In 1993, Rick Perry wrote a letter giving passive support to Hillary Clinton's efforts to reform health care in the United States through a system of mandates on employers. In 2001, he spoke in support of cross border insurance that would insure Mexican citizens living in the US.
Despite these efforts in support of government programs and increasing federal power, Governor Perry has supports state based solutions to health care while in office. He has opposed programs imposed by the federal government without state flexibility. With this in mind, Governor Perry supports the SCHIP program that matches state funds for children's insurance, and opposed the 2009-2010 health care reform efforts. He opposes a public option or single payer program.
Governor Perry started a program called TexCare to promote the SCHIP program. Enrollment peaked in May 2002 and was reduced due to a 2003 budget shortfall. A law was passed in 2003 that required enrollees to prove their continued eligibility every six months, as well as pass an assets test, and a 90-day waiting period before enrollment. These provisions were overturned in 2007. In 2010, one out of every three children in the state of Texas received their insurance through the SCHIP program.
The main efforts of Governor Perry in health care have been directed at establishing tort reform in Texas. He began these calls in 2002 seeking a cap to damages, special courts for malpractice, some immunities to providers that support low income areas, and some leeway for those previously denied malpractice coverage due to economic reasons. He stated that growing numbers of frivolous and abusive lawsuits, and escalating damage awards, settlements and legal expenses were partially to blame for skyrocketing health care costs.
Tort reform was accomplished in Texas in July of 2002. The reform consisted of a $250,000 cap on non-economic damages applied to all doctors in the case, a $250,000 cap on non-economic damages against a single institution and a $500,000 cap on all health-care institutions combined. Liability limits for hospitals that provide charity care were also included. The reform required a plaintiff to provide an expert witness report from a qualified physician within four months of filing suit, changed the Good Samaritan law to make it easier for a health care professional to provide emergency care to someone in need without fear of a lawsuit, and created a Medical Disclosure panel to draft a list of common risks which need to be disclosed to patients before they consent to a procedure.
After the passage of the tort reform legislation, Governor Perry stated that there is no greater threat posed to prosperity and growth than the triple threat of over-regulation, over-taxation and frivolous litigation. He predicted that the reform would bring prosperity to the state. When the nation was discussing health care reform in 2009, Governor Perry urged similar tort reform as an essential part to any health care reform. When discussing the ability of Texas to produce jobs during the 2009-2010 recession, Governor Perry cited tort reform as one reason jobs were being created in Texas.
Although vocally opposed to government invovlement in health care, in 2007 Governor Perry proposed a plan to provide subsidies to low-income individuals to purchase health insurance. He stated that this would be cheape in the long run as people would not use the emergency room as a primary care physician.
Governor Perry opposed the 2009 health care reform for numerous reasons. First, he stated that the program was an over-reach of federal government power into an arena which it did not have authority. He also opposed the one-size-fits-all approach which did not allow states to adjust to the realities of their populations as was done with the SCHIP program. He called for state specific solutions to the health care crisis and said that any successful solution would have different mechanisms for different states. Finally, he opposed the size of the program, the deficit spending, and the fancy accounting used to hide costs of the program.
In 2006, Texas was one of six states to participate in an Own Your Future program which encouraged those over 45 to be more active in planning for their long term health care plans. In 2007, Texas enacted Medicaid reform that established the Texas Health Opportunity Pool Trust Fund to provide premium subsidies to eligible Texans and help offset uncompensated care costs for providers who implement innovative measures to provide primary and preventive care, pilot programs such as positive incentives for healthy lifestyles, health savings accounts, and an incentive program to encourage regular health care visits, allowed individuals to opt out of Medicaid and use employer-sponsored insurance in some cases, encouraged the development and use of electronic health information standards and electronic health records to improve patient care, extended Medicaid coverage for former foster care children to age 23, if they are attending college, allowed cost sharing for non-emergency use of emergency rooms to support appropriate emergency room utilization, and used outcome-based performance measures and incentives in health maintenance organization contracts to increase access to appropriate health care services.
Governor Perry has proposed an initial health care plan that remains vague:
Work with Congress to repeal “Obamacare”
Stabilize the country’s economy for employers
Lower skyrocketing health care costs “through the proven, market-based strategies of transparency, choice and competition”
Implement Texas-style health care reform
HillaryCare
In 1993, Agricultural Commissionor Rick Perry sent a letter to First Lady Hillary Clinton stating that her health care plan to force employers to provide coverage for employees was worthy and commendable. The text of the letter is reproduced below with an image available here.
I think your efforts in trying to reform the nation’s health care system are most commendable. The task force on national health care services consists of many entities representing all types of health care providers and citizens.
I would like to request that the task force give particular consideration to the needs of the nation’s farmers, ranchers, and agriculture workers, and other members of rural communities. Rural populations have a high proportion of uninsured people, rising health care costs, and often experience lack of services.
As the Agricultural Commisioner for the state of Texas, I have a strong interest in the problem of health care delivery to rural areas. Over 50 hospitals have closed in rural Texas since the mid-eighties. Most rural communities have problems with access to adequate health care due to shortages of physicians, clinics, and hospitals within a safe driving distance.
I have made economic development for rural Texans a high priority in my administration. Leadership, education, infrastructure systems, and health care facilitites can do much towards aiding a rural community to prosper.
Again, your efforts are worthy and I hope you will remember this constituency as the task force progresses.
Bi-National Health Insurance
In August of 2001, Governor Perry gave a speech in Mexico to a border summit. In that speech, Governor Perry expressed his support for a proposed plan to provide bi-national health insurance.
Gov. Rick Perry's Remarks to the Border Summit * Note: Gov. Perry frequently departs from prepared remarks. Wednesday, August 22, 2001 • Speech
Thank you Senator Lucio. President Nevarez, UT-Pan American is to be commended for its vision and leadership in hosting this unprecedented border summit in the beautiful Texas town of Edinburg. My friends from Mexico, including Governor Tomas Yarrington Ruvalcaba of Tamaulipas, and Governor Fernando Canales Clariond of Nuevo Leon, it is an honor to be in your presence. I want to extend my gratitude to our Mexican neighbors for hosting me this July as I sought to learn one of the world’s great languages, Spanish. I enjoyed your hospitality, and was grateful for your patience as I worked on my vocabulary. No longer do I refer to “la verdad” as “la verdura.” I am delighted to see friends from the U.S. side of the border as well, including our distinguished members of the Legislature, and our county and city leaders along the border.
Today we begin a new dialogue about our shared future, a future of promising potential if we work together to solve the challenges we both face. It is fitting that we convene this summit where the great, meandering river known as the Rio Grande – or the Rio Bravo – forms the long border between Texas and Mexico. In years past, that famed body of water has been seen by many as a dividing point, If you were to walk along its banks and look to the other side, based on the stereotypes of the past, you would think you were seeing things a million miles away, instead of a stone’s throw away. But I am here today to say that while we have honest differences, there is more that unites us than divides us. The Rio Grande does not separate two nations, it joins two peoples. Mexico and the United States have a shared history, and a common future. And it is along this border where we will either fail or succeed in addressing the education, health care and transportation needs of our two peoples.
Critical to our future is meeting our border infrastructure needs. We must get traffic moving along the border so that businesses along the border and thousands of miles away can deliver products on time, and continue to grow. Companies from Spokane, Washington to Concord, New Hampshire depend on Texas highways and Texas bridges to move their products south. Seventy percent of all U.S.-Mexico truck traffic goes to, or through, the Lone Star state. Fifteen of our twenty-seven border crossings with Mexico are located in Texas. Fifty-four percent of all U.S.-Mexico trade crosses just between Brownsville and Laredo. This year the Texas legislature appropriated approximately $1 billion more in transportation funding. But more can be done.
With Texas serving as the Gateway to Mexico, it is time that we receive congressional funding that reflects the instrumental role our state plays as a port of entry. With a Texan in the White House, I believe there is no greater opportunity to end the funding discrimination that crippled Texas infrastructure under the previous administration. Good infrastructure is essential to the free flow of commerce. It is a matter of economic fact that free trade lifts the tide for all the boats in the harbor. U.S. trade with Mexico has increased by 500% since 1994. Exports and imports between Texas and Mexico now exceed $100 billion dollars annually. Thousands of jobs have been created for Texas and Mexican workers, confirming the indisputable fact that trade with Mexico is big business for Texas.
