By Bill Zeeble, KERA 90.1 reporter
Dallas, TX – Bill Zeeble, KERA 90.1 reporter: In Texas, it doesn't matter which political party is talking. Austin Democrat Elliott Naishtat and Southlake Republican Vicki Truitt, both members of the House Committee on Public Health, acknowledge health care in Texas is ailing.
Elliott Naishtat, State Representative (Democrat, District 49): If you look at Texas, of course the health care is broken. We can't go any lower.
Vicki Truitt, State Representative (Republican, District 98): The whole scheme of things is askew. It's unsustainable, the way costs are escalating and the way health care delivery and reimbursement is handled.
Zeeble: The two parties disagree on health care solutions. Last year, Naishtat urged more state funding of the Children's Health Insurance Program and Medicaid. He wanted Texas to stop leading the nation in its percentage of uninsured. But Republicans further cut those programs to help fix the state's $10 billion deficit. Representative Truitt says the health care cure lies not in spending more on government programs, but in government helping the private sector offer more affordable health insurance. Ron Misko knows about the high price of insurance in the marketplace.
Ron Misko, employee, Bravo Technical Resources, formerly with Haggar Clothing: I went from being a CIO of a major worldwide apparel company to being out for a while. I consulted for a while. I wasn't covered by any insurance benefits. I was, through my wife. Then she gets reorganized in July.
Zeeble: Misko and his wife, both once well-paid and insured, became unemployed and uninsured. For a while, they paid more than $600 a month for expensive COBRA coverage. But Misko says the money eventually ran out, so the pair took a chance, abandoning all coverage.
Misko: When you gamble and roll those dice, if you lose, you lose big time. What if something happens today, or some day you wake up and find a lump some place? I would have had to pay for the rest of my life.
Zeeble: The middle-aged couple's gamble paid off. They got jobs - and insurance - and did not get sick. Misko doesn't want government-imposed and -funded universal health insurance. He just wants an affordable option for basic coverage. Vicki Truitt says she wants the same, but adds getting there may take more legislative tort reform in Austin, on top of what was passed last session.
Truitt: Costs have escalated for a variety of reasons, not the least of which is malpractice lawsuit abuse. We were losing doctors because of the high cost of medical liability insurance, both from people moving away and people retiring prematurely.
Zeeble: Truitt says malpractice caps have lowered liability insurance fees, which could keep more doctors in the state. The jury's still out, she adds, on whether the legislature will need to do more. Others say it's actually still out for another reason. It may do nothing for under- and uninsured Texans, according to Ed Howard. He's executive Vice President of the bi-partisan Alliance for Health Reform in Washington D.C.
Edward Howard, Executive Vice President, Alliance for Health Reform: They've had the signature cap in California now for 25 years, and California's percentage of uninsured is almost as high as Texas - and sometimes higher than Texas.
Zeeble: Howard says the relatively high number of immigrants in Texas drives up the state's health care costs far more than do malpractice insurance costs. So does the rate of immunization, where Texas also lags behind most of the nation. What's more, both the General Accounting Office and Congressional Budget Office just disputed findings that medical malpractice lawsuit caps lead to big savings in medical costs. But Republicans are also backing something new to lower health care costs and insure more people. It's the HSA, or Health Savings Account.
Marianne Fazen, Executive Director, Dallas/Fort Worth Business Group on Health: It's going to be one of the biggest drivers for the consumer-directed health model, where the employee has more control over their health care dollars for discretionary spending on medical care.
Zeeble: Marianne Fazen is executive director of the Dallas-Fort Worth Business Group on Health, a trade association of more than a hundred north Texas companies. Fazen says businesses have struggled with health benefits increasing 15% a year. Many now deduct more from worker paychecks, while insurance companies provide fewer benefits for the money. Small businesses, which are the majority in Texas, worry they'll either have to drop coverage or avoid it altogether because of the expense. That's where HSAs might help. They're basically a catastrophic policy, covering fewer procedures, carrying a high deductible, and costing a company less. Employers and employees can contribute to the account, which is tax free, and use it for out-of-pocket medical expenses. Otherwise, the account earns interest and rolls over from year to year.
Fazen: It gives the employee a pot of money that they can choose to use on medical care or health services that may not be covered under an ordinary insurance plan. They still have coverage for their preventive care and their hospitalization and high dollar care.
Zeeble: Experts predict HSAs could save employers 20% a year on health benefits. And because they're a hybrid tax-exempt account and health insurance plan, for the first time financial firms - even banks - can administer them. Still, given the insurance aspect, insurance companies are expected to offer most HSAs. They were okayed by the government only last December, so Marianne Fazen doesn't expect them for another year. While the health savings account is one attempt to increase health-care access and affordability, critics worry it's an unproven experiment that'll take years to test. Meanwhile, medical officials - including Dr. Ron Anderson, who runs Parkland Hospital - says this free market plan does little to help with the uninsured poor - those Parkland routinely sees in its emergency room and must legally treat. He cites statistics showing $70 billion would cover everyone in the country through private insurance. But that lost productivity - due to those without insurance - is costing the nation $170 billion.
Ron Anderson, M.D., Chief Executive Officer, Parkland Hospital: So we're spending the money now in ways we don't recognize. There is a cost of not doing something. That cost of not doing something is intolerable, and we need a way to fund it. With poor people, it's hard to get the money when its simply not there. It's magical thinking to think they can continue to cut at the federal and state level, and that the local level won't eventually have to ration care.
Zeeble: Anderson expects no funding increase out of the legislature next year because of new officials in leadership positions. He says one big job will be to educate them on the need for more funding of Parkland and the state's other large, county hospitals. Representative Truitt, who sits on the Select Committee on State Health Expenditures, says she's aware of the growing burden on these facilities and that it's affecting other hospitals too. She says expect some legislation forcing neighboring counties to pay more for patients they send to public hospitals. But she wasn't more specific. For KERA 90.1, I'm Bill Zeeble