Code RedCode Red The Critical Condition of The Critical Condition of

Health Care in TexasHealth Care in Texas

2006 Texas Oral Health Summit

For Healthy Beginnings

November 17, 2006

George B. Hernandez, President/CEO, University Health System

Task Force organized in July 2004

Sponsored by the 10 major academic health institutions in Texas and 6 health institutions of the UT System

Nonpartisan group of 19 individuals representing business community, medical schools, health care industry and local government leaders

HistoryHistory

Task force was committed to preparing a high quality analysis of indigent health care data to policy makers, health care groups and public

Final Report released 18 months later; “Code Red: The Critical Condition of Health in Texas”

Website: www.CodeRedTexas.org

The ReportThe Report

We’re Employed - 79% are Texans who work or have a working family member

We’re Texas/U.S. Citizens - 76-82% of the uninsured are U.S. citizens

We’re Children – 22% of Texas children are uninsured (national average is 12%)

We’re Working/Non-poor – fastest growing group of uninsured individuals

Who are the uninsured? Who are the uninsured?

Uninsured ResultsUninsured Results

1million do not receive care for their chronic diseases

3 million uninsured Texans less likely to receive preventative care and screening services

5.6 million continuously without health insurance throughout the year

8.5 million without insurance at some point of the year

Why Are Texans Uninsured?

High Premiums – Average cost of health insurance premiums is $9,100

State Medicaid Program – Medicaid does not cover most adults

County Indigent Care Program – current state program affords no real coverage

Uninsured Results Uninsured Results continuedcontinued

Bankruptcies - medical expenses leading cause of personal bankruptcies

Lower Quality of Life – poor health compromises quality of life, educational attainment, workforce efficiency

Higher Premiums - responsibility of providing care is borne by insured individuals and businesses

Higher Local Taxes - burden on local taxpayer increases to cover the community’s uninsured

FindingsFindings

We’re Number One – Highest percentage of uninsured in the country (25.1%) totaling 5.6 million Texans

Texas cannot sustain the continued rise in the cost of providing care to uninsured

Emergency Room services over-extended, improperly used for primary care

Ambulatory (outpatient) strategies need development and investment

FindingsFindings (continued) (continued)

County based approach to funding health care is inadequate

Texas needs to leverage federal matching funds

Shortage in healthcare professionals adds to the cost

Healthcare for the mentally ill continues to be a challenge (and expense) for Texas

Trauma Service Area-P

AACOG Counties

Wilson307 Unfunded Visits

Cost:$335,400Reimb:$47,900

Loss: ($287,400)

Wilson307 Unfunded Visits

Cost:$335,400Reimb:$47,900

Loss: ($287,400)

Karnes62 Unfunded Visits

Cost:$168,600Reimb:$7,500

Loss :($161,038)

Karnes62 Unfunded Visits

Cost:$168,600Reimb:$7,500

Loss :($161,038)

Guadalupe689 Unfunded Visits

Cost:$498,300Reimb:$87,900

Loss: ($410,400)

Guadalupe689 Unfunded Visits

Cost:$498,300Reimb:$87,900

Loss: ($410,400)

Comal548 Unfunded Visits

Cost:$626,300Reimb:$108,400Loss:($517,900)

Comal548 Unfunded Visits

Cost:$626,300Reimb:$108,400Loss:($517,900)

Frio167 Unfunded Visits

Cost:$339,900Reimb:$19,100

Loss: ($320,700)

Frio167 Unfunded Visits

Cost:$339,900Reimb:$19,100

Loss: ($320,700)

Gillespie48 Unfunded VisitsCost:$97,100Reimb:$29,600Loss: ($67,500)

Gillespie48 Unfunded VisitsCost:$97,100Reimb:$29,600Loss: ($67,500)

Kendall393 Unfunded Visits

Cost:$418,900Reimb:$70,400

Loss: ($348,500)

Kendall393 Unfunded Visits

Cost:$418,900Reimb:$70,400

Loss: ($348,500)

Kerr111 Unfunded Visits

Cost:$362,400Reimb:$31,700

Loss: ($330,700)