The fruits of NAFTA have just begun to ripen. At the same time, we must not allow the roots of the tree to become poisoned. The NAFTA agreement not only signaled a new era of economic possibility, but a new era of bi-national cooperation. That is why it is wrong, and inherently detrimental to our relationship with Mexico for the U.S. Congress to pursue a protectionist policy that forbids Mexican trucks from U.S. roadways. It is bad public policy, and it violates the terms of the NAFTA agreement we agreed to. Mexican trucks that meet our safety standards should be given the same access to U.S. roads as our Canadian neighbors to the north.
Mexico, too, must be vigilant in realizing its treaty obligations. For more than half a century, under the 1944 Water Treaty our two nations have cooperated so that the water needs of both countries are met. But as of late, Mexico is behind in delivering the water it has promised to the U.S. A Mexican judicial injunction now threatens the livelihood of our Rio Grande Valley farmers, and has become a source of contention between our two nations. It is time to end this dispute. I would ask that the Mexican government meet its obligation under the treaty, Texas growers are depending on it.
There are other challenges that require a unified approach, especially in the area of health care. A lack of preventative medicine means conditions that could have been eliminated through childhood immunizations show up in disturbing numbers later in life. Limited availability of medical specialists means conditions like heart disease and diabetes go untreated at alarming rates. In Texas, we recently placed a strong emphasis on preventative care when we expanded access to Medicaid for more low-income children by making the Medicaid enrollment process simpler. We allocated an additional $4 billion to the Medicaid program, and more than $900 million to the Children’s Health Insurance Program. I urged legislators to pass a telemedicine pilot program that will enable, through technology, a sick border resident of limited financial means to receive care from a specialist hundreds of miles away. But the effort to combat disease and illness requires greater cooperative efforts between our two nations. It is a simple truth that disease knows no boundaries. An outbreak of drug-resistant tuberculosis, for example, endangers citizens of both our nations. We have much to gain if we work together to expand preventative care, and treat maladies unique to this region.
Legislation authored by border legislators Pat Haggerty and Eddie Lucio establishes an important study that will look at the feasibility of bi-national health insurance. This study recognizes that the Mexican and U.S. sides of the border compose one region, and we must address health care problems throughout that region. That’s why I am also excited that Texas Secretary of State Henry Cuellar is working on an initiative that could extend the benefits of telemedicine to individuals living on the Mexican side of the border.
As a compassionate state, we know that for our children to succeed, they must not only be healthy, but educated. The future leaders of our two nations are learning their fractions and their ABC’s in classrooms all along this border. Immigrants from around the world are being taught in Texas classrooms, and our history is rich with examples of new citizens who have made great contributions. We must say to every Texas child learning in a Texas classroom, “we don’t care where you come from, but where you are going, and we are going to do everything we can to help you get there.” And that vision must include the children of undocumented workers. That’s why Texas took the national lead in allowing such deserving young minds to attend a Texas college at a resident rate. Those young minds are a part of a new generation of leaders, the doors of higher education must be open to them. The message is simple: educacion es el futuro, y si se puede.
We also know that poverty is not unique to either side of the border. Some of Texas’ poorest citizens live in colonias all along the border. They often lack basic infrastructure many of us take for granted. Just today, the North American Development Bank announced it will provide $6.3 million in funding to hook up colonia residents in six border cities to water and wastewater lines. More than 18,000 residents will benefit from these water or wastewater hookups. And this November, by approving Proposition 2, Texas voters can ensure that their neighbors in colonias have quality roads so that school buses, emergency vehicles and postal trucks can reach residents, and residents can get to a job or a school reliably.
President Fox’s vision for an open border is a vision I embrace, as long as we demonstrate the will to address the obstacles to it. An open border means poverty has given way to opportunity, and Mexico’s citizens do not feel compelled to cross the border to find that opportunity. It means we have addressed pollution concerns, made substantial progress in stopping the spread of disease, and rid our crossings of illicit drug smuggling activity. Clearly we have a long way to go in addressing those issues. At the same time we must continue to deepen our economic ties, expanding opportunities for Mexican and U.S. companies to do business on both sides of the border. The outlook is promising, even if the road to prosperity is a long one. We share a bond as neighbors, and we find our culture north of the Rio Grande to be increasingly defined by the strong traits of people of Hispanic descent. Texas has long enjoyed a unique identity, an identity forged by an independent spirit, and the convergence of many different peoples. We must welcome change in the 21st Century as we have in every century before it.
Today, as we look to the south, we see a rising sun. It is perched above a people whose best days are in front of them. Let us endeavor to make the most of this new day through a new dialogue. Let us work together to combat disease, expand trade and provide educational opportunities. If we do, there are no limits to what we can accomplish for the betterment of all of our citizens. Thank you, and God bless you.
SCHIP Announcement
In September of 2001, Governor Perry issued a press statement noting a speech made discussing the recent State Children Health Insurance Program (SCHIP).
Children's Health Insurance Program Announcement * Note: Gov. Perry frequently departs from prepared remarks. Thursday, September 20, 2001 • Speech
Thank you Commissioner Gilbert. I also want to thank Janie Ruiz, the principal here at Becker Elementary, for allowing us to visit your school for this special announcement.
I’m proud to stand here today and announce that – after only 18 months – the TexCare Partnership has met, and exceeded, its goal of helping the families of more than 428,000 children in Texas gain access to health insurance with the Children’s Health Insurance Program.
And during that time, the level of uninsured children in Texas has dropped by 32 percent.
This success is due, in large part, to those schools, community-based organizations, faith-based organizations, and countless individuals around the state that successfully joined together to make Texas parents aware of affordable children's health insurance through the TexCare Partnership.
I am proud that in Texas we are a caring people. Together we agree that the most precious natural resource in Texas is, in fact, our children.
CHIP is a national program designed for families who earn too much money to qualify for Medicaid, yet cannot afford commercial insurance.
The State of Texas developed the TexCare Partnership to raise awareness of new children’s health insurance options and to help Texas families obtain affordable coverage for their uninsured children, from newborn through age 19.
This milestone is proof that those awareness efforts are working.
The TexCare Partnership offers a comprehensive benefits package with a full range of coverage, including regular checkups, immunizations, prescription drugs, eyeglasses, lab tests, X-rays, hospital visits, dental care and mental health care – from a broad choice of doctors.
However, our commitment on the state level doesn’t end with CHIP. This last legislative session was very good in terms of expanding access to quality health care.
We increased Medicaid funding by $4.3 billion, increased the Children’s Health Insurance Program by $935 million, and funded new rural and border health care priorities
In addition to the increase funding, we simplified the Medicaid enrollment process. By doing so, hundreds of thousands of our children will be insured. They will be exposed to routine and preventative care, and they will be healthy and learning in the classroom.
Between Medicaid simplification, and the Children's Health Insurance Program, our poorest young Texans will receive the care they need when they need it.
And the TexCare Partnership already has numerous accounts confirming CHIP is carrying out that mission.
Like the story of Alejandro Gamboa, a church deacon in McAllen. He's the father of eight and grandfather of 22, and encourages families in his parish to apply.
CHIP has even come to the rescue for Deacon Alejandro’s own family. His 12-year-old grandson Alex developed severe pain and a fever. Because his family was enrolled in CHIP, Alex’s mother was able to take him to the doctor and learn that he had appendicitis, which, of course, was an emergency that needed prompt surgery.
Then there’s the story of Stephanie Pena, a substitute teacher for the Austin Independent School District.
Stephanie couldn’t afford to insure her son, Drew. But when Drew brought a TexCare Partnership application home from school, Stephanie filled it out, and she was enrolled.
She’s glad she did, because Drew developed a cardiac problem while he was playing football. He had to have an extensive and expensive series of tests, which showed a heart condition that – fortunately – he will outgrow. Stephanie says she never could have afforded these tests without insurance coverage.
With me today are the children whose enrollment pushed the total over the top and helped us meet our first major goal. I’d like to ask Erica Gonzales and her children, Marina, Gilbert and Eric, to please join me.
Mrs. Gonzales, I want to thank you for calling the TexCare Partnership to sign your children up for needed health insurance. Your example provides hope to all Texas families with uninsured children that something can be done, that they can afford to cover their children.
