Point Austin: Dead Reckoning

They're not as bad as they could be.

That's the best that could be said about the Texas Department of Insurance regulations for federal health care navigators in Texas, announced Tuesday by Insurance Commissioner Julia Rathgeber. Rathgeber provided an anodyne announcement, "These rules will help ensure Texans have confidence that anyone registered as a navigator has passed appropriate background checks and received the training they need to safeguard a consumer's most sensitive and personal information." The rules were issued within a 349-page document, including both a history of the regulations and an often-tendentious defense of the rules themselves, including the flat insistence that "those who wish to seek and apply for health insurance coverage will not suffer as a result of the rules." We can only hope that's right.

As summarized by the TDI, instead of the 40 hours of additional training for navigators initially proposed, the rules will require only 20 hours: specified amounts in state Medicaid and Children's Health Insurance programs, privacy, ethics, insurance – and (just like our public schools!) exam prep. Navi­gat­ors will be forbidden to charge for their services, sell or recommend specific insurance plans, or engage in electioneering (all of which were already forbidden).

The TDI defends its rules on the grounds of federal "failure" to mandate state-specific rules with the nonprofits contracted to provide navigation; it pointedly fails to criticize the state's failure to create its own health insurance exchange, or its failure to accept federal funding to expand Medicaid to help address the more than 6 million Texans who currently have no health insurance. And of course it fails to note that the state of Texas will not only not lift an official finger to address the scandal that a quarter of its residents do without access to health insurance, but continues to do whatever it can to put obstacles in the way of Texans acquiring that coverage, of which these rules are only the latest example.

Getting in the Way

But I digress (sort of). Sen. Kirk Watson, D-Austin, carried the bill (SB 1795) that enabled these rules, and he is cautiously optimistic about the results. He issued a conciliatory statement that applauded the revisions to reduce required training, drop registration fees, and other changes that will make the rules less expensive for navigators and nonprofits to follow. He did note, as have others, that timing is a real problem: "The deadline to sign up for health insurance through the federal exchange is near the time the rules will take effect."

Sen. Sylvia Garcia, D-Houston, was less enthusiastic: "I still believe that the rules are burdensome, costly, and create obstacles in our goal of reducing the uninsured rate in Texas." And Houston Democratic Rep. Garnet Coleman was more blunt, calling the rules burdensome and unrealistic for a state where 6 million residents are uninsured. "Texas leads the nation in the percentage of people lacking health insurance," Coleman said, "and the governor is finding more ways to make it harder for Texans to sign up for coverage."

That, in fact, seems to be the situation, and though Rathgeber and the TDI backed away from the harshest proposed regs – that would have doubled the amount of redundant training and imposed even higher costs on the navigators and their organizations – the entire process appears to be little more than a yeoman's effort of "helping" by obstruction. Fort Worth Rep. Lon Burnam had bluntly accused the agency of inappropriately withholding internal documents reflecting that "the training requirements were determined by political influence and not any regular TDI process or standards," and in the wake of the revisions he suggested that his threat to disclose the background had forced the agency to make the rules less stringent.

Official Ignorance

In any event, it's hard to dispute Bur­nam's judgment that the initial rules wouldn't have survived a court challenge, because they were in fact "the very definition of arbitrary, unsupported by substantial evidence, and overly burdensome." But of course, any lawsuit – like the one (in a long line) currently challenging the state's radical underfunding of public schools – can take years to pursue, and in the meantime millions of Texans, when they need health care, can continue to whistle in the wind, or queue up at already overburdened local emergency rooms.

And that's the bottom line. For entirely political reasons, Gov. Rick Perry has not only opposed and obstructed the federal health care law at every available opportunity, he has done nothing to offer a usable alternative or even to maintain the entirely inadequate existing state health care programs. It has been more important for Perry and his GOP allies to fight a holy war against Planned Parenthood than to sustain the Women's Health Program; it has been a higher priority to cut property taxes than to provide local health care districts with state assistance; it has been politically more expedient to deny millions of Texans health care coverage through Medicaid than to accept federal funding for a program that would not only save lives but expand the state economy.

Perry, his political partners, and his would-be successors defend such policies as "fiscal conservatism," but they are more precisely defined by the venerable phrase, "penny wise, pound foolish." Public health care and readily available health insurance are neither charity nor even expensive; they are rational public policies that allow all to share (and reduce) inevitable risks and necessary costs, and protect ourselves from common ruin. One day we'll live in a state that recognizes those simple truths.