Better public policies for people with disabilities would lead to a better Texas
By Dennis Borel
Special for the American-Statesman
December 22, 2013
View this article on www.Statesman.com.
As Texans with disabilities have emerged in recent years to take a rightful place at society’s table, disability public policy raises inquisitive eyebrows. Questions are asked about whether what Texas political leaders say about Medicaid can possibly be true, whether state services to people with disabilities are out of date and whether there is accountability for civil rights violations. The answers to these questions affect Texans with and without disabilities and should be better understood.
Texas politicians regularly label the state-federal Medicaid health program a broken system. But children in poverty comprise 75 percent of the beneficiaries, with the rest being seniors, people with disabilities and low-income parents, most of them expectant mothers. Supporting these Texans is the right thing to do and brings overall benefits to society. And a study published in Health Affairs found medical spending lower in Medicaid than in private health insurance.
While it is true that a limited number of health care providers accept Medicaid patients, the problem is not within the Medicaid system, but within state politics. Reimbursement rates, set by the Texas Legislature, are so low that doctors struggle to cover their costs, much less earn a living from their services.
Additionally, direct care workers help Texans receive highly cost-effective community services that allow people to stay in their own homes and avoid hospitalization and expensive, unnecessary institutionalization. Direct care workers serve about 150,000 Texas seniors and people with disabilities in community care programs, but they hold some of the worst-compensated legal jobs in Texas. Direct care workers earn no sick leave, vacation or holiday pay, and most have no health insurance. The base hourly pay is $7.50 with virtually no opportunity for merit increases. In contrast, Salary.com reports the media annual salary for fast-food cooks in Austin is the equivalent of about $9 per hour, often with benefits. Society shouldn't value a cheeseburger more than a person's dignity.
Improving payments within Medicaid would be just one way that Texas leaders could show support for Texans with disabilities. Texas' network of 13 state institutions, called State Supported Living Centers, has remained intact sine the mid-90s, despite a precipitous decline in residents with intellectual and developmental disabilities. In fact, Texas leads the nation in the number of institutions.
Large congregate institutions for people with disabilities date back to an era when personal liberty wasn't as valued as it is today. Just as we wouldn't take an 1850s approach to issues for women, African-Americans or Native-Americans, neither should we allow people with developmental disabilities to be ware-housed in institutions. Outside Texas, states are rapidly abandoning state institutions. In 2011, United Cerebral Palsy reported 13 states with no institutions and ten other with one.
Finally, Texas must stop making claims of immunity to the Americans with Disabilities Act, a federal civil rights law barring discrimination. Complaints of ADA violations from state employees, students at any of Texas' 35 state universities or any citizen interacting with the with Texas government are met with a defense that the state's immunity trumps any discrimination based on a person's disability. Our state does not even dispute whether an act of discrimination occurred.
Of course, private businesses, Texas cities and counties and even federal actions within Texas are all subject to the ADA. The state's immunity stance is offensive to its citizens with disabilities. It was a Texan, President George H.W. Bush, who signed the ADA into law in 1991, describing it as among the most significant acts of his presidency. At his side on that glorious morning, wearing his trademark cowboy hat and boots, was Texas businessman and advocate Justin W. Dart, widely known as the father of the ADA.
The way to rid Texas of sovereign immunity to the ADA and show greater respect for our citizens with disabilities is to pass legislation waiving immunity. Such bills have been introduced in several recent legislative sessions.
Too many times, I'm asked how to control costs rather than what's best for people. The good news is that keeping people healthy and services in communities, not institutions, are core principals of cost control. Through the Texas Legislature and state agencies, our state can make sure we have Medicaid rates that ensure an adequate number of providers and a living wage for community direct care workers to improve reliability and reduce turnover. We can also right-size the state-supported living center network and end the slap-in-the-face immunity regarding the ADA.
In this season of goodwill toward men, focusing on good public policy for Texas seniors and people with disabilities would be a step in the right direction.