Yes, we’ve hit the 428,000-enrollment mark for CHIP. That’s definitely something to be proud of. But with more than one million uninsured children still left in Texas, our work is not over.
In July of 2004, Governor Perry released a press statement noting both his support for the SCHIP program and his commitment to additional funds to provide benefits for those making up to 200% of the poverty level.
Statement on CHIP Thursday, July 01, 2004 • Press Release
AUSTIN – Robert Black, deputy press secretary to Gov. Rick Perry, issued the following statement today regarding calls for increased spending on CHIP:
“Gov. Perry recognizes and shares the health care concerns of Texas families. Last session, Gov. Perry signed a budget that provided an additional $1 billion for health care programs, ensured funding for the CHIP program at 200% of the poverty level and expanded the number of Federally Qualified Health Centers to help more indigent, uninsured and underserved Texans."
“Gov. Perry remains committed to making sure that assistance is provided to those Texans who need it most.”
Texas and SCHIP
SCHIP was implemented in Texas in June 2000. It hit it's peak enrollment of 529,211 in May 2002. Due to a 2003 budget shortfall a law was passed that required enrollees to prove their continued eligibility every six months, as well as pass an assets test, and a 90-day waiting period before enrollment. This lowered enrollment. These provisions were overturned in 2007.
Call for Tort Reform
In April of 2002, Governor Perry issued a statement noting the harmful effect of extraneous lawsuits on health care in the US and Texas, and the need to reform the health care lawsuit system.
Gov. Rick Perry Says Texas Must Address Medical Lawsuit Abuse Crisis Goal Is to Ensure Texans Have Access to Quality, Affordable Health Care
Thursday, April 04, 2002 • Press Release
AUSTIN - Gov. Rick Perry today laid out a series of corrective measures to fix the medical lawsuit abuse crisis that is hurting doctors and hampering Texans' access to quality, affordable health care.
"Because of skyrocketing malpractice insurance premiums, many Texas doctors are being forced to curtail - and sometimes abandon - their practices," Perry said. "That means many high-risk patients - including children, the elderly, and those with cancer and heart disease - are losing access to needed health care."
Perry attributed the malpractice insurance crisis to growing numbers of frivolous and abusive lawsuits, and escalating damage awards, settlements and legal expenses - all of which drain health care providers' financial resources and time from treating patients.
Doctors and other health care providers from across the state have recounted troubling stories of malpractice insurance rates soaring as much as 400 percent in one year, and of insurance carriers refusing to renew policies for some doctors - even those who have never had a malpractice claim filed against them.
Perry also said the health care profession must do its share in policing the profession and responding to medical errors that harm patients. The vast majority of Texas doctors are committed professionals who daily improve the lives of their patients, Perry said.
"As Governor, I am firmly committed to doing whatever it takes to end this crisis - including reining in abusive lawsuits, improving patient protections and reforming insurance regulations," Perry added.
Among the corrective measures Perry called for are:
Enact meaningful lawsuit reform for the health care profession that caps non-economic losses to plaintiffs at $250,000 and limits personal injury trial lawyers' fees to a prescribed schedule based on the size of the award. More than 20 other states have capped non-economic damages, resulting in significantly lower liability insurance rates. California, for example, limits non-economic damages to $250,000 and has the third lowest medical liability rates in the nation.
Create special courts or designate special judges to hear medical malpractice claims. These judges would have expertise in malpractice issues and would be better able to weed out frivolous lawsuits and to sanction lawyers and award litigation costs in meritless cases.
Improve the Board of Medical Examiners' ability to police the medical profession and safeguard patient care through enforcement of licensing laws and consistent disciplinary enforcement actions.
In concert with doctors and hospitals around the state, develop clear procedures for reducing medical errors, and for clear and swift disciplinary actions against the relatively few bad doctors whose actions endanger patients and damage the reputations of all health care providers.
Extend tort immunity to health care providers who treat low-income patients under contract with the state.
Provide a form of temporary, emergency malpractice insurance coverage for doctors who have been denied coverage solely for economic reasons.
Expand the Texas Department of Insurance's ability to review insurance rates to ensure they are commensurate with losses. Unjustified rate increases would be subject to reduction.
Perry said that over the past several months, he has met with doctors all across the state to discuss issues important to physicians and health care providers. Of all the topics discussed - prompt pay, medical liability, workers' compensation, managed care, taxes, physician joint negotiations - none is more crucial to ensuring Texans have access to quality, affordable health care than the issue of medical liability insurance, he said.
Perry said the medical lawsuit abuse crisis threatens to undermine the great strides Texas has made in improving health care in recent years. Since 1998, he noted, Texas has increased health and human services funding by more than $6 billion, making health care more accessible - especially for children, low-income and elderly Texans. Texas also has improved the Medicaid program by passing measures to prevent fraud, cut red tape, and improve community and nursing home care.
The Children's Health Insurance Program has been more successful than anyone imagined, helping more than 500,000 children get high quality, affordable health insurance. Texas also protected the privacy of medical records, authorized an innovative telemedicine pilot program using technology to get medical help to Texans living in border communities, and improved the way Texas purchases prescription drugs to increase efficiency and save taxpayers money.
To help hospitals and doctors get paid for the care they provide, the legislature in 1999 passed a law requiring insurance companies and HMOs to pay promptly, and the state has levied more than $40 million in fines and restitution orders to slow-paying insurers and HMOs.
Despite these successes, though, there is still work to be done, Perry added.
Although most of the corrective measures require legislative approval next session, Perry said there are some steps that could be taken immediately to help doctors and their patients.
He said he will request the Texas Supreme Court to act on complaints that some personal injury trial lawyers have abused court procedures and used pre-suit depositions to "set up" defendants, obtaining evidence against defendant health care providers without giving them the opportunity to be present and defend themselves.
The Governor said he is also asking the State Bar of Texas to amend its disciplinary rules of professional conduct to crack down on predatory lawyers who seek out and represent frivolous cases.
Perry said the judicial branch of government should have the first opportunity to address these problems, but if they persist, "They are a proper subject of legislation next session."
Expanding Health Care Options
In May of 2002, Governor Perry issued a press statement calling for more options for small businesses to buy health insurance. He called for allowing small businesses to buy insurance in high risk pools, and allowing insurance carriers to offer flexible health care plans that provide coverage for catastrophic needs at a lower cost.
Gov. Perry Unveils Plan to Expand Health Care Options Initiatives focus on helping small businesses provide insurance for employees
Wednesday, May 29, 2002 • Press Release
SAN ANTONIO - Gov. Rick Perry today unveiled a series of health care initiatives aimed at making it easier for employees of small businesses to get insurance, expanding health care options in under-served areas of Texas, and increasing the availability of prescription drugs for senior citizens.
During a visit to CHRISTUS Santa Rosa Hospital, Perry said the heart of his proposal is a plan to help small businesses provide health insurance for their employees. The governor noted that 75 percent of uninsured Texans have full-time jobs. More than half of those Texans work at companies with no more than 20 employees.
"Too many small businesses cannot afford to purchase health insurance because a pre-existing condition among one or two employees often drives up premiums exponentially for everyone," Perry said. "In many cases, uninsured Texans are employed by small businesses that simply cannot afford to offer health insurance."
Perry called for allowing companies with fewer than 10 employees to purchase health insurance through the Texas Health Insurance Risk Pool, which currently provides insurance to Texans who cannot obtain adequate health insurance coverage as a result of their medical conditions or other factors.
"By broadening the risk pool, we will infuse it with younger, healthier workers and help make affordable health coverage more available to small businesses and their employees," Perry said. "According to a survey by the Texas Department of Insurance, four out of five small businesses not offering health insurance today would do so if it were more affordable."
In addition, the governor's plan would allow insurance carriers to offer flexible health care plans that provide coverage for catastrophic needs at a lower cost and make it easier for small businesses to learn about affordable insurance options through rate guides and other informational tools.
Noting that 62 of the 196 rural counties in Texas do not have a hospital, Perry also proposed using $20 million in tobacco settlement funds to double the number of federally qualified health centers in the state. The governor said the bulk of that funding will be available by reallocating funds designated for one-time use in the current budget and using additional tobacco receipts expected to be collected next biennium above the amount certified for the current budget.
"This is not just a rural problem," Perry said. "Our existing emergency care facilities in our largest cities are often under great strain, and patients are being transferred out of town because emergency rooms are just too busy."
