Abbott and lawmakers have the power to improve care for sick and disabled Texans. Will they use it?

Texas spends $22 billion every year to buy health care for its most vulnerable residents. But taxpayers aren’t getting their money’s worth.

As The Dallas Morning News reported this year, thousands of elderly and disabled Texans can’t get the medical care they need. Many chronically sick children have to fight for life-sustaining treatments. Countless foster kids can’t get doctors’ appointments.

Previously: Stacked against them Texas patients lose in the state’s appeals system. Catch up.

Under a program called Medicaid managed care, health care companies promise to save taxpayer money and to help patients by hiring care coordinators to connect them with doctors and treatments.

But Texas cannot prove it is saving money, and the state’s own analysts found that most patients aren’t getting much — or any — care coordination.

The good news is that Texas leaders can fix this mess. We interviewed more than a dozen experts, looked at what’s working in other states, and identified eight specific steps that could mend the state’s broken public health-care system and protect vulnerable Texans.

Some require action from lawmakers, who convene in Austin in January. But most could be implemented by Gov. Greg Abbott’s administration now.

There are a number of potential fixes for Texas' managed-care problems that Gov. Greg Abbott could put into place without the need for legislators to take action. (Nick Wagner/Austin American-Statesman)

Abbott, who ultimately controls the Texas Health and Human Services Commission, has defended managed care and hasn’t publicly offered any clear solutions. Last month, The News provided Abbott’s office detailed explanations of the reforms that experts recommend. But his spokesman, John Wittman, repeatedly declined to address our inquiries.

State health officials, meanwhile, have taken some steps in response to our reporting. Those fixes include hiring 100 more regulators and nurses to ensure patients get the care they qualify for; changing the way the health commission monitors the networks of doctors that health-care companies advertise; and improving the way it handles appeals from patients who are denied doctor-ordered treatments.

But if Abbott and lawmakers want to improve care and crack down on companies that fail, experts say they should consider more substantial reforms: