| Perspectives on Texas

The disability community faces significant obstacles and opportunities as lawmakers convene in Austin to pass new laws and write the biennial budget for our state. But our concerns really are all Texans’ concerns.

One word — access — is the common link. Consider my organization’s legislative priorities for this session, and you may find issues and interests that matter to you and your family.

Access to transportation? Ensure accessible transportation for all Texans, including those with disabilities. Safety for pedestrians with disabilities? Act to ban texting while driving statewide. Self-sufficiency and independence?

Fix special education, create meaningful opportunities to learn job skills and promote entrepreneurship. Then there’s always the 800-pound gorilla in our state budget: the Medicaid program for low-income Texans and Texans with disabilities.

That old expression, “we’re all in this together,” rings true here, too. After all it’s our collective tax dollars — from individual taxpayers and businesses — at work.

How the Texas Legislature chooses to address these issues will have a profound impact not only on the state’s disabled population, but also on all taxpayers asked to support these critical initiatives.

More than ever, we need bold leadership in Texas. We believe the state can be a good steward of tax dollars and build a sustainable public health program. That means being willing to put money where it’s needed in cost-effective “front-end” practices — as opposed to shortchanging prevention and paying far more in later, avoidable acute care, hospitalizations, ER visits and unnecessary institutionalization.

Let’s get specific.

Kids with disabilities have a unique window of opportunity for lifelong improved functioning. Legislators should restore past cuts to Early Childhood Intervention and kids’ medical therapies. Likewise, people with traumatic brain and spinal cord injuries have huge upsides if they can get short-term Comprehensive Rehab Services — an opportunity that should not be denied, so the Legislature should fund it. Seniors and people with disabilities who need help with daily activities overwhelmingly prefer to stay in their own homes, yet the community care workforce is being crushed out of existence by an $8-per-hour base wage. Texas’ budget would benefit greatly by paying a few dollars more and getting the reliable care that keeps people as healthy as possible.

Lawmakers should face the fact that Texas doesn’t need 13 high-cost state supported living centers (SSLCs) with their 40-year history of declining resident populations. Instead, right-size to a smaller, more manageable number and offer residents the choice of staying in an SSLC or a community placement. Dedicate savings to reducing the unconscionable 12-year-long wait list for community waiver services.

Pharmacy policy is a hot topic. Texas lawmakers can and should work to strengthen consumer protections in both commercial health care and Texas’ Medicaid program. A consumer who is stable on a certain medicine should not be forced off of it and we should encourage medication adherence using prescription drug synchronization.

We’ll take a big issue head on. State leaders should be wary about whether to put Medicaid pharmacy benefits under managed care, commonly known as a carve-in.

Today, the pharmacy benefits in Medicaid operate outside of managed care. It’s not in dispute that the Medicaid Vendor Drug Program (VDP) uses its large buying power to draw down significant rebates from drug makers. Last year, it netted more than $1.87 billion in rebates, bringing overall program costs down by nearly 60 percent and the price the state pays per prescription to well below national averages.

Disrupting this program, in light of unknown protections and access to prescribed medicines and uncertainty about additional cost savings, could create unproductive barriers.

We really are all in this together. Let’s hope the Texas Legislature takes steps to address these most critical concerns that impact not only the disability community but all of us, as taxpayers and Texans.