The governor said the $20 million would be used to help local communities establish or expand federally qualified health centers, and it would position Texas to tap into a $114 million proposed increase in federal funding for the centers. Perry estimated that expanding the number of federally qualified health centers to 360 would enable the state to provide health care services to an additional 500,000 Texans each year.
"These centers can bring better health care to rural Texas while relieving the burden on our urban emergency centers," Perry said.
The third element of the governor's proposal calls for a new law requiring insurers to offer prescription drug benefits as a part of all Medicare supplemental plans. The prescription benefit would be offered as an option, and consumers could then decide whether or not to include the benefit in the package they purchase. Currently, insurers offer 10 types of Medicare supplemental policies in Texas; however, only three of those plans include a prescription drug benefit.
"All too often, seniors wanting a prescription drug plan have to purchase supplemental packages with options they do not need," Perry said. "That drives up the cost, and forces those seniors to cut corners because of financial constraints."
Other elements of the governor's health care plan include:
Directing the Health and Human Services Commission (HHSC) to apply for a waiver from the federal government to allow families eligible for the Children's Health Insurance Program (CHIP) to purchase employer sponsored health insurance. Under this program, CHIP would reimburse the families for the cost of the children's insurance if the employer plan is less expensive than CHIP premiums. This would save the state money and allow qualifying families to be covered under the same insurance policy.
Directing HHSC to identify existing funds to support Senate Bill 532 to provide treatment services for women eligible for assistance under the federal Breast and Cervical Cancer Prevention and Treatment Act.
"By making it easier for small businesses to buy health insurance, by expanding health care options in under-served areas, and by making prescription drugs more easily available to seniors, we can improve health care in Texas and save lives," Perry said.
Fulfillment of Tort Reform
In June of 2002, the state of Texas enacted tort reform legislation that placed a $250,000 cap on damages, required the plaintiff to have an expert witness, and required a list of common risks for all procedures.
New Measures Will Help End Crisis That Threatened Texans' Access to Affordable Health Care Tuesday, June 11, 2002 • Press Release
Gov. Perry Reappoints Matson to Executive Council of Physical Therapy and Occupational Therapy Examiners HOUSTON – Gov. Rick Perry today signed historic lawsuit reform legislation to help end a growing medical malpractice crisis and ensure that all Texans have access to quality, affordable health care.
“Because of these medical malpractice reforms, our hospitals and clinics will be open to the patients who need them,” Perry said during a ceremony at Mach Industrial Group in Houston. “Pregnant women will not have to worry about finding an obstetrician to help them deliver their newborns. Texans who suffer a trauma can know that when their life is on the line, the specialist they need will be on call.”
The reforms in House Bill 4 include a $250,000 cap on non-economic damages to prevent exorbitant jury awards that drive up malpractice rates. The cap applies to all doctors involved in a case to deter trial lawyers from skirting the reforms by suing every doctor who saw the patient. In addition, there is a $250,000 cap on non-economic damages against a single institution and a $500,000 cap on all health-care institutions combined. Additional liability limits for hospitals that provide charity care will help make sure health care remains accessible to the neediest Texans.
Perry declared medical malpractice reform an emergency issue for the 78th Texas Legislature in response to a growing medical lawsuit abuse crisis that was hampering Texans’ access to health care. Doctors across the state have seen skyrocketing malpractice insurance rates, and insurance carriers have refused to renew some policies – even for doctors who have never had a malpractice claim filed against them.
“We are removing the incentive personal injury trial lawyers currently have to file frivolous lawsuits and run doctors out of business,” Perry said. “And it is worth pointing out that Texans wrongfully harmed by an act of malpractice will still be able to recover the full amount of their medical bills and lost wages and, in some cases, punitive damages if determined by a unanimous jury.”
Other provisions of the new legislation that will help limit frivolous malpractice claims include:
Requiring a plaintiff to provide an expert witness report from a qualified physician within four months of filing suit. This will prevent lawyers from dragging out frivolous lawsuits.
Tightening up the Good Samaritan law to make it easier for a health care professional to provide emergency care to someone in need without fear of a lawsuit.
Creating a Texas Medical Disclosure panel to draft a list of common risks which need to be disclosed to patients before they consent to a procedure.
The governor noted that the lawsuit reform measures in HB4 will protect other businesses from frivolous lawsuits as well and provide another incentive for companies to create jobs and make investments in Texas.
“With this comprehensive lawsuit reform measure, we are ending costly and intentional legal delays, requiring reasonable attorneys’ fees in class action lawsuits, and removing the incentive for trial lawyers to file frivolous lawsuits,” Perry said. “We will save thousands of jobs, generate millions in new revenue to the state, and protect patient access to quality health care.”
Rep. Joe Nixon, R-Houston, authored HB4. Sen. Bill Ratliff, R-Mount Pleasant, sponsored the bill in the Senate.
Tort Reform will Spur Economy
In October of 2003, Governor Perry issued a press statement noting his views that the recent tort reforms enacted in Texas would help to spur the economy.
Gov. Perry: Historic Tort Reforms Will Fuel Economic Recovery, Job Creation Wednesday, October 08, 2003 • Press Release
NEW YORK - Gov. Rick Perry today said the state’s successful efforts to pass historic lawsuit abuse reforms and rein in runaway government spending have paved the way for job creation and economic recovery.
“There is no greater threat posed to prosperity and growth than the triple threat of over-regulation, over-taxation and frivolous litigation,” Perry said in a speech to the Manhattan Institute, a public policy think tank. “Lawsuit abuse is one of the greatest job killers in America today. “
Perry declared medical malpractice reform an emergency issue for the 78th Texas Legislature in response to a growing medical lawsuit abuse crisis that was hampering Texans’ access to health care. The legislature responded by approving a $250,000 cap on non-economic damages to prevent exorbitant jury awards that drive up malpractice rates. In addition, there is a $250,000 cap on non-economic damages against a single institution and a $500,000 cap on all health-care institutions combined. On Sept. 13, Texas voters approved a constitutional amendment in support of the caps set by the legislature.
“These comprehensive reforms restore balance to the Texas system of justice while maintaining proper protections and compensation for Texans who are truly harmed,” Perry said. “Texas economist Ray Perryman estimates that our sweeping lawsuit reforms will create more than 240,000 permanent jobs and add $36 billion to the Texas economy.”
The governor also praised the Texas tort reforms for going “one step further than any other state.” The Texas tort reforms include:
Tightening up the Good Samaritan law to make it easier for volunteer firefighters, teachers and charity volunteers to provide important public services.
Allowing defendants to appeal class certification directly to the Texas Supreme Court to decide up front, not after years of costly litigation, if the plaintiff has a class action.
Ensuring that if clients in a class-action suit get paid in coupons, so do lawyers.
Reforming product liability laws so retailers are not left on the hook for a manufacturer’s mistake.
Closing loopholes that allow trial lawyers to venue shop.
The governor, who has made economic development and job creation a cornerstone of his administration, said the state’s comprehensive tort reforms and aggressive efforts to recruit new businesses to the state already are paying off.
“Texas is now wide open for business, growth and opportunity,” Perry said. “A more prosperous Texas is essential to a more prosperous America, and we’re doing our part to ensure that the economic recovery goes forward.”
Own Your Future
In October of 2006, Governor Perry released a press statement noting the "Own Your Future" program. The program was to encourage people to save for their future health care costs in their senior years.
Perry Urges Texans Age 45 to 65 to Begin Planning for Long-Term Care Healthy Active Lifestyles Also Important as Texans Age
Thursday, October 12, 2006 • Press Release
AUSTIN – Gov. Rick Perry today announced that Texas is one of six states selected by the federal Department of Health and Human Services to participate in a long-term care planning promotion campaign called “Own Your Future.”
“This campaign will focus on encouraging Texans age 45 to 65 to begin thinking about their long-term care needs, such as long-term care insurance, legal decisions about major life decisions, physical fitness and retirement savings,” Perry said. “It’s never too soon to prepare for long-term care.”
“Own Your Future” is an aggressive campaign the federal Department of Health and Human Services developed to promote long-term care planning among state residents.
Perry said the importance of planning for later years is underscored by the fact that only 8 percent of older Texans today report personal savings as their largest source of income and that one in three Americans provide unpaid care for a friend or a relative over the course of a year.
