Focusing on the Fundamental Challenge: Texans Lacking Health Insurance

For months in Austin and across Texas, several different advocacy groups and a few legislators have been calling for Medicaid Expansion utilizing the Affordable Care Act (ACA); additional voices support the effort but call for an alternative that achieves coverage expansion in a Texas specific manner. On the other side, conservative think tanks have been posting up stories and articles opposing any form of Medicaid or coverage expansion that embraces the ACA (short of some sort of undetermined block grant). The arguments move from policy to financial to philosophical to political and everything in between.

In the coming weeks and months, it is expected that the debate will include the challenges of renewing the 1115 waiver in Texas that has increased mental health services as well as improving numerous other points of needed access to health services. Unfortunately, it would seem that at the moment, the leaders of Texas would prefer discussing anything other than the fundamental components of this challenge.

What has been lost in this debate is the actual problem that has been a challenge to the healthcare systems in Texas (as well as the country) for decades: people who lack health coverage still get sick and hurt, and as a society we support delivering care to those in need regardless of the ability to pay. In fact, President Ronald Reagan signed the law that mandates care back in 1986 (via emergency facilities in hospitals), and the federal government has been holding hospitals accountable to that mandate ever since.

A direct payment for the cost of delivering this care was not included in that act or subsequent acts of Congress, so hospitals (and communities) have created cost-shifting mechanisms to cover this uncompensated care, including pursuing special funds from the federal government to help offset the costs. With the passage of the ACA in 2010, Congress and President Obama called for a change in this uncompensated system by significantly reducing the number of uninsured, but the implementation of that law has been a challenge from the start.

We are not going to begin defending or critiquing the ACA, but with this change in law, the challenge of paying for the care of people who lack health coverage is shifting. The tools and mechanisms that have held health care delivery systems together, including those in Houston, can’t address the current situation. As the Harris County Healthcare Alliance, we are working to encourage an open and collaborative conversation about the best way to move forward, but we must first gain consensus from the leaders that indeed this challenge is the one we are working to solve: finding the most effective and efficient way to provide healthcare to Texans who are sick or hurt and have no health insurance coverage. If we can encourage leaders to agree on the problem, we are at least 80% of the way to finding a solution that is palatable to all Texans.

The Alliance will be working to build a consensus to make the case that this needs to be the focus of the discussions as the Legislature continues its work. We will keep you posted on how you can help. Stay tuned!

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