Patience and Strategy Needed for Healthcare Reform

Following the U.S. Supreme Court’s ruling on the constitutionality of the Patient Protection and Affordable Care Act (PPACA), Texas will need patience and strategy with two important decisions regarding Medicaid expansion and the implementation of the State Health Insurance Exchange. Texas Governor Rick Perry recently announced Texas would not expand Medicaid coverage or implement a state health insurance exchange.

Texas leads the nation with an overall 27 percent uninsured population. Those numbers climb to 30 percent in North Texas. Within our state, 1.2 million children have no medical insurance and 40 percent of Texas women do not receive appropriate prenatal care. Many babies are subsequently admitted to neonatal intensive care units, which can be very expensive.

The Urban Institute Health Policy Center calculates 5.8 million uninsured non-elderly residents (64 years of age or younger) live in our state. The Bloomberg Government Study estimates the federal and state portions of Medicaid payments from 2014-2018 will be $45 billion. The state will have to spend $2-$3 billion on Medicaid expansion, putting an uncomfortable strain on the state budget. However, the return on investment is significant and will help fellow Texans receive health care.

The non-elderly population represents only 49 percent of those receiving health insurance through an employer because many Texans working within industries such as food service, retail and agriculture are uninsured. In Texas, an estimated 34 percent of our children, 21 percent of our adults (ages 19-64) and 17 percent of our elderly population live in poverty. Texas is ranked 42nd in physicians per capita, with 25 counties having no doctors at all. We have a limited number of residency slots for our doctors to train, forcing many to leave the state and never return.

Our state needs to expand Medicaid so approximately 4.1 million residents can receive health care coverage. We should also implement a State Health Insurance Exchange to accommodate local Texas requirements by creating an efficient private insurance marketplace for consumers not covered in Medicaid expansion. We need private insurers to participate while balancing complicated pooling risks and managing public subsidies. Essential health benefits need to be clearly defined in order to be understood, affordable and transparent.

As we expand Medicaid and implement the insurance exchange, we must continue to build a strong primary care network so we offer coverage and access to our patients. This is a complex problem, but we are all stakeholders in developing a system which is the backbone of a cost effective, coordinated health care with positive outcomes.

This is easier said than done. With collaboration and stakeholder ownership, we can begin the journey of addressing health care in Texas. We will be involved in an ongoing educational process as legislative leaders, insurance companies, providers and employers work collaboratively to benefit our most important stakeholder—our fellow Texans. In the words of Henry Ford, “Coming together is a beginning; keeping together is progress; and working together is success.”

Steve Love is president and CEO of the Dallas-Fort Worth Hospital Council.