“In addition, many people mistakenly believe that Medicare will meet all their long-term care needs,” Perry said. “This is not the case, and if a Texan age 65 or older develops a disability while living in the community, they can expect to pay an average of $175,000 over the remainder of their lives on care for that disability.”
Perry also highlighted the importance of Texans leading active, healthy lifestyles because poor diet and physical inactivity are on the verge of replacing tobacco use as the leading preventable cause of death.
“Texas is working to combat preventable illness with the Aging Texas Well Initiative, which is aimed at ensuring Texans age with dignity and independence,” he added. “In addition, programs like the Texas Roundup and Texercise are designed to help improve the health and well-being of millions of Texans, ensuring a healthy lifestyle as each of us advance in age.”
Healthier Texas
In February of 2007, Governor Texas proposed a new program for health care during the 2007 "State of the State" address. The program was called "Healthier Texas" and would have provided subsidies to low-income individuals to purchase health insurance.
Today I am proposing a new initiative called “Healthier Texas” that will open the door to more affordable insurance options for two million working Texans. This initiative redirects hundreds of millions of federal dollars spent on uncompensated care for the uninsured to the creation of a funding pool to purchase insurance for working Texans below 200 percent of the federal poverty level.
For every half a million Texans that sign up for insurance under this plan it would cost the state a little more than $200 million and help us draw down a federal match of more than $300 million.
And there would be no cost to state general revenue, which I will explain in detail in a few minutes.
Under Healthier Texas, the state would provide monthly premium assistance payments of as much as $150 per individual, depending on family income. For some this would help with the purchase of a catastrophic plan. For others it could be part of the financing for a full-benefit plan that could include contributions from employers and individuals too. And for a low cost we could add children too.
The financial cost would be modest, the social benefit extraordinary.
That’s because this plan recognizes the long-term benefits of providing Texans preventative care through insurance instead of paying for costly emergency room visits.
Patients once stuck in overcrowded emergency rooms would start seeing primary care physicians. Preventable conditions would be treated with less pain and at a lower cost. And we will make the private insurance market more robust.
This solution recognizes the wisdom of expanding the insurance market without a government takeover of your healthcare and without adding one more Texan to the government rolls.
Like any plan, its success will depend upon the willingness of uninsured Texans to enroll at a modest cost. The foundation of personal empowerment is personal responsibility. Government can design programs, but adults must take the initiative to do what is best for their children and themselves.
Senate Bill 10 - Medicaid Reform
In June of 2007, the state legislature passed and Governor Perry signed Senate Bill 10 to reform portions of the state medicare program. Governor Perry issued a press statement noting his support for the legislation which accomplished the following reforms:
Establishing the Texas Health Opportunity Pool Trust Fund to provide premium subsidies to eligible Texans and help offset uncompensated care costs for providers who implement innovative measures to provide primary and preventive care.
Improving health outcomes and increasing consumer choice and responsibility through pilot programs such as positive incentives for healthy lifestyles, health savings accounts, and an incentive program to encourage regular health care visits.
Increasing employer-based insurance options through the Medicaid Health Insurance Premium Payment reimbursement program and allowing individuals to opt out of Medicaid and use employer-sponsored insurance in some cases.
Encouraging the development and use of electronic health information standards and electronic health records to improve patient care.
Extending Medicaid coverage for former foster care children to age 23, if they are attending college.
Using tailored benefits packages for children with special health care needs to better meet the complex needs of this population, reduce costs and simplify program administration.
Allowing cost sharing for non-emergency use of emergency rooms to support appropriate emergency room utilization.
Using outcome-based performance measures and incentives in health maintenance organization contracts to increase access to appropriate health care services.
Gov. Rick Perry's Remarks at the Medicaid Reform Bill Signing- Temple * Note: Gov. Perry frequently departs from prepared remarks. Thursday, June 14, 2007 • Speech
Thank you Dr. Rohac (James Rohac, director of Scott & White.) The Medicaid reform bill I am signing today is so sweeping and historic that the U.S. Secretary of Health and Human Services, Mike Leavitt, joined us earlier today in Fort Worth to celebrate its passage. It is visionary legislation that will improve health services for 2.7 million of our poorest Texans, encourage personal responsibility, promote consumer choice and provide hundreds of millions of dollars to insure working Texans who are one terrible illness away from financial ruin.
Senate Bill 10, authored by Senator Jane Nelson and sponsored by Representative Dianne Delisi, is a groundbreaking attempt to reform Medicaid, and control its costs. With Secretary Leavitt’s approval of a waiver, the state will have more flexibility in managing the diverse population served by this $39 billion program. Medicaid costs have exploded, now representing 26 percent of our budget. With this reform bill, we seek to provide unique plans for different populations, such as Texans with special needs and children who have different health needs than other segments of society, such as adults with long-term care needs. This bill creates a pilot program that rewards Medicaid recipients who make healthy lifestyle choices. It expands consumer choice through health savings accounts and consumer-directed services. And perhaps most significant in my mind, this bill establishes a premium assistance program to help uninsured, working adults purchase insurance in the private market so that they can be protected in the face of catastrophe. This was a major goal of mine as discussed in my State of the State Address in February.
I especially like the fact, while some states are expanding insurance by greatly increasing the public rolls, our plan uses public dollars to help transition recipients to private and employer-sponsored plans, which optimizes state funds and creates a more vibrant health insurance market. It is not the end-all, be-all in a state with unique healthcare challenges, including more than 5 million uninsured, many of whom have immigrated here from poor conditions. But this plan is a good start at solving the problem for working Texans who make too much to qualify for Medicaid, but not enough to affordably purchase health insurance coverage. At the same time, we recognize that while some Texans will continue to go uninsured, we must continue to expand access to federally qualified health centers that provide basic health care for the uninsured, underinsured and indigent Texans. And I am very proud this legislation expands access to breast and cervical cancer screening and treatment services.
By optimizing available funding for health services, expanding consumer choice, encouraging personal responsibility for Medicaid recipients, and providing new sources of financing for private insurance, we are taking an historic step toward a better, more accessible healthcare system. We are also encouraging greater use of electronic health records to reduce medical errors through legislation passed this session, and working to make the cost of health services more transparent to patients.
To expand upon the merits of this bill, I would like to ask the house sponsor, Representative Dianne Delisi, to share her thoughts.
Concern over Health Care Proposals - State's Rights
In early 2009, health care reform was a topic of discussion in Washington. Governor Perry responded to this discussion with concern that reform on a federal level could impede on the rights of states to determine the health care of the residents of that state. Governor Perry spoke often about this concern and appeared on the Mark Davis radio program in July of 2009.
As some of the proposed plans in Washington became public, concerns over state's rights became larger. Given the mandates that were present in the reform packages, there was a concern that the states may not be capable of paying for the services that the federal government was dictating that they must provide. On September 23, 2009 Governor Perry issued a press statement noting his belief that health care was a state right, that the propositions being considered by the federal government would impede on those rights, and that the mandates would be too costly to Texas.
Gov. Perry: States Should Have the Right to Create Health Care Solutions
Wednesday, September 02, 2009 • Lubbock, Texas
Cutting into a state’s ability to apply local fixes to local problems stifles the sort of innovative solutions that states are best suited to develop. These one-size-fits-all health care proposals will cost taxpayers billions of dollars without significantly improving access to or treatment in our health care system.
Later in September, Governor Perry issued another press release noting that the solutions to health care should be accomplished at the state level. He stated that the mandates in the federal plan would cost Texas $60 Billion dollars over the next ten years. The press release echoed statements sent in a letter to Senate Finance Committee Chairman Max Baucus and the Texas Congressional Delegation.
Gov. Perry: Successful Health Care Reform Must be Achieved through State-Specific Solutions
Wednesday, September 23, 2009 • Austin, Texas
Instead of government mandates and more deficit spending, successful health care reforms can be achieved only by providing states the flexibility to develop state-specific solutions. I urge you to support our right, as a state, to further explore these approaches, rather than forcing us to implement federal mandates that promise financial hardships for the states and little in the way of benefits for our economy and all of our constituents.
When the health care reform legislation passed through the House, Governor Perry sent a letter to other Governors asking them to join with Texas to stand up to unprecedented federal intrusion in health care.
