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KERA Documentary, <i>Life in the Balance</i>, Examines Texas Health Care Crisis

By Sujata Dand, KERA 90.1 reporter

KERA Documentary, Life in the Balance, Examines Texas Health Care Crisis

Dallas, TX –

Sujata Dand, KERA 13 reporter: Clutching a baby in one arm, with a 4-year-old clinging to her leg, Veronica Sccaffetti waits to see a doctor at Parkland Hospital. She has been on her feet for nearly five hours.

Veronica Sccaffetti, Parkland Hospital patient: I'm really scared. I don't know what it is.

Dand: She looks sick. Dark circles envelop her eyes, premature for someone who is 30 years old. It took her three months to get an appointment; the lump in her breast has doubled in size.

Sccaffetti: I believe in Jesus that it is not a cancer. But if it is, I got four kids and nobody in the hospital is going to take care of them if something wrong happens to me.

Dand: Veronica is an illegal immigrant from Argentina. She can't pay for the mammogram and she doesn't have insurance, like nearly 5 million people in Texas. As that number grows, the burden is falling on public hospitals - which have fewer funds. In 2003, faced with a $10 billion shortfall, state lawmakers cut Medicaid that helps the poor and disabled and limited eligibility for the Children's Health Insurance Program - which covers children of the working poor. County hospitals lost hundreds of millions of dollars.

Dr. Ron Anderson, CEO, Parkland Hospital: The problems at Parkland are the problems from Austin.

Dand: Dr. Ron Anderson is CEO of Parkland in Dallas. The state cuts forced him to cut his hospital's budget, reducing non-medical staff and patient services.

Anderson: We inherited these revenue cuts at a time when if they hadn't had these cuts, we would have had a $25 million positive bottom line. So people can talk about this as a crisis at Parkland. This is a crisis of leadership at the state in my opinion.

Dand: The Republican Party holds every major office in Texas and the majority of seats in the Texas House and Senate. It is deeply divided on how to solve the health care crisis.

Carole Keeton Strayhorn, Texas Comptroller: We are dead last in working adults without insurance. We are dead last in adults without insurance and we are dead last with children without insurance. But what has gone on in this state is unconscionable. We can be leaner, not meaner. Right now, our Governor signed legislation that left us leaner and meaner.

Dand: Strayhorn is considering a run for Governor against fellow Republican Rick Perry. She has repeatedly called on him to use additional revenue she found to restore the Children's Health Insurance Program. Perry ignored her requests.

Rick Perry, Governor of Texas: I happen to think the Texas legislature has done well, considering the budgetary restraints and the needs that this state has we are making good progress. Since 1999, this state has made a huge commitment to insure those that did not have health insurance. A substantial amount of money has flowed into our children's health insurance program, for instance.

Dand: Since September 2003, a third of the children are no longer enrolled in the state subsidized program because of stricter regulations and increased monthly premiums.

Strayhorn: The true fiscal conservative position is this: I would rather spend $97 a month and insure that child that's a child of the working poor than $6700 - which is the average cost for one hospital stay for that child.

Dand: The Governor doesn't want the state to be in the insurance business. He would rather focus on business development - believing by creating jobs, more Texans will be able to afford insurance.

Garnet Coleman, Texas State Representative: It was a tight budget year, but the choices of which you cut and don't cut are priorities that are laid out by government. Governor Perry took our savings account - which was $300 million or $297 million - to spend on economic development projects.

Dand: State representative Garnet Coleman is a Democrat from Houston. He helped to create CHIP in Texas in 1999.

Coleman: CITGO, an oil company a gas company, moved to Houston. The state gave them $5 million. And the chairman of the company said, "We don't need that $5 million, but thank you, we'll take it."

Dand: Warren Chisum is a state representative from the Panhandle. He says it's individuals who make foolish choices when it comes to health care - by drinking, smoking and taking drugs - and the state shouldn't have to pay for that.

Warren Chisum, Texas State Representative: The more liberal side would like to see more public money just poured into health care. You know, kind of the "no child left behind," you know, regardless of whether they take care of theirself or don't take care of theirself. There's another side of us that says we're happy to do that but we want people to be responsible.

Anne Dunkelberg, Center For Public Policy Priorities: Yes. Demanding responsible behavior from parents may be an important societal goal, but protecting children is also an important societal goal.

Dand: Anne Dunkelberg works for a public policy think tank in Austin.

Dunkelberg: Essentially, what the message I'm hearing is, it's more important to punish parents for bad behavior than it is to protect the healthcare of children.

Dand: Uninsured children and their parents often end up in the ER and a third of those patients don't pay. Hospital administrators admit they raise prices to make up the difference, creating a cycle that affects everyone.

John Guest, Former Harris County Hospital District President: There's the stories about the $10 aspirin that are pretty famous, and they're real. As these financial strains hit the hospital organization, one of their solutions is to raise the amount that they charge for the services that they provide. And the effect of that - if you put those strategies in place all over the country - is that the cost of health care is continuously ratcheting up. And we're seeing escalation of health care costs that are causing more and more people to lose their insurance coverage.

Dand: As the number of uninsured rises, public hospital administrators say the quality of care is diminishing even for patients with insurance. In Houston, Ben Taub General Hospital redirects critically injured patients to other hospitals a third of the time, because their ER is at capacity.

Dr. Ken Mattox, Chief of Staff, Ben Taub Hospital, Houston: That creates a real crisis to the community because we say to the ambulances, "Please don't come." We do know in this city that if we redirect patients away from the two level-one trauma centers, your chances of dying are 75 percent greater than if we were open.

Dand: People with scheduled surgeries and appointments are also being put off. At Parkland, patients like Veronica wait as long as five months for critical procedures like breast biopsies, because doctors classify them as "elective," treating all emergencies first.

Anderson: Many of these electives are not elective type surgeries. They are really critically important surgeries. It doesn't look like rationing to the general public, but to us - as physicians - it concerns us a great deal.

Dand: Ultimately, the Texas legislature will have to draw the line between compassionate public health policy and fiscal responsibility. But in the meantime, as public hospitals weigh patients' needs against the cost of their care, doctors complain that they are the ones being forced to make impossible choices. For KERA 90.1, I'm Sujata Dand.

Visit KERA's Life in the Balance site for more information about this program, including broadcast schedule for Texas public TV stations, a guide for organizing discussions of the issues, resources for further research, and a slideshow of Veronica Sccaffetti's journey from new mother to cancer survivor at Dallas' Parkland Hospital.

Email Sujata Dand about this story.