5 Things Texas: FAR and Abbott, COVID-19, Arielle Kane

The best resource I’ve found on COVID-19 is this one. It’s a useful read, even if you’ve read a lot already. At State of Reform, we are tracking the disease across nine states as best we can, which you can see here and here. For a sense of what life is like at the epicenter of the American outbreak, we’ve started this new column “Dispatch from Seattle” to discuss life amid “community spread.”

As always, thank you for your support and for reading our stuff.




With help from Michael Goldberg and Monte Whaley


1. Last night’s primary results and health care

Last night’s performance by Joe Biden seemed to galvanize his lead in delegates in the nomination process. The states ahead have relatively conservative electorates, likely helping Biden over Bernie Sanders.

But, don’t buy the hype that this is over. Sanders is unlikely to concede gracefully without getting assurances in return. After all, Biden is unlikely to have a majority of delegates heading into the Milwaukee convention. As he did in 2016, Sanders is likely to remain in the race to help elevate issues he cares about, like health care.

Will Biden trade support for Medicare for All to get Bernie out of the race early, and to work to unify the party? We’ll see, but expect health care to play a central role in those negotiations.

2.  MFAR and Gov. Abbott’s reluctance to engage

The new Medicaid Fiscal Accountability Rule (MFAR) “has the high probability of destroying all of our rural hospitals.” That from Eddie Read, CFO of Hamilton General Hospitals at our recent State of Reform event. States like Texas, which fund a considerable amount of Medicaid through mechanisms targeted by this rule, have a lot to lose.

If any group could put a stop to this rule, it would be the Republican Governor’s Association. And, it turns out this year, it’s led by Texas Gov. Abbott. He has a unique position of leverage at the RGA, and this would be a policy issue to use it on. However, I’m told that the RGA will not be making any comment. The governor’s office would not provide any comment for us on the question of Abbott’s possible leadership on the issue, a puzzling position given the importance to hospital financing.


3. Video: Arielle Kane, Progressive Policy Institute

Arielle Kane is the Director of Health Care at the Progressive Policy Institute and was advising Mayor Mike Bloomberg’s presidential campaign before he exited the race last week. We spoke to her in Dallas to discuss the potential benefits of an idea often absent in the national health care policy conversation: Maryland’s all-payer rate setting model.

“I don’t think we need to do exactly what Maryland has done on a national scale, but I don’t understand why what Maryland has done hasn’t risen to the national conversation. I recently wrote a paper that talked about bringing the Medicare Advantage Model to where you have a price cap for health care services into the commercial market and insurers and providers could still have contracts and pay a little more, or a little less, than that price cap based on what they think that service is worth in their market.”

4. State of COVID-19 in Texas

As of last night, 16 cases of COVID-19 have spread in the state with a new case in Tarrant County. Or maybe it’s 32 cases. Or just 13, perhaps. Reporting on the growing and evolving disease isn’t offering the most clarity yet, a function of the “fog of this war.”

Texas Health and Human services has singled out long-term care facilities as particularly high risk locations and have encouraged the facilities to bar visitors. While Texas health officials have not yet observed “community spread” of the disease, they are coordinating with Gov. Gregg Abbott and the Texas Division of Emergency Management to reinforce precautionary strategies.


5. Capretta: “An actual bipartisan plan”

In his most recent column, State of Reform columnist Jim Capretta of the AEI highlights the Bipartisan Policy Center’s (BPC) new health reform plan. He calls the plan both notable and important during a time when “political polarization has largely paralyzed Washington.”

“There is no panacea for the many and varied problems that need attention, but the BPC proposals include ideas that would lower costs, stabilize insurance coverage, and improve the quality of care provided to patients,” says Capretta. The plan’s list of major reforms include: reinsurance, expanded premium assistance, price transparency, price competition in the hospital market, and the elimination of surprise billing.