Gov. Perry: States Must Stand Up to Unprecedented Federal Intrusion Texas to review constitutionality of Nebraska compromise Wednesday, December 23, 2009 • Austin, Texas • Press Release
Gov. Rick Perry today sent a letter asking other governors to join him in ongoing efforts to assert the constitutional rights of states as guaranteed under the 10th Amendment with regard to the federal health care bill being forced through by Congress. He urged the governors to support and join efforts by Texas Attorney General Greg Abbott and several other state attorneys general to determine the constitutionality of a compromise in the pending federal health care legislation exempting the state of Nebraska from increased Medicaid costs resulting from the bill’s passage.
"As the chief executive officers of our individual sovereign states, we must stand up to this unprecedented intrusion in to our lives and the rights of our citizens. We must demonstrate resolve in the face of this infringement,” Gov. Perry wrote in the letter. “Texas Attorney General Greg Abbott is joining with several other state attorneys general to place this deal under proper scrutiny, to determine if such an exclusion is unconstitutional. His office, along with mine, will continue to explore all options available to us as we attempt to minimize the damages that can be caused to Texans by this ill-advised piece of legislation."
In Texas, this health care bill will cost up to $21 billion over the next 10 years, adding an estimated 2 million more people to our Medicaid rolls.
In his letter the governor emphasized that this bill will impose unprecedented intrusion in to the lives and the rights of citizens by mandating that every American purchase health care coverage or face penalties. Additionally, taxpayers in Texas and in most other states will pay even more to effectively subsidize expanded Medicaid for Nebraska and select states that caught additional sweeteners on issues like rural health care and Medicare Advantage for some seniors in a few states.
The Public Option in Health Care
In late 2009, some federal legislators were discussing enacting a public option and allowing states to opt out. Governor Perry appeared on Fox Business and discussed his opposition to the plan in that states that opt out would still make you pay for it. He urges Americans to continue protesting the reform.
Fox: What do you think of this so called "opt out" plan that we're now hearing from Congress where they are saying "you as a state governor, you might not like what is being proposed by Washing and you can get out of it. All's fair."
Governor Perry: Yea, it's better than forcing us into it. Here's my concern: it's that they give you the opt out, but they still make you pay for it. I wanna see the fine print so to speak. That's what wears you out about Washington DC. They say "oh, well don't worry about it," and then they keep taking you money in the form of the federal income tax and were gonna keep taking the dollars through the federal income tax that they collect and then their gonna spread them out to some other state that is "on the take" if you will from the federal government. They buy these states off by saying "look, you guys come and get into this and here's how much money we'll send you." I hope that there's enough governors elected in 2010 that will stand up and say "Hey, the tenth amendment means something." And we don't want Washington down here trying to make this one size fits all deal work for Connecticut or Ohio or Texas. States should compete with each other and the states that have the best ideas ... go steal those ideas. That's a great way to do business, go see what works ... go look at the innovators out there.
Fox: To which the government would say "No, we need one plan fits all in order for it to be fair and balanced." To which you would say...
Governor Perry: That's socialism and I am not for it.
Reaction to Passage of Health Care Reform
In March of 2010, Governor Perry issued four press statements on health care reform. One asked the national representatives from Texas to vote no on the passage of what he called Obamacare, and the other three noted his opposition to the legislation and his plans to oppose it with a lawsuit. Two of those press statements and an editorial are highlighted below, noting Governor Perry's opposition to the reform and his plans to oppose it.
Statement by Gov. Rick Perry on Passage of Federal Health Care Bill
Sunday, March 21, 2010 • Austin, Texas
Gov. Rick Perry issued the following statement on the passage of the federal health care bill:
"Unfortunately, the health care vote had more to do with expanding socialism on American soil than it does fixing our health care finance and delivery systems. The Obama health care bill undermines patient choice, personal responsibility, medical innovation and fiscal responsibility in America.
"As passed by the U.S. House, the bill will cost Texas taxpayers billions more, and drive our nation much deeper into debt. Congress's backroom deals and parliamentary maneuvers undermined the public trust and increased cynicism in our political process.
"Texas leaders will continue to do everything in our power to fight this federal excess and find ways to protect our families, taxpayers and medical providers from this gross federal overreach."
Statement by Gov. Rick Perry on Texas’ Legal Challenge of Federal Health Care Bill Tuesday, March 23, 2010 • Austin, Texas
Gov. Rick Perry today issued the following statement regarding Texas' legal action challenging the constitutionality of the federal health care bill:
"Our state's lawsuit is the next reasonable approach to protecting our individual and states' rights from an unreasonable and unresponsive federal government. Left unchallenged, these 2,400 pages of unprecedented federal overreach will seriously diminish the quality of healthcare, impose onerous new taxes and penalties on individuals and employers, and crush our state budget."
Health Care Fight Isn't Over Thursday, April 08, 2010 • Austin, Texas • Editorial
President Obama's signature on Congress's disastrous health care plan was a disappointment to everyone who values limited government, bipartisanship and – most of all – quality and affordable health care.
In forcing through this bill, Democrats from Speaker Nancy Pelosi on down have substituted their own desires and political goals for the good judgment and common sense of the people they represent. Indeed, the more the American people learned about these socialist proposals, the more they hated them.
We've known for a while that the Obama administration and Congressional leaders might eventually twist enough arms, broker enough backroom deals and bend enough procedural rules to pass this bill. Still, it's surprising that it's come to this, with the federal government unconstitutionally mandating the purchase of a specific product, and threatening those who don't abide with government fines. Further, never before has there been such a dramatic expansion of the ability of the federal government to require citizens to fund or subsidize abortions. This bill represents a federal overreach unprecedented in scope, reaching into the lives of each and every person in America today, with the staggering costs handed down to generations yet unborn.
The fight, however, is far from over.
We can't afford to accept this situation, and I mean that literally. As Lieutenant Governor David Dewhurst, Speaker Joe Straus and I wrote in a letter to the Texas delegation, The Texas Health and Human Services Commission estimates this bill will double the number of Medicaid recipients in the Lone Star State. The burden this will place on Texas taxpayers can be as much as $26 billion over the next 10 years. Despite that increased cost to our taxpayers, there will be no improvement to either the cost of health care or its quality.
So I am working with other state officials – including Lieutenant Governor Dewhurst, Speaker Straus and Attorney General Greg Abbott – as we explore our various options to protect Texans from this disastrous bill. General Abbott's lawsuit, joining with numerous other states, is the next logical step in the battle. Beyond that, I am working with other governors, and other leaders in various states, to explore all our options to defend taxpayers from this aggressive federal overreach. I will also work with members of the Texas Senate and House to see what can be done legislatively.
Again, it's vital we fight this on every front available to us, because mandates are both painful to rank-and-file Texans and also extremely ineffective. Don't ask me, ask Massachusetts. In the Bay State, where a mandate is already a fact of life, premiums are 40 percent more expensive than elsewhere in the country, and it's becoming harder and harder to find a doctor to see even if you are covered.
In Hawaii, which passed mandates of its own 35 years ago, the percentage of uninsured remains about the same as it was in 1974, according to the American Legislative Exchange Council.
Mandates flat-out don't work.
It's important that we send the message that opposition to this bill is not generated by angry mobs, as the media portrayals might suggest, but instead by everyday people legitimately concerned to see the federal government so quickly expanding its control over all of our lives. In fact, more than 1,000 e-mails flooded into my office over the weekend prior to this bill's passage, almost exclusively against it.
Here in Texas, we also face the specter of cap-and-trade legislation and EPA regulation that will cripple our state's energy sector and cause the price of most goods and services to skyrocket for no environmental benefit. Texas had led the charge against this federal overreach, as well, and 16 other states have joined us in that effort. We've also refused to be bribed into joining ongoing efforts to establish a federal educational standard that will let Washington decide what your children learn, instead of leaving those decisions up to our state and communities.
Truth is, it's getting harder to find areas of life the Obama Administration doesn't want to place under federal control, all while the mountain of escalating debt they're generating grows to blot out our future.
Texas will continue to push back against Washington's big government intrusion into individual liberty, and continue to champion the rights of states to enact measures that best protect our citizens, families, employers and communities.
Response to Health Care Ruling
On October 14, 2010 Governor Perry responded to a ruling by a judge that challenges to the constitutionality of the 2009 health care reform legislation were valid by issuing a press release noting his opposition to the legislation.
