PLAN COULD REVISE RULES ON INDIGENT HEALTH CARE: IDEA TO USE "ASSETS TEST" MIGHT LIMIT GOLD CARD ELIGIBILITY, CRITICS SAY
By Liz Austin Peterson Houston Chronicle
Publication: The Houston Chronicle (Texas)
http://www.allbusiness.com/health-care/health-care-facilities-hospitals/...
Date: Monday, December 15 2008
Dec. 15-The Harris County Hospital District soon may begin including the value of patients' assets, rather than just their incomes, as they evaluate applications for free- and reduced-cost health care.
Chief Financial Officer Ferdinand Gaenzel told the hospital district's board of managers earlier this month that officials are considering implementing an "assets test" for the Gold Card program to ensure people with substantial savings do not take advantage of the discount program. The district currently bases eligibility decisions solely on applicants' incomes.
Some advocates worry that such a move could limit access to treatment at a time when more people are losing their jobs and health insurance.
"We have some real concerns about that," said Dr. Rebecca Wills, a retired family practitioner who works on health care issues for The Metropolitan Organization, a Houston-area network of churches and groups working to improve access to health care for the poor.
Wills said she fears some needy applicants may not qualify because their family has two cars even if both parents need one to get to work. Even people who still qualify may have trouble gathering all the paperwork to meet the new requirements, she added.
"It's like it's placing another barrier," she said.
Gaenzel mentioned the assets test proposal while describing several changes the hospital district is making in an effort to make it easier for poor residents to get the treatment they need.
As of Dec. 8, applicants no longer have to provide identification documents for family members when they are the only person in the household seeking care.
The district also plans to shorten the application form from three pages to one in the coming months and train the clerks who register patients to help them with the eligibility process so patients do not have to wait in multiple lines.
The TMO and other groups long have complained that the application process for the hospital district's Gold Card program is unnecessarily long and confusing, often requiring multiple trips to eligibility centers to provide additional documentation.
Adriana Guzman would welcome such a change. Guzman had to visit a district eligibility center every day for eight days in August - sometimes twice a day - before she was able to get approval for her mother's uterine cancer treatment at Ben Taub General Hospital. Each time she thought she'd found the last required document, the clerks told her something else was missing.
"I'm telling you, it was devastating for me to come home with my mom waiting for me to say yes or no," said Guzman, a youth minister at Holy Name Catholic Church. "To her, this was life and death."
About 30 percent of Harris County's 3.8 million residents lack health insurance, and the district's three hospitals, 12 community health centers and numerous clinics serve as their primary safety net. The Gold Card's discount programs offer assistance to impoverished adults who cannot qualify for Medicaid because they are not disabled, have no dependent children or have children, but are not on welfare.
Through the Gold Card program, the hospital district offers discounts on a sliding scale to patients whose income is less than 250 percent of the federal poverty level, or $53,000 a year for a family of four.
Hospital district spokesman Bryan McLeod said officials are considering an assets test because they want to make sure taxpayers are not subsidizing care for people who could afford to pay full price.
He said it was too early to say how the test would be structured but added officials are leaning toward the Medicaid model, which generally bars recipients from having assets worth more than $2,000, not counting their homes or their family's first car. That standard would have to be tweaked to mesh with the hospital district's sliding-scale
Dec. 15-The Harris County Hospital District soon may begin including the value of patients' assets, rather than just their incomes, as they evaluate applications for free- and reduced-cost health care.
Chief Financial Officer Ferdinand Gaenzel told the hospital district's board of managers earlier this month that officials are considering implementing an "assets test" for the Gold Card program to ensure people with substantial savings do not take advantage of the discount program. The district currently bases eligibility decisions solely on applicants' incomes.
Some advocates worry that such a move could limit access to treatment at a time when more people are losing their jobs and health insurance.
"We have some real concerns about that," said Dr. Rebecca Wills, a retired family practitioner who works on health care issues for The Metropolitan Organization, a Houston-area network of churches and groups working to improve access to health care for the poor.
Wills said she fears some needy applicants may not qualify because their family has two cars even if both parents need one to get to work. Even people who still qualify may have trouble gathering all the paperwork to meet the new requirements, she added.
"It's like it's placing another barrier," she said.
Gaenzel mentioned the assets test proposal while describing several changes the hospital district is making in an effort to make it easier for poor residents to get the treatment they need.
As of Dec. 8, applicants no longer have to provide identification documents for family members when they are the only person in the household seeking care.
The district also plans to shorten the application form from three pages to one in the coming months and train the clerks who register patients to help them with the eligibility process so patients do not have to wait in multiple lines.
