Doing the Texas "To-Do" Steps - Texas healthcare delivery system

Healthcare Financial Management, June, 2001 by Jeff Eppinette

The Uninsured Population

The Texas comptroller's office has estimated that the total cost to local, state, and Federal governments of providing health care to uninsured Texans in FY98 was about $4.7 billion. [h] Of this amount, hospital care alone accounted for about $2.1 billion.

Although the Texas unemployment rate historically has more or less tracked with the national unemployment rate, the percentage of Texans living in poverty remains considerably higher than the national level. As a result, a greater percentage of Texans do not have access to or cannot afford to purchase health insurance, compared with the percentage of uninsured Americans overall.

Although Texas has more than 40 Federal programs that fund healthcare services for the uninsured, the Texas Blue Ribbon Task Force on the Uninsured has found that an average of 4.8 million Texans lacked health insurance each month from 1996 through 1998. [i] This number reflects about 27 percent of the population in Texas under age 65, compared with a national average of about 17 percent. The Blue Ribbon Task Force also found that about one in five uninsured people in Texas are noncitizens and almost one in three are under the age of 18.

In 1999, an estimated 1.4 million children in Texas were without healthcare insurance, and nearly 600,000 of those children were eligible for Medicaid. [j] In response to the need for broader children's coverage, the BBA created the Children's Health Insurance Program (CHIP), which provides for additional insurance coverage for children who might not otherwise qualify for Medicaid. Because of CHIP's less stringent eligibility requirements and streamlined application process, 320,612 children in Texas were able to enroll in the program as of April 16, 2001, and another 86,772 have been determined to be eligible for CHIP enrollment. [k] Moreover, 139,706 CHIP enrollees have been referred to the Medicaid program as of April 10, 2001.

Inadequate Infrastructure

The report of the Texas Blue Ribbon Task Force points to a significant disparity in incomes and health infrastructure between the 43 counties closest to the Texas-Mexico border and the rest of the state. Although these counties only account for 20 percent of Texas' estimated population of 20 million, they represent one-third of those living in poverty. According to the report, if these counties were compared with the rest of the nation, they would rank 51st in terms of per capita income. A dramatic shortage of healthcare professionals and facilities in this area has led to 81 percent of these counties being designated as "medically underserved areas." Providers located in these areas have expressed concern that the payments they receive for Medicaid and CHIP beneficiaries often are insufficient to cover the costs of the healthcare services provided.

Given the general living conditions and less-than-adequate water and sewage systems, this region will continue to challenge the existing healthcare infrastructure. This area also will challenge those charged with funding the healthcare programs necessary to counter the increased risk of infectious diseases facing this population.