Statement by Gov. Rick Perry on Challenge to Federal Health Care Act
Thursday, October 14, 2010 • Austin, Texas
Gov. Rick Perry today issued the following statement regarding a federal judge's decision to allow Texas' and other states' challenge to the legality of federal health care legislation to proceed:
"Today's decision on the federal health care bill lawsuit represents a significant step forward in the ongoing fight against rampant federal overreach. While we would have preferred to see the court proceed on all six counts, we're encouraged that states' rights protected under the Constitution's 10th Amendment will be addressed, and that Americans facing this unconstitutional mandate will now have their day in court."
Tort Reform
In August of 2009, Governor Perry wrote and editorial which noted that tort reform was passed in Texas in 2003. He stated that the effects of this reform in Texas have been a greater presence of doctors, a greater availability of health care, and a lower overall cost. He urges the US Congress to consider tort reform when developing plans. In that same month, he released a press statement noting that tort reform was essential to any health care reform on a national level.
Tort Reform is Essential to Healthcare Reform Tuesday, August 18, 2009 • Austin, Texas • Editorial
To hear federal officials tell it, they’ve got all the answers on health care and it’s up to the rest of us to sit, wait and embrace whatever solution — if any — they may eventually provide.
I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.
Texas, in fact, stands as a good example of how smart, responsible policy can help us take major steps toward fixing a damaged medical system, starting with legal reforms.
Just six years ago, Texas was mired in a health care crisis. Our doctors were leaving the state, or abandoning the profession entirely, because of frivolous lawsuits and the steadily increasing medical malpractice insurance premiums that resulted.
Two thirds of our state’s counties had no practicing obstetricians, and for pregnant women that meant long trips in cramped cars and higher fuel bills. Sixty percent of our counties had no pediatricians, which often meant delayed, or denied, health care for sick children.
And 24 counties in the Rio Grande Valley had no primary care doctors at all.
Each of those factors made it more likely that patients in underserved areas would postpone seeking care, which meant minor issues became major issues, and illnesses that could have been treated simply, easily and economically in the doctor’s office turned into severe health crises that had to be treated in the emergency room.
And the situation was worsening with every passing day. By 2002, 13 of the state’s 17 liability insurance carriers had left Texas, leaving less competition and leaving doctors with insurance bills that were seeing double-digit increases, if they could get insurance at all. That same year, applications for medical licenses plummeted to the lowest level in a decade.
This being Texas, instead of throwing money at the problem or debating endlessly, we identified the root causes and decided to do something about it.
In 2003, I declared the medical liability crisis an emergency item, and the legislature responded, passing sweeping reforms that protected the patient, but also shielded doctors and hospitals from unscrupulous trial lawyers eager to make a quick buck at the system’s expense.
We capped non-economic damages at $250,000 per defendant, or up to $750,000 per incident, while placing no cap on more easily determined economic damages, such as lost wages or cost of medical care due to injury. We ended the practice of allowing baseless, but expensive, lawsuits to drag on indefinitely, requiring plaintiffs to provide expert witness reports to support their claims within four months of filing suit or drop the case.
These measures were supported by the people of Texas, who in September of 2003 approved a ballot measure, Proposition 12, authorizing all of these changes.
Changes were seen immediately, and continue to be felt. All major liability insurers cut their rates upon passage of our reforms, with most of those cuts ranging in the double-digits. More than 10 new insurance carriers entered the Texas market, increasing competition and further lowering costs.
As a result, Texas doctors have seen their insurance rates decline by, on average, 27 percent.
The number of doctors applying to practice medicine in Texas has skyrocketed by 57 percent. In 2008, the Texas Medical Board received 4,023 licensure applications and issued a record 3,621 new licenses.
In all, in just the first five years after reforms passed, 14,498 doctors either returned to practice in Texas or began practicing here for the first time.
And our reforms finally brought critical specialties to underserved areas. The number of obstetricians practicing in rural Texas is up by 27 percent, and 12 counties that previously had no obstetricians now have at least one. The statistics show major gains in fields like orthopedic surgery, pediatrics, neurosurgery and emergency medicine.
The Rio Grande Valley has seen an 18 percent growth in applications to practice medicine, adding about 200 doctors to this critically underserved area.
And what about the money that used to go to defending all those frivolous lawsuits? You can find it in budgets for upgraded equipment, expanded emergency rooms, patient safety programs and improved primary and charity care.
Success stories like ours need to be told, and need to be remembered as we continue this national debate.
Instead of handing down “one size fits all” mandates on how it’s going to be, Washington should be enabling states to set their own agendas, and solve their own problems, when it comes to health care.
State Solutions
In September of 2009, Governor Perry released a press statement noting the need for state specific solutions in the health care debate.
Gov. Perry: Successful Health Care Reform Must be Achieved through State-Specific Solutions Wednesday, September 23, 2009 • Austin, Texas • Press Release
Gov. Perry: Loser Pays Lets Employers Spend Less Time in the Courtroom, More Time Creating Jobs Gov. Rick Perry today sent a letter to Senate Finance Committee Chairman Max Baucus and the Texas Congressional Delegation outlining his concerns about the impact on Texas taxpayers and the state budget of federal government-run health care bills currently under consideration by Congress. The committee began consideration of Chairman Baucus’ proposed bill and amendments this week.
“Instead of government mandates and more deficit spending, successful health care reforms can be achieved only by providing states the flexibility to develop state-specific solutions,” Gov. Perry said. “I urge you to support our right, as a state, to further explore these approaches, rather than forcing us to implement federal mandates that promise financial hardships for the states and little in the way of benefits for our economy and all of our constituents.”
According to the Texas Health and Human Services Commission, the federal health care proposals could add up to $60 billion to the state budget over the next 10 years, creating twice the number of Texas Medicaid recipients. The bills also place a new tax burden on certain businesses, and provide for the federal takeover of some current state insurance functions.
The governor also reiterated his request to U.S. Health and Human Services Secretary Kathleen Sebelius for approval of the Texas Medicaid reform waiver, which was originally submitted in April 2008. This waiver, which would enable more low-income working Texans to purchase private health insurance, promote preventive care, and improve quality and access to care, is stalled at the Centers for Medicare and Medicaid Services.
High Risk Pools
In April of 2010, Governor Perry issued a press statement noting his decision that the State of Texas could not commit to operating a new temporary high-risk pool program due to the lack of program rules or reliable federal funding.
Gov. Perry Announces Decision on Temporary High-Risk Pool
Lack of rules and financial assurances are not in best interest of Texas taxpayers, families, patients or health care providers Friday, April 30, 2010 • Austin, Texas • Press Release
Gov. Rick Perry sent a letter to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius notifying her that the State of Texas cannot today commit to operating a new temporary high-risk pool program due to the lack of program rules or reliable federal funding.
“After careful analysis of the new law, consultation with state health and insurance officials and communications with state lawmakers and HHS, the State of Texas cannot today commit to operating the new high-risk pool due to the lack of program rules or reliable federal funding,” Gov. Perry said. “I do not believe the aggressive implementation and the lack of assurances on financial solvency of the program are in the best interest of Texas taxpayers, families, patients or health care providers.”
The governor cited concerns with many unanswered questions relating to the implementation of both federal health care reform and the temporary high-risk pool program, such as the absence of key contract terms and passage of federal rules and covenants to ensure financial solvency so that taxpayers and state revenue systems are held harmless.
While Congress has committed $5 billion to operating these risk pools in all 50 states for at least four years, most experts believe this amount to be insufficient. In the coming years, state officials could be forced to reduce health coverage, raise premiums or ask state taxpayers to pay for these high-risk pools once the federal funds run dry.
Initial Health Care Plan
On August 25, 2011 Governor Perry proposed an initial health care plan to the Texas Tribune. The plan was non-specific and entailed four key items:
Work with Congress to repeal “Obamacare”
Stabilize the country’s economy for employers
Lower skyrocketing health care costs “through the proven, market-based strategies of transparency, choice and competition”
Implement Texas-style health care reform
TEA Party Debate
In September of 2011, Governor Perry participated in the TEA party debate. He was asked about the prescription drugs benefit known as Medicare Part D and stated that he would not push to repeal the program.
BLITZER: Thank you, Senator.
Governor Perry, it was President Bush who pushed for prescription drug benefits for senior, not President Obama. It was President Bush who pushed for prescription drug benefits for seniors. The question to you: If you were president -- it's not a difficult question -- would you vote to eliminate, to repeal those prescription drug benefits for seniors under Medicare?
