HOUSTON - Gov. Perry has said he'll oppose expanded Medicaid in Texas, but the next legislature will also have a say. Meanwhile, a growing chorus of social service advocates, health care providers and local officials are making it clear: They want to tap the billions of new federal dollars that would enable more low-income Texans to get health coverage under the Affordable Care Act.

Physician Laura Guerra-Cardus, associate director of the Children's Defense Fund of Texas, says accepting the money would go a long way toward improving the state's worst-in-the-nation uninsured rate - largely by increasing coverage among low-income 19- to 64-year-olds.

"There are 3.6 million in that group, and 2 million of them are uninsured. That's 57 percent. That's the very group we are potentially denying affordable health care coverage."

The figures are based on data released Wednesday by the U.S. Census Bureau, which has posted an online tool for tracking county-by-county coverage. Under the new health care legislation, adults who earn below 138 percent of the federal poverty level would be covered by expanded Medicaid. State health officials have estimated that Texas would cut its uninsured rate in half - from 24 percent to 12 percent - if the state embraces the plan.

Opponents argue that the federal aid comes with too many federal strings, and that state contribution levels might rise in the future. However, some of the largest Texas counties are exploring alternative ways to participate in the Medicaid expansion, even though it is not yet clear if the federal government would approve of local plans without state buy-in.

Guerra-Cardus says it's the counties that most bear the burden of the costs associated with the uninsured.

"They are being passed on to all taxpayers through hidden taxes on health insurance premiums and higher hospital district taxes."

A recent study published in the New England Journal of Medicine shows a significant decline in the adult death rate in states that have already expanded Medicaid on their own. Guerra-Cardus thinks that's the kind of statistic that will eventually lead states like Texas to reverse their opposition. She points out that the current Medicaid program, which is also optional, was eventually embraced by every state.

"There is good reason to hope that, in time, every state will adopt the new options. And the deal we're getting for this expanded Medicaid for adults is far better than the deal we got with original Medicaid."

States now pick up about 40 percent of their Medicaid expenses. The federal government would pay 100 percent of the expansion for the first three years, after which states would have to contribute up to 10 percent. The expansion was a key component of the Affordable Care Act, but the Supreme Court ruled that states had the right to reject it.

U.S. Census coverage estimates are at http://1.usa.gov/rUfEu. The NEJM study is available at http://bit.ly/Oa2iVI.




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Toughing it out during spring allergy season is not in your best interest if you want to avoid asthma later in life.

New Mexico has plenty of grass and weed pollens carried by the wind which contribute to itchy, watery eyes, a stuffy nose and sneezing fits this time of year.

Dr. Osman Dokmeci, associate professor of internal medicine at the University of New Mexico, suggested for those who suffer acutely, seek an allergy test and possibly medication to prevent asthma from taking hold.

"One out of 10 has asthma in America," Dokmeci pointed out. "Having seasonal allergies increases your chance of developing asthma at least fivefold."

He recommended treating allergies early and as aggressively as possible. May is "Asthma Awareness Month," which aims to bring attention to the health issue and highlight improvements in care and quality of life. Nationwide, asthma affects more than 25 million Americans, including 4 million children, and disproportionately affects certain racial and ethnic groups.

Allergies do not "cause" asthma but people who have allergies, or have family members who have allergies, are more likely to get asthma than those who do not. Research shows allergy season is starting earlier and lasting longer. A 2022 study from the University of Michigan found pollen count could increase by 200% by the end of the century due to climate change, which is why Dokmeci stressed it is important not to ignore the problem.

"There's no treatment that actually makes your asthma not happen," Dokmeci explained. "But once you develop asthma, there are good treatment options."

The estimated economic impact of asthma is more than $80 billion per year from direct and indirect costs, such as missed school and workdays.

Recent research shows approximately half of people who die by suicide had contact with a health care professional within the month prior to their death.

However, a recent study shows only 8% of hospitals are currently implementing all four recommended suicide prevention practices: safety planning, warm handoffs to outpatient care, patient follow-up and lethal means counseling.

Melissa Tolstyka, director of Behavioral Health Services for Trinity Health Ann Arbor, said a seamless transition from inpatient to outpatient care is critical. At Ann Arbor, she saw a 46% increase in compliance with comprehensive suicide risk assessments and patients discharged on the suicide care pathway now receive a safety plan, which she sees as progress.

"We continue to see a need for really robust programming," Tolstyka explained. "Not just within the behavioral health world, but in the medical world as well. Our organization really wanted to focus on bringing the behavioral health and the medical services together to enhance our safer suicide care practices for our patients."

The initiative is being piloted across various units at Trinity Hospitals in Ann Arbor and Grand Rapids including the emergency department, psychiatric medical and inpatient nursing units. If you or anyone you know is struggling or in crisis, help is available 24 hours a day, seven days a week, by calling or texting 988, the Suicide and Crisis Lifeline.

Casie Sultana, clinical nurse leader for Trinity Health Grand Rapids, prioritizes patient well-being, emphasizing support and improvement over solely managing risks within the facility.

"We want to be someplace that people feel welcome to come to who are dealing with suicide," Sultana emphasized. "You feel so alone. It's a very lonely journey and we want people to come seek help and feel welcomed when they do that."

Susan Burchardt, clinical services manager at Trinity Grand Rapids, advised other hospitals considering a similar program to learn from organizations already using it.

Support for this reporting was provided by The Pew Charitable Trusts.


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Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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