Kerr111 Unfunded Visits

Cost:$362,400Reimb:$31,700

Loss: ($330,700)Bandera

306 Unfunded VisitsCost:$393,428

Reimb:$110,200Loss: ($283,200)

Bandera306 Unfunded Visits

Cost:$393,428Reimb:$110,200Loss: ($283,200)

Medina360 Unfunded Visits

Cost:$430,800Reimb:$37,600

Loss: ($393,200)

Medina360 Unfunded Visits

Cost:$430,800Reimb:$37,600

Loss: ($393,200)

Atascosa683 Unfunded Visits

Cost:$1,144,000Reimb:$18,425

Loss: ($1,125,000)

Atascosa683 Unfunded Visits

Cost:$1,144,000Reimb:$18,425

Loss: ($1,125,000)

Bexar County: 2005 Uncompensated Care CostsBexar County: 2005 Uncompensated Care Costs

Trauma Service Area-P

AACOG Counties

Real21 Unfunded

VisitsCost: $21,500Reimb: $445Loss: ($21,100)

Real21 Unfunded

VisitsCost: $21,500Reimb: $445Loss: ($21,100)

Maverick97 Unfunded VisitsCost: $386,400Reimb: $6,200Loss: ($380,200)

Maverick97 Unfunded VisitsCost: $386,400Reimb: $6,200Loss: ($380,200)

Zavala49 Unfunded VisitsCost: $134,600Reimb: $2,200Loss: ($132,400)

Zavala49 Unfunded VisitsCost: $134,600Reimb: $2,200Loss: ($132,400)

Uvalde111 Unfunded VisitsCost: $270,900Reimb: $15,500Loss: ($255,500)

Uvalde111 Unfunded VisitsCost: $270,900Reimb: $15,500Loss: ($255,500)

Kinney5 Unfunded VisitsCost: $25,700Reimb: $2,100Loss: ($23,600)

Kinney5 Unfunded VisitsCost: $25,700Reimb: $2,100Loss: ($23,600)

Edwards4 Unfunded VisitsCost: $2,326Reimb: $866Loss: ($1,400)

Edwards4 Unfunded VisitsCost: $2,326Reimb: $866Loss: ($1,400)

Val Verde45 Unfunded Visits

Cost: $64,100Reimb: $4,000Loss: ($60,100)

Val Verde45 Unfunded Visits

Cost: $64,100Reimb: $4,000Loss: ($60,100)

La Salle52 Unfunded VisitsCost: $159,200Reimb: $21,300Loss: ($137,900)

La Salle52 Unfunded VisitsCost: $159,200Reimb: $21,300Loss: ($137,900)Dimmit

80 Unfunded VisitsCost: $315,000Reimb: $750Loss: ($314,200)

Dimmit80 Unfunded VisitsCost: $315,000Reimb: $750Loss: ($314,200)

Gonzales37 Unfunded VisitsCost: $61,576Reimb: $23,100Loss: ($38,400)

Gonzales37 Unfunded VisitsCost: $61,576Reimb: $23,100Loss: ($38,400)

Bexar County: 2005 Uncompensated Care CostsBexar County: 2005 Uncompensated Care Costs

Funding RecommendationsFunding Recommendations

Increase Statewide FPL from 21% to 100%

Maximize State Match of Federal Medicaid Program Dollars

Create incentives for small businesses to provide employee health care insurance

Establish Quality Assurance Fee for health care providers

Policy RecommendationsPolicy Recommendations

Move from a County Based Delivery Model

Expand coverage through CMS Waivers, Pilot Programs, Grants

Create a local structured and connected system of care

Increase/develop community ambulatory care facilities and services

Education and Prevention

Findings – Success in education is closely linked to health status Recommendation - Integrated approach to school health includes an emphasis on nutrition, exercise, dental health, and disease managementHealth Programs in dental hygiene are valuable in view of the prevalence of dental disease

ConclusionConclusion

Is NowIs Now the time for Texas to take bold stepsbold steps to address the problems with the lack of health insurance coverage and health care access to protect and assure economic vitality and the health of the State ??