Task force addresses consequences of Texas’ uninsured

CONTACT: B.J. Almond
PHONE: (713) 348-6770
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TASK FORCE ADDRESSES CONSEQUENCES OF TEXAS’ UNINSURED
  Recommendations Will Be Presented To Public Tonight at Rice University

A statewide system of regional multi-county health districts that offers Texas’ uninsured residents access to adequate levels of health care should replace the current county-based system, according to a report issued today by a health-care task force.

“Twenty-five percent of the population of Texas is without health insurance – and the national average is only 15.7 percent,” said Neal Lane, chair of the Task Force on Access to Health Care in Texas: Challenges of the Uninsured and Underinsured. In 2004, 5.6 million non-elderly people living in Texas were without health insurance. In some parts of the state, including Harris County, the percentage of the population without health insurance exceeds 30 percent or more.

“If we don’t address this critical situation soon, the health problems of Texas’ rapidly growing population are likely to be even more devastating to the state economically, educationally, culturally and socially,” said Lane, senior fellow in science and technology at Rice University’s Baker Institute for Public Policy. “The significant economic impact already is being felt by individuals and businesses burdened with rising health-insurance premiums and out-of-pocket health-care costs.” It is estimated that Texans with health insurance pay over $1,500 annually in their premiums to cross-subsidize care for the uninsured.

To study the issues and develop recommendations for how to address the impending crisis, Baylor College of Medicine, Texas Tech University Health Science Center, Texas A&M Health Science Center, University of North Texas and the six health institutions of the University of Texas System created and funded a task force that also included employees of small and large businesses, health providers, insurers and consumers. The task force is the first broad-based Texas group of its kind whose membership was not determined by governmental or political considerations. The report was subject to outside peer review, but the sponsoring institutions had no control over its content.

The task force will present its findings and recommendations at 6 tonight during a public forum at Rice University’s Baker Institute. Their report, “Code Red: The Critical Condition of Health Care in Texas,” is available online at http://www.CodeRedTexas.org/.

Health insurance in Texas is usually obtained through employment, individual purchase or a publicly sponsored plan such as Medicare, Medicaid or the State Children’s Health Insurance Plan. Some people may be uninsured over the entire year, but others move in and out of uninsured status when they change jobs or their eligibility for a public plan changes. Seventy-nine percent of uninsured adults in Texas are part of the workforce or have one or more family members in the workforce. For a family of four at the federal poverty level in 2004 ($18,100 a year), the average cost of private health insurance ($9,100) was about half their income. “The majority of the uninsured simply cannot afford health insurance,” said Jack Stobo, vice chair of the task force and president of the University of Texas Medical Branch at Galveston.

The task force found that uninsured individuals commonly go from one health care institution to another, often via the emergency room, where care is costlier. Significant numbers of laboratory tests, X-rays and other expensive medical procedures are often unnecessarily repeated at each visit. In the absence of coordinated care, medical problems are left untreated until they progress to a more-advanced stage and impaired health, which warrants costlier intervention. The lack of health education and preventive medicine means that conditions such as hypertension and diabetes are not prevented and instead progress to complex diseases requiring expensive treatment.

The task force noted that an unhealthy, poorly educated workforce results in lower productivity and reduces the vitality of the state’s economy. Hospitals and emergency rooms that are feeling the increasing burden of providing care for the uninsured may find they can no longer exist as financially viable institutions.

Among the task force’s recommendations to address these developments:

* Texas should adopt a principle that all individuals living in Texas should have access to effective, efficient, safe, timely, patient-centered and equitable health care.

* Texas should authorize and encourage efforts to move indigent health care from a county-based model to a system based on regional multi-county health districts.

* Since indigency in Texas is currently defined as people living at 21 percent or less of the federal poverty limit (under $1,700 a year for a single adult), the statewide federal poverty level should be increased to 100 percent from 21 for indigent care responsibility in Texas counties.

* A minimum 8 percent of general revenue tax levy on county expenditures should be mandated for indigent health-care services.

* Texas should redouble its efforts to aggressively pursue Medicaid and other federal reimbursement programs for which a state investment will result in substantial federal matching and supplementary reimbursements.

* The state should develop and adopt tax policies and initiatives that encourage and enable employers, especially small businesses, to provide health insurance to their workers.

* Texas should assess a quality assurance fee of 3 percent on revenue of all hospitals and freestanding surgery centers to obtain a federal match to enhance overall finances for provider reimbursement and enhancement of the quality and efficiency of health care to the uninsured. This would produce about $1.1 billion in state general revenue, and the federal match would provide $1.50 for each state dollar.

Other recommendations of the task force can be found in its online report, which concludes with a call for Texas to take bold steps to address the pervasive problems associated with the lack of health insurance coverage and health-care access in Texas.

“By increasing access to health care and insurance, improving current health-care delivery models, educating an adequate and diverse health-care workforce and reducing absenteeism in schools and the workplace, Texas will provide for and protect the health of its people and the strength of its economy,” the task force wrote.