Blue Ribbon Task Force on the Uninsured Holds Public Hearing at Upshur County Civic Center in Gilmer
GILMER - The Blue Ribbon Task Force on the Uninsured held a public hearing in Gilmer Wednesday, September 13, 2000, at the Upshur County Civic Center. This is the seventh hearing. The task force was created by Senate Concurrent Resolution (SCR) 6 passed in the 76th Legislature, Regular Session. The group was created to examine the problems of Texans who lack health insurance and to review the related demographic trends. The committee is examining other state's programs, laws, and systems of addressing health care coverage.
The nine member task force is composed of three senators appointed by the lieutenant. governor, three representatives appointed by the speaker of the Texas House, and three public members appointed by the governor. Members of the committee include Senators Chris Harris of Arlington serving as chair, David Bernsen of Beaumont, Eliot Shapleigh of El Paso, Representatives Bob Glaze of Gilmer, Garnet Coleman of Houston, Craig Eiland of Galveston, and citizens Dr. Nancy Wilson Dickey of College Station, Dr. John C. Goodman of Dallas, and Boone Powell of Dallas.
The first topic of discussion was rural health issues of the uninsured. The hearing began with testimony from Robert J. (Sam) Tessen, Executive Director of the Texas Center for Rural Health Initiatives. Tessen testified about the differences in providing health care in rural settings versus urban areas. In rural areas, the uninsured are friends and neighbors, not faceless statistics. Because of this, their circumstances do not go unnoticed or unattended. Of Texas' 254 counties, 196 are considered rural. In these counties, approximately 21% of the population fall below poverty levels. Tessen noted the connection between poverty levels and the number of the uninsured.
Sandra Curphey testified representing the Amarillo Diabetes Partnership. Curphey spoke of the success their program has with individuals, but the problems of attracting participants. Curphey suggests community based health plans rather than a statewide system.
Task force member Dr. John C. Goodman testified about portable insurance. Goodman addressed the difficulties relating to businesses and insurance companies, particularly small group markets. Currently, businesses pick the coverage for their employees every 12 months. It is difficult to choose a perfect plan for all the employees, and businesses have the option of changing companies or dropping coverage each year. Goodman would like health insurance to be as easy to administer as the 401k program. The employee would pick the plan they want and it would be mobile, moving with them when changing employers.
Elmer Ellis testified representing the East Texas Medical Center (ETMC). Ellis gave an overview of the ETMC System, who they serve, and how providing health care to the uninsured is placing East Texas residents, hospitals and rural communities at risk. ETMC is a network of 14 not-for-profit medical centers, and physician clinics, rehabilitation centers, home health and the second largest not for-profit EMS program in the nation. Ellis stated that serving the uninsured could undermine the complete system. The ETMC System will provide $100 million in indigent health care this year. Ellis recommended tax credits for the purchase of insurance, simplifying the Medicaid enrollment process, providing incentives to employers to offer expanded insurance options, possibly mandating catastrophic health coverage.
J. Lindsey Bradley representing Trinity Mother Francis Health System testified. Bradley discussed problems with the paperwork required of physicians and the need to simplify Medicaid applications. Bradley urged the committee to adopt a 12-month continuous eligibility for Medicaid rather than the 6-month eligibility currently in use. Bradley also called for some relief for physicians from the current Medicaid reimbursement rates.
Dr. Ronald Garvey representing University of Texas Health Science Center (UTHSC) at Tyler testified. Dr. Garvey presented a chart of the escalating costs related to providing health care to the uninsured.
Jose Camacho representing the Texas Association of Community Health Centers. Camacho asked the committee to simplify the process of eligibility for Medicaid, particularly for children. Texas is one of five states that continues to use both an asset test and an interview process. Thirty-four states have discontinued use of both procedures. The state-imposed assets test requires that 'countable' assets must be less than $2,000 per family.
Dr. Joyce Roberts, M.D. of Mount Vernon testified about problems facing family and rural physicians. Roberts gave compelling testimony about her experiences putting a face on the uninsured.
George Miller representing Jasper Memorial Hospital testified. Miller told the committee of the problems facing the hospital system including the outstanding debts owed to them for health care provided. Among the recommendations Miller gave the committee, he suggested expanding the definitions of dependents, and of small employers.
During the hearing, Senator Harris appointed four subcommittees to study specific issues. Harris directed the subcommittees to coordinate with the clerk if there is need for more public testimony.
The first subcommittee appointed includes Glaze as chair, Dr. Dickey and Powell to study elements of the rural problem including Medicaid enrollment, insurance availability and lasering certain employee groups. The subcommittee is to come up with suggestions that can be put into immediate effect.
The second subcommittee includes Coleman as chair, Bernsen and Eiland to study Medicaid including existing waivers that have not been applied for, how much of the problems on the application were created by the state and how much is agency driven. The subcommittee is also directed to study the transportation issues specifically relating to the Justice ruling. U.S. District Judge William Wayne Justice ruled that Texas' system for administering preventative medicine and other health care for children in Medicaid programs was flawed and ordered the state to make improvements on August 14, 2000.
The third subcommittee includes Dr. Goodman as chair, Shapleigh and Glaze to identify changes that need to take place in federal law specifically the issue of insurance portability.
The fourth subcommittee includes Eiland as chair, Bernsen and Dr. Dickey to study HMOs and how they can be more effective. The subcommittee is also to look into the Attorney General's opinion on office visits as it relates to the physician negotiation bill passed in the 76th Legislature, Regular Session.
The task force stands recessed subject to the call of the chair. The task force will submit recommendations to the 77th Legislature which will convene in January of 2001.