The TMO and other groups long have complained that the application process for the hospital district's Gold Card program is unnecessarily long and confusing, often requiring multiple trips to eligibility centers to provide additional documentation.
Adriana Guzman would welcome such a change. Guzman had to visit a district eligibility center every day for eight days in August - sometimes twice a day - before she was able to get approval for her mother's uterine cancer treatment at Ben Taub General Hospital. Each time she thought she'd found the last required document, the clerks told her something else was missing.
"I'm telling you, it was devastating for me to come home with my mom waiting for me to say yes or no," said Guzman, a youth minister at Holy Name Catholic Church. "To her, this was life and death."
About 30 percent of Harris County's 3.8 million residents lack health insurance, and the district's three hospitals, 12 community health centers and numerous clinics serve as their primary safety net. The Gold Card's discount programs offer assistance to impoverished adults who cannot qualify for Medicaid because they are not disabled, have no dependent children or have children, but are not on welfare.
Through the Gold Card program, the hospital district offers discounts on a sliding scale to patients whose income is less than 250 percent of the federal poverty level, or $53,000 a year for a family of four.
Hospital district spokesman Bryan McLeod said officials are considering an assets test because they want to make sure taxpayers are not subsidizing care for people who could afford to pay full price.
He said it was too early to say how the test would be structured but added officials are leaning toward the Medicaid model, which generally bars recipients from having assets worth more than $2,000, not counting their homes or their family's first car. That standard would have to be tweaked to mesh with the hospital district's sliding-scale system.
Dallas County does not include patients' assets in eligibility decisions for its charity care program unless the person receives Medicare, said Lynsey Purl, spokeswoman for Parkland Health & Hospital System.
Anne Dunkelberg, a health care policy expert with the Austin-based Center for Public Policy Priorities, said almost every state but Texas has discarded asset tests for government insurance programs because they generally are not worth the time and effort.
While Gaenzel told the board the district wanted to avoid helping someone with a small income but $200,000 in the bank, Dunkelberg said such a scenario is "unbelievably rare."
"The bottom line is, asset tests are seen as really antiquated and almost an excuse to deny people benefits," she said.
But Karin Dunn of Gateway to Care, a nonprofit that helps uninsured people in the Houston area navigate the health care system, said she believes few of her clients would have enough in the bank to be affected by an assets test.
"I'm not going to say, 'Oh yeah, there's not going to be any problems with the district putting in an assets test,' but at the same time, until we see some details, we can't say that there will be," she said. "So, we just have to wait."
LET'S GET 'REAL' ON IMMIGRATION
COMMENTARY
By RICK CASEY
http://www.chron.com/disp/story.mpl/metropolitan/casey/6120157.html
Copyright 2008 Houston Chronicle
Nov. 18, 2008, 10:48PM
The Methodist minister sitting next to me, an African-American, was explaining at our lunch table Monday one of the benefits of the election of Barack Obama.
It means, he said, that he wouldn't find himself involuntarily cringing every time a black man was in the news for committing a heinous crime. Now, he said, he doesn't have to worry so much that people will think that the criminal is representative of black men.
"One of ours is in the White House," he said.
I hope he's right. It is as irrational to assume black criminals are typical of blacks as to assume that white criminals are typical of whites.
A couple of hours earlier, an Irish-American Catholic priest had approached me in anger about reporter Susan Carroll's series on illegal immigrants being freed by Harris County authorities after being accused or even convicted of violent crimes, only to commit more.
Same old stereotypes
He was afraid the series would feed hysterical stereotypes of illegal immigrants as violent criminals.
Carroll had noted in the first of the three articles that, "Most research has found that recent immigrants are far less likely than their U.S.-born counterparts to commit crimes and end up in prison."
But the priest was correct to assume that at least with many readers the series would feed stereotypes that are part of anti-immigrant hysteria.
The reality is that it is horrible for illegal immigrants who have committed violent crimes to be released so they can commit them again. Carroll's stories are important, because authorities need to fix the problem.
The reality also is, as the research Carroll referenced shows, that the vast majority of immigrants - legal and illegal - work hard, keep their heads down and are less likely to get into trouble than native-born Americans.
Immigrants here illegally suffer from the same sort of stereotypes that blacks long endured, being branded as violent criminals while working hard in hopes of making a better life for their families. But they can't hope that one of theirs will be elected president.
Which brings us to why that Catholic priest and Methodist minister were among nearly 200 religious and community leaders from all over Texas gathered at Houston's Congregation Beth Israel synagogue Monday.
