopefully those that are in those income categories will be able to participate and get some sort of coverage.
Recommended Citation
Foxhall, Lewis E. MD and Rosolowski, Tacey A. PhD, "Chapter 20: Texas and the Affordable Care Act" (2014). Interview Chapters. 869.
https://openworks.mdanderson.org/mchv_interviewchapters/869
Conditions Governing Access
Open
