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Constable's Notebook - March 2007

One of the first laws passed after Texas gained independence from Mexico required counties to provide health care for indigent people. Today counties continue to serve as the safety net of last resort for most of the 5.5 million Texans who cannot afford health insurance. Two studies sponsored by medical professionals found the Texas health care system to be under-funded, inequitable, and poorly organized. The Indigent Health Care Advisory Committee found that “Texas has the third highest obesity rate in the country; has one of the highest death rates from preventable causes; ranks number 46 on expenditures per capita for mental health and number 32 on state spending for health care as a percentage of gross product.” The findings contained in Code Red, a study commissioned by hospital professionals, include:

• Texas has the highest percentage (25%) of uninsured citizens in the nation
• Seventy-nine percent of uninsured Texans work or have a working family member
• Three million Texans are less likely to receive less costly preventative care
• One million uninsured Texans do not receive adequate care for chronic diseases
• Medical expenses are the single biggest reason for personal bankruptcies in Texas
• The overall health condition of Texans is poor

The Indigent Health Care Advisory Committee reported that “The number of uninsured in Texas is particularly acute among small employers and the “working poor" – people earning less than 200% of the federal Poverty Limit (FPL) ($18,000 per year for a single individual, and $40,000 for a family of four.)” Texas counties are required to spend 8% of their budget to provide health care services for residents who make less than 21% of FPL (the very poor). Some counties including Travis, provide services for people up to 100% of FPL ($20,000 for a family of four). This patchwork of health care eligibilities and services has resulted in a migration of residents from counties with few services and restricted eligibilities to counties with higher eligibilities and more available services. Much of the cost of providing health care is due to ER visits that are not actually emergencies and for emergencies that would not have become emergencies if patients had access to or took advantage of preventative health care services.

Both studies concluded that in order to effectively and economically treat chronic ailments, provide guidance on healthy eating and exercise habits, and prevent illnesses, all citizens should have access to basic primary health care services. They call for the Texas Legislature to consider creation of regional health care districts to focus on access to primary care and share fairly the costs; expand and standardize eligibility requirements; take full advantage of available federal funds; and offer incentives to help small businesses provide health insurance.

There is general agreement that health care services cannot keep pace with increasing needs and rising costs. The Legislature has a real opportunity to craft a more equitable and affordable health care system for all Texans. Let's hope that they don’t punt.

Copies of the studies cited can be obtained at CodeRedTexas.org and dshs.state.tx.us/cihcp/default.shtm.



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