The all-day session was organized by The Metropolitan Organization (TMO) of Houston and the statewide coalition of Industrial Areas Foundation community organizations. Participants included Cardinal Daniel DiNardo as well as Protestant bishops and rabbis from around the state. They all seemed to quote scriptural injunctions, in various words, to welcome the stranger.
Also taking part were clergy and other church leaders.
The purpose, said TMO co-chair and True Light Baptist Church Pastor John Bowie, was to "see how we can organize our congregations to pursue meaningful immigration reform that brings people out of the shadows and incorporates them into society."
Leading the sessions was Austin-based Ernesto Cortes Jr., a legendary community organizer who now heads the southwest region for IAF. Starting in the early 1970s, Cortes has established effective community organizations from Houston to Los Angeles.
He was a MacArthur Foundation "genius grant" recipient and is currently a Martin Luther King Visiting Professor at MIT. As a footnote, he also helped lead the 10-day Chicago IAF training that Obama went through in 1984 (although Obama did not work for an IAF community organization).
The strategy, Cortes stressed, is to engage church members in what he called "real conversations," one-on-one, in the "house meetings" that are a staple of IAF organizations, and in church gatherings.
"People are organized around their anxieties and fears and insecurities," he said. "We need to tell our own stories and listen to them tell theirs. We need to work with them on their concerns."
Those stories, for almost all of us, include immigrating to America. But many of us, said Rabbi Larry Bach of Temple Mount Sinai in El Paso, "have amnesia."
Bach said he was planning a Seder service around the very real story of Eastern European Jews who immigrated to El Paso last century through Mexico because they were barred from direct entry by quotas.
It's what community organizers do, the slow, slogging work of building constituencies through listening and talking - real conversations as Cortes says - seeking real solutions to real problems.
Can it work in a story-of-the-minute media culture dominated by sound bites and shouted talking points?
One can only hope.
You can write to Rick Casey at P.O. Box 4260, Houston, TX 77210, or e-mail him at [email protected]
CARDINAL CALLS FOR BROAD-BASED LEGALIZATION PLAN
Church activists at summit take aim at U.S. policies
By ALLAN TURNER
http://www.chron.com/disp/story.mpl/life/religion/6117984.html
Nov. 17, 2008, 10:38PM
Copyright 2008 Houston Chronicle
In arguments rich in biblical allusion, church and social activists Monday took aim at the nation's immigration policies - laws they contended split families, criminalize undocumented workers and undercut America's reverential self-image as a land of opportunity.
"There are 200 million migrants," Cardinal Daniel DiNardo of the Catholic Archdiocese of Galveston-Houston told those gathered for The Metropolitan Organization's Clergy Summit: Welcoming the Stranger and Immigration Reform. "War, famine, economic collapse drive them, and it's unstoppable. In our own country, 12 million undocumented people work and live in the shadows."
Borrowing language from a 2002 Catholic Conference of Bishops policy statement, DiNardo called for legalization of undocumented workers already in the country.
"Without some form of broad-based legalization," DiNardo said, "the problems will just fester and fester."
Janice Huie, resident bishop for the United Methodist Church's Texas Annual Conference, joined the call for granting legal status to undocumented workers. In May, she said, Texas Methodist leadership formally opposed job-site raids and criminalization of undocumented workers and their indefinite detention.
"We would support policies that point to the best of who we are," she said.
Huie and others reported an intensification of anti-immigrant feeling in the U.S. fueled by the Sept. 11, 2001, terrorist attacks.
"I am encountering hateful, stereotyped and racist anti-immigrant language that is almost acceptable in the mainstream," Huie said.
'Red meat issue'
Rhetoric surrounding immigration issues has heated as talk radio programs exploit the issue, suggested Houston immigration lawyer, Charles Foster, chairman for Americans for Immigration Reform.
"They found this red meat issue bashing immigrants," he said.
Foster's group has launched a $20 million campaign to back immigration reform. Current immigration policies, whether they regard building border fences or regulating the number of legal entrants, often prove unworkable, he said.
"The annual quota for semi-skilled workers, as opposed to families or professionals is 5,000," he said. The nonprofit Pew Hispanic Center estimates 500,000 undocumented workers entered the U.S. annually from 2005-08.
Government efforts to dislodge undocumented workers also are ineffective, Foster said.
"If these workers risk their lives coming here," he said, "they're not going home. They're going further down the economic scale."
A warning on complacency
Although President-elect Barack Obama has pledged to speedily address immigration concerns, Foster warned those at Monday's conference not to become complacent. President George W. Bush, he noted, was a staunch supporter of failed efforts to reform immigration laws in 2006 and 2007.
"The problem was in the House," Ernesto Cortes Jr. said, alluding to the U.S. House of Representatives. "The mail they were getting was 100-1 against, and that's not going to go away."
