Task Force Addresses Consequences of Texas’ Uninsured

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 from the Task Force on Access to Health Care in Texas: Challenges of the Uninsured and Underinsured.

Twenty-five percent of the population is without health insurance, the highest in the nation and growing. In some parts of the state, including Harris County, the percentage of the population without health insurance exceeds 30 percent or more.

The University of Texas Health Science Center at Houston was one of 10 academic health centers that together created and funded the task force to study the issues and develop recommendations for how to address the impending crisis, which will affect the state economically, educationally, culturally and socially. Kenneth I. Shine, M.D., executive vice chancellor for health affairs at the UT System, served as senior advisor to the task force.

“This is such an important problem for Texas and for our country,” said James T. Willerson, M.D., president of the UT Health Science Center at Houston. “Dr. Ken Shine and his colleagues have done a terrific job in describing the problem of uninsured patient care and of recommending potentially important approaches to it.”

Seventy-nine percent of uninsured adults in Texas are part of the workforce or have one or more family members in the workforce.

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. 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.

Recommendations

Among the task force’s recommendations:

All individuals living in Texas should have access to effective, efficient, safe, timely, patient-centered and equitable health care.
Texas should authorize and encourage moving indigent health care from a county-based model to a system based on regional multi-county health districts.
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 level should be increased to 100 percent for indigent care responsibility.
A minimum 8 percent of general revenue tax levy on county expenditures should be mandated for indigent health-care services.
Texas should 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 adopt tax policies and initiatives that encourage and enable employers, especially small businesses, to provide health insurance to their workers.
Texas should assess a fee of 3 percent on revenue of all hospitals and freestanding surgery centers to obtain a federal match for enhancement of overall provider reimbursement and 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.

The complete task force report, “Code Red: The Critical Condition of Health Care in Texas,” is available at http://www.coderedtexas.org.

Task Force Members

Member institutions of the task force were: 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. The task force also included employees of small and large businesses, health providers, insurers and consumers.

Among the 19 individual members of the task force were Hector Balcazar, Ph.D., regional dean of public health and professor of behavioral science at the UT School of Public Health El Paso Regional Campus, and Michael McKinney, M.D., senior executive vice president and chief operating officer of the UT Health Science Center at Houston.

Among those presenting information at task force meetings were School of Public Health faculty members: Charles E. Begley, Ph.D., professor in management policy and community health; Stephen Linder, Ph.D., interim director of the Institute for Health Policy and associate professor in management policy and community health, health promotion and behavioral science, and environmental and occupational health; and Nancy Murray, Dr.P.H., assistant professor in health promotion and behavioral science.