By Marla Crockett, KERA 90.1 reporter
Dallas, TX – Phyllis Cole, Collin County Commissioner: We have quite a few changes; we've just approved a new budget.
Sitting in her office in McKinney, Collin County Commissioner Phyllis Cole looks through the new health care budget approved by the Commissioners Court. She's pleased with the outcome, especially for women and children.
Phyllis Cole: We are opening a brand new WIC clinic in Frisco ... We are going to open a CHIPS clinic in McKinney. CHIPS is children's health insurance program.
Cole also points to the county's main indigent clinic in McKinney, contracts with two hospitals to serve the poor, and a prenatal program as evidence the county is doing its job. But from where Pam Kaus sits in Plano, these measures aren't nearly enough. As the Director of Social Justice at St. Elizabeth Ann Seton Catholic Church and a leader of Plano Area Interfaith, she's spent months investigating health care needs in Collin County.
Pam Kaus, Plano Area Interfaith: There is not accessible health care in the county; we have found that out. We found out from talking to families and people they may wait days for a doctor to see them, maybe weeks until get to the point where they'll come to a faith based organization to at least see a doctor.
Kaus also learned there's no hospital taxing district in the county. There used to be one for a public hospital in McKinney, but commissioners sold the facility almost 20 years ago and put the money into a health care trust fund to serve the indigent. Kaus has a problem with how the $25 million fund is being spent.
Pam Kaus: We know there's a small clinic in McKinney that is funded by the health care foundation; we also know the eligibility requirements to access that clinic are very stringent. And so you really almost have to be living on the street in order to be eligible.
The county will pay medical expenses for the poor if their income is 25% of the poverty level or below. That's $185 a month or less for an individual and $377 a month or less for a family of four. Last year, the trust fund served 330 indigent adults. Plano Area Interfaith would like Collin County to raise its eligibility requirements so more people can get care people like Laurel Winship, a parishioner at St. Elizabeth Ann Seton and the mother of two.
Laurel Winship, Plano resident: There are so many people in our situation now who have been living at a certain income level, a certain comfortability, and having that health insurance there, and when you lose it, it's devastating.
Laurel's husband lost his job as a programmer and web designer last fall. He's back working - at an hourly wage - and the family has some health insurance again. But during the four months they went without any income, Winship says one of the things they did was apply to the county for indigent coverage. They ran into some unexpected requirements.
Laurel Winship: We figured income was not an issue, but because we had cars and we had assets, which was our 401K plans, we didn't qualify for anything ... and we sold our cars, liquidated our 401K so we could start qualifying for things, and we still don't qualify because our one car is worth too much and we kept my husband's 401K plan.
Commissioner Phyllis Cole says she feels for families like the Winships...
Phyllis Cole: It is not my belief or philosophy that we are supposed to take care of all uninsured people. We can never do that.
Especially since the county will be paying more for indigent care after it renegotiates a 20-year-old hospital contract. Estimates put the county's uninsured at about 77,000 people. Ron Anderson, President and CEO of the Parkland System in Dallas, says his public hospital saw 1,000 of them last year at a cost to Dallas County taxpayers of $2-3 million. That's not an excessive amount, he says, but when you add up all the other patients from surrounding counties who come to Parkland, the cost climbs to almost $20 million.
Ron Anderson, President and CEO of Parkland Hospital in Dallas: I don't think the counties around us can continue to get a free ride. State law allows them to get by by paying 25% of poverty only and so they're protected in every way, so they don't see the need to change, but the demographics are going to force change, because they have poor people living in their community now, and it's not sustainable to provide care on a regional basis for a public hospital. Parkland needs 550 beds now by the year 2011 because of the growth of the indigent population in Dallas County.
Collin County does loosen its income requirements for the poor when there's a hospital emergency, but Anderson calls officials irresponsible for not investing more of their trust fund on prevention and primary care. He'd like to see the state hold Collin County and others like it more accountable. Camille Miller understands the frustration with government. She's the President and CEO of the Texas Institute for Health Policy Research, a 6-year-old Austin non-profit that's working to improve the health of Texas communities. Ron Anderson sits on her board, but she also emphasizes another approach.
Camille Miller, President of The Texas Institute for Health Policy Research: Our philosophy is the community needs to take charge. People in the community need to come together, identify the problem, find the solution, and then work with elected officials to get the kinds of changes they need, but only after they've figured out what they already have. It's not the philosophy of the institute that it's the government's role to fix all these problems.
Miller says Houston and Amarillo are running successful collaborative health care projects in their communities. And Plano Area Interfaith is very taken with this idea.
Pam Kaus, Plano Area Interfaith: We believe that a collaborative grassroots health care facility needs to be established in this county supported with public, private, corporate money, and congregations ... a totally grassroots facility that will serve all.
Collin County Commissioner Phyllis Cole: They've never made a proposal to me.
Again, Collin County Commissioner Phyllis Cole...
Phyllis Cole: If they come up with a plan Presbyterian Community Forum determined a dental need for senior citizens in Plano. Different groups put up the money, the county provides the space. Everybody worked together and we moved forward. We can do that, but Interfaith hasn't come forth in that same vein.
Pam Kaus says Interfaith needs the county's resources to more fully study the need and help build a budget. The Dallas Fort Worth Hospital Council is conducting a needs study in Collin County, and Phyllis Cole says the county will examine those numbers when they become available in December. For KERA 90.1, I'm Marla Crockett.
To contact Marla Crockett, please send emails to mcrockett@kera.org.