Cortes, southwest regional director of Industrial Areas Foundation, a nonprofit group founded by the late Chicago activist Saul Alinksy, was the only non-church affiliated speaker.
Cortes urged his audience to "go boldly, move forward, but lovingly and attentively."
The key to building support for immigration reform, he said, is building "relationships of trust, to bond together."
"We need to create social learning networks ... not to persuade so much as understand," he said. "To do that, we need to learn the language of concern."
WHEN TMO SPEAKS, CANDIDATES LISTEN
Voters voice their thoughts on reform in meeting with office-seekers
By ALAN BERNSTEIN
http://www.chron.com/disp/story.mpl/metropolitan/6079531.html
Oct. 26, 2008, 11:08PM
Few Republican candidates braved a grilling Sunday by members of The Metropolitan Organization, the Houston-area network of church-based groups working for social justice, such as better access to health care for the poor.
The four GOP candidates who did address an ethnically diverse audience of 600 people, wedged into the east side social hall of Immaculate Conception Church, mostly joined a stream of Democrats in agreeing with nonpartisan TMO's liberal-leaning agenda.
But there were some differences in the one-minute-each presentations by the candidates, which were made in reaction to testimonials and near-demands by the group about proposals to reform schools, the justice system and other institutions. The TMO format reverses the usual formula campaign events, making the voters the speakers and the politicians the listeners.
Democratic county judge candidate David Mincberg, saying he is sensitive to social justice issues as the child of immigrants who came to America with no money, agreed to push for simplifying qualifications for access to the county public health care system.
He also agreed to establishing a public defender's office for poor accused criminals, inspecting job training programs elsewhere in the state and expanding the use of special courts that provide treatment and rehabilitation programs, rather than incarceration, for addicted and mentally ill violators of the law.
Mincberg is challenging Republican incumbent Ed Emmett, who agreed to some of the points but also said he favors public defenders in only some kinds of cases.
Instead of directly pledging to expand the speciality courts, he said he was very interested in juvenile justice reform.
District attorney hopefuls
Former Houston Police Chief C.O. "Brad" Bradford, the Democratic contender for district attorney, agreed with the TMO drive to, among other things, make grand juries more reflective of the entire community.
His Republican opponent, former Judge Pat Lykos, urged people there to volunteer for service on grand juries, which decide whether to bring charges in criminal cases, and to look at her record for impaneling grand juries as a judge.
But she added, "I will not play politics with the grand jury system" by making wholesale changes.
The composition of grand juries has been an issue in the campaign for district attorney.
Bradford says grand jury members should be chosen at random from a cross-section of the county; Lykos says the current system of judges picking grand jurors will suffice if run responsibly.
Republican Dorothy Olmos signed on to the TMO agenda along with opponent Ana Hernandez, a Democratic member of the state House. Republican Gilbert Pena attended as part of his campaign against Democratic state Sen. Mario Gallegos, who was absent.
Sheriff Tommy Thomas, Tax Assessor-Collector Paul Bettencourt and State Rep. Dwayne Bohac were among the Republican invitees also absent, leaving Democrats to dominate the group of candidates crowded onto the stage.
TMO member Rosa Abram of Fifth Ward Missionary Baptist Church said she was happy with the result of her first "accountability meeting" with the candidates, who included U.S. Rep. Gene Green, D-Houston.
"I feel most of the elected officials will do what they say," Abram said, "but I have my doubts about some of them. So we need to do this more often."
METRO PLANS TO RAISE FARES
Officials consider hikes of 25 cents to $1
By ROSANNA RUIZ
http://www.chron.com/disp/story.mpl/metropolitan/6058923.html
Oct. 15, 2008, 5:52AM
Copyright 2008 Houston Chronicle
Bus and rail passengers would pay 25 cents to $1 more to ride under a proposal before Metro's board of directors this week, the first of three annual fare increases planned by the transit agency.
Under the proposed hikes, local bus and rail fares would go up by 25 cents to $1.25.
Park and Ride fares would rise according to how much riders travel. For example, Park and Ride users in Missouri City would see fares go from $1.50 to $2; Katy Park and Ride customers would pay $4.50, up $1 from current fares. If approved, the new fares would take effect Nov. 2.
The board is set to vote on the fare increases and Metro's proposed $330 million operating budget Thursday.
Metropolitan Transit Authority officials said Tuesday that base fares have remained the same for 14 years, and blamed rising diesel and other costs for the proposed hikes.
