Expansion of medical coverage a hot topic during discussion

EDINBURG — Various problems with the current status of health care were identified during an event attended by medical professionals, legislators and academics Wednesday but one of the issues that kept coming up was the expansion of the Medicaid program, or at least, the refusal of the state to do so.

The Future of Health Care event was hosted by the Texas Tribune and consisted of five panel discussions on various aspects of health care.

During the discussion on access, titled “More Access, Better Outcomes,” the topic of Medicaid expansion was unavoidable.

When asked what he would recommend to improve access to health care, aside from Medicaid expansion, Manny Vela, the CEO of Valley Baptist Medical Center, instead suggested a re-branding of Medicaid expansion.

“If this is a cemented game based on politics then let’s call it something else,” Vela said. “If we’re not going to call it expansion of Medicaid but we know the need exists, then let’s call it something else so my hope for this legislative session would be, let’s concentrate, if we can, on just incremental gains.”

Vela noted the rate of uninsured in the state was at 11% among children — and over 20% among adults — and said he hoped the legislature could start by improving access for children and then building to improve access for adults.

“Like I said, I don’t care what they call it,” he said. “The goal is access to care.”

Vela noted that expanding Medicaid through the current program would benefit the state’s economy.

State Sen. Nathan Johnson, D-Dallas, agreed there was no financial reason not to expand access in the state.

Anne Dunkelberg pointed out that 85 percent of uninsured people are in working households and noted the discriminatory effect of not expanding Medicaid.

Evan Smith, CEO of the Texas Tribune, provided other sets of statistics when he moderated the “Health Care & the Texas Legislature” conversation.

He noted that about 5 million Texans had no health insurance, about 17.7% of the population. The national percentage of uninsured is 8.5%, according to the U.S. Census Bureau.

State Rep. Four Price, R-Amarillo, said the uninsured rate was a real problem for the state but said the state legislature was paralyzed in addressing that issue.

The problems that contribute to legislators inability to reach an agreement, Price said, were over: costs, the perceived efficiency of the current system and the belief that it needs to be repaired before it can be expanded, and the possibility of over-utilization by patients if they no longer bear any cost.

State Rep. Donna Howard, D-Austin, noted the legislature tried to expand Medicaid in 2013 but if failed.

She said that with Medicaid expansion, the state would get $10 billion a year from the federal government — 90 percent of the cost. The state would have to pay about $1 billion.

“Now that’s a lot of money but not when you’re talking about a $250 billion budget,” Howard said. “It’s not too expensive to do; it’s too expensive to not do.”

However state Rep. Tom Oliverson, R-Cypress, criticized the current Medicaid program and noted low participation in the program among doctors.

“Less than half of physicians even accept Medicaid,” Oliverson said. “Because it doesn’t offer a reimbursement that people want and I would say there’s too many administrative hurdles and burdens to providing that care.”

During that panel, the four legislators, which included state Rep. Juan “Chuy” Hinosa, D-McAllen, opined on whether they had done enough in health care during the 2019 legislative session and what the top priorities were going forward.

One of the biggest accomplishments last year, they agreed, was the passage of Senate Bill 1264 which protects patients from “surprise” medical bills.

However, Hinojosa said the shortage of doctors was still a problem.

Oliverson, R-Cypress, said price transparency was the future of health care.

“Health care is the only industry, I’m aware of, in the United States where you’re unable to know in advance of getting services what the services will cost,” he said. “And I just think that’s ridiculous.”

Oliverson also noted that another bill that passed during the previous session that removed the requirement of face-to-face supervision of nurse practitioners.

“Now, a nurse practitioner working in Amarillo can have a supervisory arrangement with a doctor working in Galveston,” he said, “and as long as they’re communicating electronically or by whatever means is convenient for both of them, as long as that relationship exists, we’re not going to micromanage how that relationship occurs.”

Howard, however, noted that nurse practitioners in other states were already working without that supervision in the first place.

“This particular business model, perhaps it is saving some dollars somewhere for someone,” she said. “It’s not saving dollars for the nurse practitioners who have to pay these physicians to provide supervision regardless of what the level of supervision it is that the physician provides.”

But another topic that kept popping up was the distinction between health care and health and the need to encourage and educate healthy living to prevent the need for health care.

Johnson, the state senator from Dallas, said they weren’t giving up on Medicaid expansion but said he believed there wasn’t enough spending on health such as health literacy and education.

Elena Marks, president and CEO of the Episcopal Health Foundation, also said she hoped the legislature would focus more on what the needs are for healthy living.

“I would ask the legislature to consider people and the value of people and what it is they need to live a healthy life,” Marks said. “And look at it from that perspective and make those kinds of investments.”

Vela, CEO of Valley Baptist, noted there were groups in the Rio Grande Valley working on educating the public about health living and noted the lifestyle changes he’s made for his own health.

Marks, however, said the issue went beyond personal responsibility.

“Educating people only goes so far, people have to have the ability and the means to be able to access healthy food, to exercise,” she said.

“If you’re working three jobs and taking care of kids, you’re barely making ends meet,” Marks said, adding that people living in colonias may not have sewage or running water.

“So you have really basic conventions that thwart the opportunity that people have when they get the education and so we’ve got to do more than just tell people, ‘It’s your fault that you’re not eating right and exercising,’” Marks said to applause from the audience.

“We have to have the conditions in the state that allow people to have a healthy life.”