5 Things Texas: Sen. Nathan Johnson, COVID transmission, insurance crisis

“We have to make an effort in the United States, we have to make an effort to understand, to go beyond these rather difficult times… What we need in the United States is not division; what we need in the United States is not hatred; what we need in the United States is not violence or lawlessness; but love and wisdom, and compassion toward one another, and a feeling of justice toward those who still suffer within our country, whether they be white or they be black.”

These were the words of Robert Kennedy on April 4, 1968. He offered these the night of Martin Luther King’s death, standing in the back of a truck before a largely Black audience in Indianapolis. I would encourage you to listen to the speech. I must have listened to it 25 times over the last few days.

I’ve been reflecting on Kennedy and King’s works this week as our country descends into turmoil; as the chaos posed by the very few attempts to corrupt the meaningful and important protests by the many.

We have to work harder in the United States than other countries to keep this experiment in self-governance working. We have to work harder than other peoples to reaffirm the common ties that bind us. And, we have to work harder than at other times in our history to address our challenges, and forestall the worst that may be yet to come.

Don’t lose hope that we can solve the deep problems we face. There is no survival value in pessimism.





With help from Michael Goldberg

1. COVID transmission is up: does it matter?

The reproductive factor of a disease (R factor) is the number of folks you are statistically likely to infect while you are contagious. R factors under 1 mean the virus is not spreading; above 1 it is. According to Rt.live, an aggregator of public health data on COVID infections, every state that had an R factor above 1 six weeks ago has now moved down below R=1, with the exception of Maine. However, one state moved from approximately 43rd on this list six weeks ago to third on the list last week: Texas.

On April 7, Texas had an R factor of 0.85. The most recent report shows Texas with an R factor of 1.04. That move represents a 22.4% increase in transmission in Texas during the last six weeks. Texas now usually has the second highest number of new daily confirmed infections. It may not matter. The IHME predictive model currently shows the number of cases trending down throughout the summer.

2. Post-pandemic insurance crisis looming in Texas

new report from the Episcopal Health Foundation shows that 1.6m Texans are likely to lose employer sponsored insurance coverage as a result of losing their jobs. Of these, only 328,000 are going to be eligible for Medicaid “because of Texas’ restrictive Medicaid eligibility.” EHF cited a poll from last year showing 64% of Texans supported Medicaid expansion.

EHF estimates about 881k will be eligible for subsidized ACA plans on the individual exchange, but even those subsidized plans could be out of reach for many. Hospitals and providers, which rely on commercial reimbursement, will be hit hard by folks moving to Medicaid or the uninsured. That this will happen on the heels of a tough financial quarter (and year) from COVID isn’t lost on hospital leaders.

3. Video: Sen. Nathan Johnson

Sen. Nathan Johnson represents Senate District 16, which comprises the northern part of Dallas County, and serves on the Health and Human Services Committee. For this edition of “What They’re Watching,” Sen. Johnson sat down with State of Reform to make the moral and economic case for Medicaid expansion in Texas.

“When you get business groups looking at issues that may traditionally have been social issues and throwing their weight behind it, that’s when things really start to happen. So I think we’re seeing a business realization as well as a rising demand from the public that we do something about our health care system that encourages the most expensive form of care and leaves a lot of people out.”

4.  Employer groups call for health reform

The Texas Business Group on Health, Houston Business Coalition on Health, the DFW Business Group on Health, and 33 other organizations across the country sent a letter to Congressional leadership outlining recommendations to ensure Americans have access to quality, affordable health care during and after the COVID-19 pandemic. Among several proposals, the letter recommends increasing tele-health coverage, ensuring sufficient COBRA subsidies, approving additional financial assistance for primary care, prioritizing banning surprise billing, and mitigating risk in the health insurance market.

If we look to history, this could be seen as an important move towards reform. In 2009, as health reform was picking up, it was an open question about whether large employers would support or oppose the package. Their opposition hindered reform efforts led by President Clinton in 1993-94. Their support in 2009-2010 became a difference maker in getting the ACA passed, however. If large businesses or business groups are now starting to mobilize in support of reform, it’s a signal of significant new momentum for federal effort.

5. Introducing: “5 Slides We’re Discussing” & “Leadership Series”

During this time of COVID, we are proud to be launching two new virtual series to foster conversations around reform. “5 Slides We’re Discussing” features the topics and data points that senior health care executives and policy leaders are talking about. Our “Leadership Series” goes one-on-one with some of the most thoughtful leaders in the sector today. Both are very much like the experience on our keynote stage at our State of Reform events.

So far, we’ve featured a panel on how MCOs are dealing with COVID and another on how philanthropy is working to fill the gap. Later this month, we’ll feature a discussion on the “new normal” in Texas health care. We’ll have more for you on that next week.