By Robert T. Garrett / The Dallas Morning News rtgarrett@dallasnews.com
AUSTIN Texas will empty one-third of its pocketbook on health care in the next two years.
And thats maintaining an unwanted superlative: Texas remains the state with the highest percentage of people without health insurance 25 percent.
Still as the Senate approved a two-year $182.2 billion state budget Wednesday the fact that it would spend $61.4 billion on health care drew barely a mention. Its by far the largest category of spending above public schools ($52.1 billion) and higher education ($22.7 billion).
Promoting prevention
Wow said Sen. Carlos Uresti D-San Antonio after studying a summary of health care expenditures from the 905-page budget. The first word that comes to mind is prevention. We dont do enough of that.
Uresti said lawmakers should do more to prevent young Texans from smoking a habit he said causes illnesses that cost the state $5.8 billion a year to treat. He also urged more spending on programs to prevent mistreatment of children by parents who are often teen parents.
All were doing is reacting he said. Until we start spending money and doing things to prevent illness on the front end the numbers will get worse and worse.
The budget passed 26-5 now goes to the House. All five no votes were from Democrats; the other seven Democrats joined all 19 Republicans in voting yes.
Bob Deuell R-Greenville the Senates chief budget writer for health care and social programs said he tried to restrain health care spending.
His Senate Finance Committee work group handled health care for poor elderly and disabled Texans. The state also spends billions on health insurance programs for current and retired public employees.
Weve held it pretty well considering the costs and caseloads said Deuell a physician. It wont be enough to satisfy some people though.
The budget would spend $45.6 billion on Medicaid the nations main health care program for the poor. And it would spend $2.3 billion on the Childrens Health Insurance Program for youngsters from families that make too much to qualify for Medicaid but cant afford private health coverage.
Health coverage for current and retired state employees would run $2.4 billion while costs for school district employees university employees and retired educators are slightly less. Health care for prison inmates costs $1.2 billion.
Health care costs go up faster than consumer prices which means the budget falls further and further behind every two years said Eva DeLuna Castro senior policy analyst at the Center for Public Policy Priorities which advocates for middle- and low-income Texans.
She said that theres a big difference between struggling households and the state.
Texas is absolutely not like a family trying to live within its means DeLuna Castro said. Most families dont try to pay the full costs of their own health insurance they cant afford it without an employer subsidy.
Deuell referring to the $11 billion of federal economic-stimulus money in the budget responded I guess you could call the federal government our employer.
He said budget writers looked for savings wherever possible. However federal programs that underwrite about half of Texas health care spending are intricate and contain many mandates.
Negotiations ahead
Deuell said his group adopted a list of possible savings in Medicaid only to be thrown on the defensive by one. It called for expanding a managed care approach to rural areas saving $7 million. But rural safety net hospitals protested they would lose $200 million in federal matching funds for hospitals treating a lot of uninsured patients.
He promised to try to change or remove the provision during upcoming budget negotiations with the House.
He touted modest increases for hospitals doctors and others who treat Medicaid patients generally about 3 percent. And he said 11000 enfeebled people waiting for in-home care will be able to get off state waiting lists.
Health care in general it goes up beyond the normal inflation rates for the nation sometimes people think exponentially Deuell said. As a physician I can certainly say that I see that being the case as I try to get services for my patients.
On another issue Sen. Steve Ogden R-Bryan the Senates chief budget writer promised to work during negotiations with the House to try to alleviate worries about his provision that would bar using money in the budget on embryonic stem cell research.
Ogden said he wasnt trying to shut down research being done with private and federal funds.
AT A GLANCE: STATE BUDGET
Total: $182.2 billion over two years
Highlights: $61.4 billion on health care costs compared with $52.1 billion for schools and $22.7 billion for higher education
Whats next: A House committee will approve its version then the full House must approve the budget. Then House and Senate negotiators will hash out differences.