PERRY: No. It's a $17 trillion hole that we have in our budget we've got to deal with. And I think that's the issue of, how do you find the savings and still deliver the services?
For instance, in the state of Texas, we combined a substantial amount of our health and human services from 10 down to five agencies. We put an Office of Inspector General into place, and we saved over $5.3 billion, Newt, just by finding the waste and the fraud in Texas state government. I'm thinking there might be more waste and fraud in the federal government than even there is in the Texas government.
BLITZER: But, Governor, just to be precise, if you were president, you wouldn't repeal prescription drug benefits for seniors under Medicare?
PERRY: That's what I said when I started the conversation.
Michigan Economic Debate
In November of 2011, Governor Perry participated in the Michigan economic debate. He discussed his support for returning Medicare and Medicare to the states.
BARTIROMO: Thirty seconds, Governor Perry?
PERRY: Obviously on the Medicare side, you have to have an insurance type of a program where people have options of which -- give them a menu of options of which they can choose from. I think you have to have the doctors and the hospitals and the other health care providers being given incentives on health care rather than "sick care."
And then on Medicaid, it is really pretty simple, just like Jon and Mitt both know, you send it back to the states and let the states figure out how to make Medicaid work, because I will guarantee you we will do it safely, we will do it appropriately, and we will save a ton of money.
Campaign Website Statements
Gov. Perry on Health Care and Tort Reform
Under Gov. Perry, Texas has reformed its child protective services, insured more of Texas’ needy children than ever before, and increased health care investments by more than $20 billion while promoting prevention and wellness programs to cut down on future health care costs. Gov. Perry has also led the most sweeping lawsuit reform in the nation, cracking down on junk asbestos claims and frivolous medical malpractice lawsuits. Now thousands more doctors, including specialists, are practicing in Texas, bringing greater access to quality health care for Texans.
Cracking Down on Frivolous Lawsuits. Medical Liability Reform. In 2003, Gov. Perry led the fight to pass the most sweeping medical liability reforms in the nation. Since then, frivolous lawsuits against doctors and hospitals have dropped dramatically, insurance costs have fallen, and access to health care has greatly improved. - More Doctors. More Specialists. In 2007, the Texas Medical Board received a record 4,041 applications for physician licenses, and issued a record 3,324 licenses. The board topped that again the next year, granting a new record 3,621 licenses in 2008. Texas has added 215 obstetricians since 2003, and the number of obstetricians practicing in rural Texas has grown by 27 percent.
Increased access in underserved areas. In 2009, Gov. Perry signed legislation to expand access to medical care in rural and medically underserved areas. House Bill 2154 creates a dedicated source of revenue to support education loan forgiveness for physicians who work in health professional shortage areas and provide services to Medicaid or CHIP recipients.
Protecting Children. Over 2.4 million of Texas poorest children – one out of every three children in the state – are now covered under the Children’s Health Insurance Program and Medicaid program.
Texas Protects its Most Vulnerable Citizens. Texas overhauled state supported living centers, formerly known as state schools, to provide more oversight and protection for the residents of the centers and those in community-based services.
Tough on Fraud. Gov. Perry authorized the creation of the Office of the Inspector General of the Health And Human Services Commission which saved taxpayers over $1.5 billion in fraud detection in government health care programs.
Issues - 10th Amendment and the Fighting Intrusive Washington Policies
Federal Healthcare Reform. The federal government is spending huge amounts of borrowed money on fixes that don't necessarily solve the problem. The "one-size-fits-all" approach to healthcare just doesn’t work because it hinders Texas’ ability to apply local solutions to local problems and stifles the sort of innovative solutions that states can create when given the chance. The current proposals circulating through Congress could cost Texas up to $21 billion over the next 10 years. A better solution to healthcare challenges should be to allow states greater flexibility to address their own unique needs, and should focus on delivering care as cost-effectively as possible. A free market approach that promotes more competition and innovation will help bring about improvements to access and quality.
Under Gov. Perry’s leadership, Texas has proposed its own healthcare alternatives which include promoting reforms to the small employer health insurance market, working to reduce the number of uninsured Texans by restructuring federal Medicaid funding to reduce reliance on expensive emergency room visits for non-emergency care, and make it easier for the working poor to buy into employer-sponsored health coverage. Gov. Perry outlined his vision for such reforms in a waiver request that has been languishing before the federal government since April 2008.
2012 Health Care Plan
REFORM MEDICARE AND MEDICAID TO IMPROVE HEALTH CARE Reform Medicare to be Sustainable for the Long-Term
Medicare is a program in crisis. According to an analysis by the Urban Institute, a single-earner couple earning the average wage will pay $60,000 in Medicare benefits over their lifetime but receive $357,000 in benefits.48 A program that continues to pay out far more than it collects is simply unsustainable. CBO wrote that the program will be insolvent by 2020.49 And instead of shoring up Medicare for future generations, ObamaCare took $500 billion from the program to create even higher levels of unsustainable entitlement spending.50
According to CBO’s own calculations, repealing ObamaCare will reduce the cost of health insurance premiums and reduce federal spending on health care.51 But total repeal of Obama’s unconstitutional health care law is only the beginning. More steps are needed to ensure Medicare’s sustainability, along with continually improving quality health care available at a lower cost.
Lawmakers like Rep. Paul Ryan, Sen. Tom Coburn, Sen. Jim DeMint, and Sen. Joseph Lieberman have recognized the importance of tackling Medicare’s fiscally unsustainable future and put forward serious, credible proposals that deserve to be fully considered and debated as the nation moves forward to reform Medicare.
Viable Medicare reform options must keep our promises to those at or approaching retirement age, they must ensure the long-term solvency of the program, they must address the enormous fraud and waste that plague the current system, and empower individuals to make choices that best fit their needs in a competitive marketplace.
In particular, Medicare reform options include gradually raising the age of Medicare eligibility (alongside the gradual increase in the full retirement age under Social Security); adjusting Medicare benefits to be paid on a sliding scale based on the income of the recipient; and giving Medicare recipients more control to choose the plan that best fits their unique, individual needs through bundled premium support payments directly to the individual or as a credit against the purchase of health insurance coverage offered through the program. Gradually Raise the Eligibility Age for Medicare
Just as recommended for Social Security, advances in medical technology and innovation have allowed Americans to lead longer, more productive lives today than ever before. As a result, full retirement and eligibility for programs like Medicare and Social Security must adapt to reflect these changes and the viability of the program going forward.
Empower Consumers While Reducing Fraud and Waste
The adage that nobody spends someone else’s money as carefully as they spend their own is certainly true in Medicare where estimates of fraud and waste are often thought to meet or exceed $100 billion annually, or 10% of Medicare spending.52 Giving Medicare recipients greater control over their health care dollars not only empowers these individuals to choose the coverage and care that best meets their needs, but also puts an important check against fraud and waste when those dollars belong to people, not a bureaucracy. Whether Medicare benefits are bundled with other payments to retirees, or simply applied to the purchase of health insurance coverage, the value of the benefit is transparent to the recipient.
Medicaid Rolls Expanding
Return Medicaid Responsibility to States to Increase Health Care Quality and Access
Medicaid was originally designed as a safety net for the poorest of the poor, but it has since grown to the point where it can no longer provide quality care or ensure health access to those who need it most.53 Due in part to the recent economic downturn, Medicaid rolls have been increased dramatically, increasing from 42.3 million in June 2007 to over 50 million in July 2010.54 The system is rapidly approaching a breaking point.
The current administration’s response to the myriad problems facing Medicaid has only made matters worse. Instead of working to find a sustainable path for Medicaid, the president has dramatically expanded the program, far beyond its original intention, trapping 25 million new patients in a system where they struggle to access quality health care.55
The one-size-fits-all approach that the federal government has applied to Medicaid has failed. The best solution for those in need of access to quality health care is to return responsibility for achieving the original goals of Medicaid to the states using the 1996 welfare reform law as a model. States simply must have the flexibility to design and administer health programs in ways that address the unique challenges faced by each individual state. Instead of the federal government confiscating money from states, taking a cut off the top, and the sending the money back out with limited flexibility for how states can actually use it, individual states should control the program’s funding and requirements from the very beginning. Medicaid must be reformed to better serve patients and taxpayers.