"We felt like, to be fiscally prudent and to be stewards of taxpayer dollars, we needed to go to our customers and say, 'Hey, we're going to need help paying for all this,' " said Metro spokeswoman Raequel Roberts. "And we tried to spread it out equitably among our passengers."
The last rate increase was in 1994, when bus fare went from 85 cents to $1.
The proposed increase comes after Metro did away with its complex system of discounts and passes last year in favor of a Quick Card, or Q Card, payment system.
Although base fares have remained the same, Metro has increased services by 18 percent in the last two decades, Roberts said. Metro's fuel costs are projected to double next year to $23 million, she added.
Fares make up 21 percent of Metro's operating budget. The remainder is comprised of sales tax revenue and federal funds. The increase is expected to result in $14 million in additional revenue for fiscal 2009, which began Oct. 1; Metro projects total fare revenues of $68.2 million in the current fiscal year.
Also included in the proposal are fare increases for local and Metro Rail fares for the coming years. Those fares would go up by a nickel in 2010 and 2011. Park and Ride fares would increase by as much as 20 cents each of those years. Airport service will remain $15 one-way and $30 round-trip.
Public hearings on the budget and fare increases were conducted Tuesday because earlier hearings on Sept. 16, three days after Hurricane Ike hit the region, failed to draw attendees.
Those waiting for buses outside Metro's downtown headquarters on Main were not pleased about the news. "I'm having trouble as it is riding the bus," said Kelley Yarber, 50. "I'll probably have to walk if I don't have the money."
Edgar Robinson, 28, said he'll have to pay because he has no other way to get to work. "I'm not too happy about it."
The Rev. Richard Hassell, a member of The Metropolitan Organization, a nonpartisan group of churches, synagogues and nonprofits, suggested Metro allow the public more time to respond to the proposal.
"Ike has caused a lot of pain and suffering in our community," said Hassell, pastor of Sheeler Memorial Church in Independence Heights. "It would just be another hardship for people in our community."
Roberts said Tuesday's hearings were the only ones planned before Thursday's vote.
Also Thursday, Metro's board will take up its capital and general mobility budgets. The general mobility budget calls for $164 million for city and county projects and repairs. The $520 million capital improvement budget includes $441 million for the Metro Solutions plan as the agency begins work on expanding light rail.
COMMENTARY
A BUDDING TAKS REVOLT
By RICK CASEY
August 13,2008
http://www.chron.com/disp/story.mpl/metropolitan/casey/5940103.htm
Parents are looking forward to Texas' annual tax-free weekend beginning Friday for back-to-school-related purchases.
Many students, parents and teachers yearn more adamantly for a TAKS-free school year.
Teachers have long chafed at the drill-and-kill culture in many schools that has been fostered by an accountability system that relies so heavily on student performance on the standardized test called the Texas Assessment of Knowledge and Skills.
Many students who struggle to pass the test go to school with dread, knowing that, whatever their grades, they face being held back from promotion if they mark too many wrong bubbles.
TAKS is working, isn't it?
Many students who pass easily spend days in mind-killing boredom as school principals, whose futures depend on student passage rates, pressure teachers to do whatever it takes to make sure lagging students make the grade.
Still, the test is making Texas schools better, isn't it?
Early this month the Texas Education Agency announced that a record number of schools were rated "exemplary," the highest level.
And slightly fewer schools than last year were rated "unacceptable," the lowest level.
Yet, less than a week later, the Governor's Competitiveness Council, whose 29 members include the likes of the heads of AT&T and Exxon Mobil as well as high state officials, issued a report highly critical of the performance of Texas schools.
TEA 'games' not at fault
"If the state's talent development system does not not make critical changes at every level to ensure a dependable work force is available, Texas will not remain a high quality place for doing business," it warned.
One of its recommendations: Require the schools to graduate students who are ready either for college or the work force.
Council members recognized that half of first-year students in Texas colleges require remedial courses.
They seem to think graduates are equally unprepared for jobs.
Some business leaders blame the accountability system for being too lenient.
Bill Hammond, president of the Texas Association of Business, is highly critical of the TEA for inflating results in a number of ways, such as exempting school districts from national dropout standards, and rounding up on some measurements to give schools higher ratings than they actually scored.
In a recent interview with Austin journalist Harvey Kronberg, Hammond attacked the agency for "numbers games and bureaucracy" that mask failures exemplified by schools that have a 50 percent passing rate for math and graduate only two-thirds of their students.
He has a point. But the likelihood is that the disconnect between the performance of schools and students on the TAKS test and the readiness of graduates to take on college and the world has little to do with the "games" played at TEA.
It has to do with the fact that we evaluate the schools on how students do on the TAKS test. If that is the main measure of schools, that is what the[limit]