Code RedCode Red

Kenneth I. Shine, M.D.Executive Vice Chancellor for Health Affairs

The University of Texas System

Access to Health Care in TexasAccess to Health Care in Texas• CODE RED: The Critical Condition of Health Care in Texas,

a report by the Task Force Access to Health Care in Texas: Challenges of the Uninsured and Underinsured.

• Sponsored by the 10 major Texas academic health institutions – Baylor College of Medicine, Texas Tech, Texas A&M, North Texas and the six health institutions of The University of Texas System.

• Membership includes representatives from large and small employers, hospitals, medical schools, health policy experts, and community leaders.

Task Force MembersTask Force Members

Neal Lane – ChairJohn Stobo - Vice Chair

Hector BalcazarKirk Calhoun

David ChappellPatrick CrockerCharles Haley

George Hernandez Winell HerronRich Johnson

Task Force MembersTask Force Members

Wm. Fred LucasMichael McKinney

Kathy Mechler Elaine MendozaRob Mosbacher*Steve Murdock

Betsy Schwartz David WarnerM. Roy Wilson

* Resigned as of October 18, 2005

Current Conditions in TexasCurrent Conditions in Texas

• 25.1% of Texans or 5.6 million were without health insurance in 2004 – one out of every four.

• 15.7% or 46 million Americans were without health insurance in 2004.

• The problem will increasingly worsen as the population in Texas increases from 22 million in 2003 to a projected 51.7 million in 2040.

Who are the Uninsured?Who are the Uninsured?

• 79% of uninsured adults in Texas work or are members of families where someone works.

• Only 37% of small employers (less than 50 employees) offer health insurance and only 35% of their employees actually enroll.

• For a family of four at the federal poverty line ($20,000 a year), the average cost of health insurance is $9,100 – almost half their income.

Who are the Uninsured?Who are the Uninsured?

• Many adults do not qualify for Medicaid in Texas.• Medical Indigence in Texas is currently defined as

those living at or less than 21% the federal poverty line – less than $1700 a year for a single adult.

• The State Children’s Health Insurance Program covers children who make at or less than 200% the federal poverty line, but their parents are not covered.

ConsequencesConsequences• Poorer Health status• Affects education and work status• Damage to community resources such as hospitals

and emergency rooms• Family disruptions including bankruptcies• Higher health care costs borne by those who do

have insurance• Rising tax burdens and less attractive business

environment

FindingsFindings• The overall health status of Texans is poor.• Texas has the highest proportion of uninsured individuals in the

United States.• Strategies to control the cost of health insurance are needed. • Current trends in the delivery of health care will exacerbate problems.• Emergency rooms provide an expensive method for providing care.• Texas communities are making great efforts to improve access to

health care.• Expansion of ambulatory (outpatient) services is an essential.• The continuing rise in Medicaid and health care expenditures is

unsustainable.

FindingsFindings• The state of Texas has not taken full advantage of federal matching

funds. • The current county based approach to health care in Texas is

inadequate and inequitable.• There is a significant shortage of health care professionals in Texas. • Educational attainment and health are inexorably linked in Texas.• Care of people with mental illness remains a major unresolved

problem for Texas.• The solution to adequate access to health care for the uninsured and

underinsured is a shared responsibility where partnerships are crucial.

Shared ResponsibilitiesShared Responsibilities

• The Task Force concluded that solutions to the challenge of the uninsured must arise out of a shared responsibility for the problem by a broad diversity of participants.

• Additional resources and the more efficient and effective use of resources will be required in order to provide appropriate services to the uninsured.

Recommendation 1Recommendation 1

Texas should adopt a principle that all individuals living in Texas should have access to adequate levels of health care.

Recommendation 2Recommendation 2

Texas should provide more adequate resources and aggressively seek more efficient and effective methods to support health care to the indigent and uninsured with the goal of reducing rising health care costs.

Recommendation 2 (Cont.)Recommendation 2 (Cont.)

• Move to Regional/Multi-County Care• Increase Eligibility from 21 to 100% of FPL• Aggressively Pursue Federal Funding• Improve Tax Policies• Prefer Contractors and Subcontractors for

Government Contracts Who Provide Health Care Coverage

Recommendation 3Recommendation 3

A Quality Assurance Fee (called a provider tax in some states) of 3% should be assessed on revenues of all hospitals and free standing surgery centers in order 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.

Quality Assurance FeeQuality Assurance Fee

• 35 States have quality assurance fees.• All classes of providers will be impacted (e.g.

hospitals, and surgicenters).• At 3% it will produce ~$1.2 billion in fees• Federal match will be ~$1.8 billion additional

funds

Quality Assurance Fee - UsesQuality Assurance Fee - Uses

• Reimburse hospitals at Medicare rates• Generate funds for:

– Electronic health records– Increase graduate medical education funding– Increase ambulatory care/disease management– All facilities will contribute to care of uninsured

Recommendation 4Recommendation 4

The state should significantly increase its capacity and commitment to conduct experiments in health care delivery and funding (e.g. 1115 Waivers, funding pools, employer subsidies).•Adopt 3-Share Programs•Modify EMTALA•Family Health Waiver

Recommendation 5Recommendation 5

The concept of virtual care coordination for the uninsured (including these patients in a structured system of care) should be developed by local communities and by the Texas Health and Human Services Commission.

Recommendation 6Recommendation 6

Health care institutions and other providers must contribute to increasing community based ambulatory care, which includes integrating the latest developments in disease management and other cost effective models of health care delivery that seek to improve the quality of patient care while decreasing the cost of care.

Recommendation 7Recommendation 7

Texas must increase investment in the education and training of health professionals who will provide significant amounts of care to the uninsured and underinsured.

Recommendation 7 (Cont.)Recommendation 7 (Cont.)

• 3000 More Residents Annually (Over 10 years)

• 2000 More Nursing Graduates Annually• Expand Medical Student Repayment

Programs• Forgive Debt for Serving Medicaid and

Uninsured Patients• Fund FQHC’s and “Look A-likes”

Recommendation 8Recommendation 8

The Task Force recommends implementation of an integrated approach to school health including an emphasis on nutrition, exercise, dental health, and disease management of such problems as asthma.

Recommendation 9Recommendation 9

Academic health institutions, state and local governments, and communities, foundations, and the private sector should support the development of health science research programs to study cost effective health care and other characteristics of a high quality and efficient health system.

Recommendation 10Recommendation 10

Texas should adequately invest in public health programs (including research and community health) at the state and local level.

Some outcomes from the 80th Legislature Some outcomes from the 80th Legislature

Increased funding and improved eligibility for CHIP Extensive Medicaid reform including an 1115

waiver Support of the three share health insurance subsidy

program Committee of North Texas counties to study

regionalization of care

Some outcomes from the 80th LegislatureSome outcomes from the 80th Legislature

Expanded telemedicine programs Pilot project on collaborative electronic health

record between local and regional indigent care systems and HHSC

Additional $38 million for GME Additional $9 million for nursing education

Some outcomes from the 80th LegislatureSome outcomes from the 80th Legislature

New nursing education initiatives Disease management program for diabetes in

school aged children Increased requirements for student physical activity

and assessments

Full list of outcomes by bill number: www.coderedtexas.org

ConclusionConclusion

Now is the time for Texas to take bold steps to address the problems associated with the lack of health insurance coverage and health care access in Texas, and to protect and assure the economic vitality and health of the state.

For More InformationFor More Information

Task Force Websitehttp://www.utsystem.edu/hea/taskforce/homepage.htm

Report Website

http://www.coderedtexas.org