Legislators need to back Texas Health and Human Services Commission
By Ken Janda
Have you followed much news coverage of our Texas Health and Human Services Commission ? In the midst of escalating concerns and long-running criticism, some valid and some not, what might surprise you the most is learning the Health and Human Services Commission of the state of Texas runs the best Medicaid operation in the country — despite being a gigantic, wide-ranging organization charged with helping often overlooked poor and frail Texans; despite being underfunded year after year, and despite sometimes serving as a whipping post for policymakers.
In spite of contracting mix-ups and executive resignations, the faithful public employees at HHSC have inaugurated and overseen Medicaid Managed Care contracts saving Texas taxpayers $4 billion since 2010, as compared with the old fee-for-service system. Health care leaders from other states visit Texas to learn from our success how they might set up a similar system.
Now another high-profile departure is looming: Charles Smith, executive commissioner, will leave at the end of May. Smith is one of six HHSC officials to resign recently, among the dozens of experienced senior leaders who have departed in the last several years.
Former Republican state Sen. Tommy Williams, who represented District 4 in the Woodlands in Montgomery County, has been tapped as the short-term fix-it guy, to find out what went wrong and set the Health and Human Services Commission — with all its divisions and agencies —on the right path.
Regardless of what Smith has done well, or not well, simply setting up new management or more careful contract oversight is a little like renovating the kitchen of a Texas Gulf Coast house before the next hurricane season. That better, more efficient kitchen is not going to protect the house from an environment of rising water or raging storm surge, otherwise known as legislative actions that seem to make it harder for HHSC to serve those in need.
Can Williams persuade his former colleagues in the Legislature to appropriately fund the work of HHSC? Can Williams help the statehouse further embrace the mission of caring for children, elderly Texans and vulnerable people throughout our state? If he can’t redirect a storm surge of program bashing, an internal HHSC reorganization isn’t going to help much.
Certainly, reforms are needed at HHSC. This department charged with oversight of 100,000-plus contracts worth more than $60 billion needs experienced, trusted staff able to manage large contracts. It needs a more robust culture of accountability and respect. But more than anything else, HHSC needs the moral support of legislators and state leaders who believe in the mission, support the people and celebrate the results.
What is the mission, what are the results? HHSC encompasses the human condition in Texas, from pregnant mothers and babies and hurricane help to vulnerable senior citizens and food benefits. Looking at the Medicaid program alone, the per capita cost of the Medicaid Managed Care program in Texas has grown by only 1 or 2 percent annually for the last 15 years. This incredibly low cost is less than the Consumer Price Index, and much less than the cost of Medicare or employer-sponsored insurance, including the cost of health insurance for state employees, municipal employees and teachers throughout the state. Medicaid serves mostly children, aged and disabled residents, and it protects the lives of the unborn through funding maternity care for low-income women. While achieving all of these successes, this single HHSC program has saved Texas more than $4 billion since 2010.
At the same time, access to care in Medicaid has never been better, continues to improve and customer satisfaction is better than for employer-sponsored insurance. Health outcomes for women, children and the disabled are all improving. Children on Medicaid now have access to care, pediatric well-child visits and immunization rates as good as commercially insured kids.
Yes, there is much work to do to improve the lives of those who depend on Medicaid and to find ways to expand this Texas success to others in need. Yes, HHSC needs fresh direction and that starts with investment from our state leaders. In this case, Texas doesn’t need less government, it needs better governance. Unfortunately, it is too late for.Charles Smith, and if our state keeps going this route, piling on HHSC will drive out the remaining wonderful employees who work there. Losing our experienced public servants hurts Texans from the cradle to the grave.
It’s time for our elected officials to invest wholeheartedly in the work of HHSC, and this starts with telling the great story of the successful Medicaid program in Texas.
Janda (@HealthyTexans) is president and CEO of Community Health Choice Inc. (Community), a Houston-based, nonprofit managed care organization that provides innovative health insurance plans focused on low-income families. He also teaches health policies as an adjunct professor in the Jones Business School at Rice University.
Read original story as published by the Houston Chronicle https://www.houstonchronicle.com/opinion/outlook/article/webhead-webhead-12898484.php