Thread: A gap in candidates' health coverage plans (IAs?)

A gap in candidates' health coverage plans
Illegal immigrants, other Texas problems ignored

12:00 AM CST on Tuesday, January 22, 2008
By JASON ROBERSON / The Dallas Morning News
jroberson@dallasnews.com

While health coverage is shaping up as one of the major issues of this presidential campaign, no candidate, Democrat or Republican, has proposed a plan that would address all of Texas' concerns.


Nurse Julia Grenier runs a makeshift clinic at the Plano Day Labor Center and says she's not concerned whether those who see her are in the U.S. legally. She offers a safety net that would be needed under all candidates' plans. Democrats' stump speeches talk of covering all Americans but so far have avoided the politically explosive issue of whether to treat the 12 million illegal immigrants living in the U.S.

Along with such immigrants, Texas also has the second-highest number of uninsured residents – and some of the nation's highest rates of pre-existing chronic illnesses. Those illnesses could create problems if Republican candidates' plans to encourage more reliance on individual insurance policies are enacted because those people couldn't find insurance.

And some in the medical profession here argue that the candidates are not facing up to a lack of doctors and the reality that some refuse patients with government health coverage that pays at a low rate. Even with 5.4 million uninsured, Texas already has a shortage of doctors to treat patients seeking care. Broader coverage, leading to an increase in patients, would probably amplify that.

"I think that because it is so high on the interest of people of this state, this nation, our candidates are trying to create some elements to help give people some solace that there's going to be change," said Doug Hawthorne, CEO of Texas Health Resources, the largest hospital system in North Texas. "But I'm not sure that's substantive to the extent that it's going to be helpful."

He favors creating a public-private agency to come up with policies for improving the quality of health care and making sure more people are covered. Mr. Hawthorne said candidates are rushing into health care reform and are creating proposals to keep people quiet.

Illegal immigrants

Texas' 1.6 million (as of 2006) illegal immigrants remain an open question.

It is an emotional one.

"Prisoners who are criminals receive better health care, and nobody minds that," said Enrique Hubbard Urrea, the consul general of Mexico in Dallas. "They cut your grass, tend to your children, and all they want is a chance to protect their families."

But Jean Towell, 71, and a leader in Dallas-based Citizens for Immigration Reform, feels just as strongly on the other side. "They are not citizens; they are here illegally," she said. "They made the choice to come here illegally, and they should not receive the money citizens have paid into the system."

At Dallas' Parkland Memorial Hospital, more than half of all patients are Hispanic. Although the hospital does not say how many are here illegally, 70 percent of the women who gave birth at Parkland in the first three months of 2006 were illegal immigrants, according to a patient survey.

Dr. Ron Anderson, CEO of Parkland Health & Hospital System, has brainstormed with Mexican officials about creating a program to cover immigrant workers, hoping the Mexican government and U.S. employers will cooperate to offer a barebones insurance plan. Now, Parkland and other hospitals pay for emergency care of indigents, including illegal immigrants, though they're not reimbursed for all the costs.

Budget cuts

Meanwhile, Democratic presidential hopeful Hillary Rodham Clinton is calling for a budget cut that could hurt Parkland.

To find money for her health care plan, she proposes a $7 billion reduction in a federal subsidy for hospitals that serve a disproportionate number of low-income patients, according to an analysis of the candidates' health plans from tax firm PriceWaterhouseCoopers.

Such payments accounted for $140 million in revenue for Parkland last fiscal year.

"We depend on everything you can imagine to piece this thing together," Dr. Anderson said of the hospital that treats 1.1 million patients a year. "Any one of those things legislatively could be taken away, and you lose your entire bottom line."

Dr. Jim Walton, an internist at Baylor Health Care System, raises another issue: Most politicians focus on funding new programs, but few, if any, discuss how health care is delivered. Like many doctors, he says this is an especially big problem in Texas.

"Even after you cover these people with some type of insurance, generally the reimbursement rate is such that the patient will have trouble finding a provider that will take care of them," said Dr. Walton, referring to government-provided coverage. (Democrats, including Barack Obama, want to expand federal programs such as Medicaid to insure more people.) "When you challenge the policy folks around that, I don't honestly think they know how to respond."

Texas doctors are already stretched thin. There are 160 doctors here for every 100,000 patients, according to Dr. Anderson. The national average is 240 doctors per 100,000, he said.

While Democrats such as Mrs. Clinton and John Edwards want to require most employers to cover workers and bring more of the poor under the Medicaid umbrella, Republican candidates like John McCain, Mitt Romney and Rudy Giuliani instead call for tax deductions or tax credits to encourage people to buy their own health insurance. The Republican focus is more on individual responsibility.

Chronic diseases

But that could hurt Texas, given the state's large number of both uninsured residents and Texans with chronic diseases such as Type 2 diabetes. People with pre-existing conditions often find it difficult if not impossible to buy comprehensive health insurance – at any price.

For example, nearly 8 percent of Texans 18 and older – an estimated 1.3 million people – have been found to have Type 2 diabetes. That accounts for more than 8 percent of the national total, according to the Texas Diabetes Council.

Texas already lags the nation in the percentage of Type 2 diabetes patients receiving the recommended care, according to a recent study from the Dallas Fort Worth Business Group on Health.

Type 2 diabetes is the more treatable and preventable form of diabetes; lack of treatment can lead to costly hospitalizations, blindness and limb amputations.

Business-friendly

On the other hand, Democratic proposals to expand health coverage by building on the current model of employer-provided insurance – requiring that more employers offer policies – might have an unintended consequence in Texas.

Historically, the state has lured industry with a business-friendly reputation and low employee costs, said Dana Johnson, chief economist at Dallas-based Comerica Bank.

A national law requiring companies to provide insurance may benefit more uninsured workers here, but some say it could detract from Texas' appeal to employers looking for a less expensive place to hire.
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