Code Red The Critical Condition of Health Care in Texas 2006 Texas Oral Health Summit

1. Code Red The Critical Condition of Health Care in Texas 2006 Texas Oral Health Summit For Healthy Beginnings November 17, 2006 George B. Hernandez, President/CEO, University Health System

2. 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 History

3. 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 Report

4. 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?

5. Uninsured 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

6. 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 Why Are Texans Uninsured?

7. Uninsured Results continued • 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

8. Findings • 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

9. Findings (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

10. Trauma Service Area-P AACOG Counties Bexar County: 2005 Uncompensated Care Costs Gillespie 48 Unfunded Visits Cost:$97,100 Reimb:$29,600 Loss: ($67,500) Kendall 393 Unfunded Visits Cost:$418,900 Reimb:$70,400 Loss: ($348,500) Kerr 111 Unfunded Visits Cost:$362,400 Reimb:$31,700 Loss: ($330,700) Bandera 306 Unfunded Visits Cost:$393,428 Reimb:$110,200 Loss: ($283,200) Comal 548 Unfunded Visits Cost:$626,300 Reimb:$108,400 Loss:($517,900) Medina 360 Unfunded Visits Cost:$430,800 Reimb:$37,600 Loss: ($393,200) Guadalupe 689 Unfunded Visits Cost:$498,300 Reimb:$87,900 Loss: ($410,400) Frio 167 Unfunded Visits Cost:$339,900 Reimb:$19,100 Loss: ($320,700) Wilson 307 Unfunded Visits Cost:$335,400 Reimb:$47,900 Loss: ($287,400) Karnes 62 Unfunded Visits Cost:$168,600 Reimb:$7,500 Loss :($161,038) Atascosa 683 Unfunded Visits Cost:$1,144,000 Reimb:$18,425 Loss: ($1,125,000)

11. Trauma Service Area-P AACOG Counties Bexar County: 2005 Uncompensated Care Costs Real 21 Unfunded Visits Cost: $21,500 Reimb: $445 Loss: ($21,100) Edwards 4 Unfunded Visits Cost: $2,326 Reimb: $866 Loss: ($1,400) Val Verde 45 Unfunded Visits Cost: $64,100 Reimb: $4,000 Loss: ($60,100) Uvalde 111 Unfunded Visits Cost: $270,900 Reimb: $15,500 Loss: ($255,500) Gonzales 37 Unfunded Visits Cost: $61,576 Reimb: $23,100 Loss: ($38,400) Zavala 49 Unfunded Visits Cost: $134,600 Reimb: $2,200 Loss: ($132,400) Kinney 5 Unfunded Visits Cost: $25,700 Reimb: $2,100 Loss: ($23,600) Maverick 97 Unfunded Visits Cost: $386,400 Reimb: $6,200 Loss: ($380,200) La Salle 52 Unfunded Visits Cost: $159,200 Reimb: $21,300 Loss: ($137,900) Dimmit 80 Unfunded Visits Cost: $315,000 Reimb: $750 Loss: ($314,200)

12. Funding 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

14. Policy 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

15. 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 management Health Programs in dental hygiene are valuable in view of the prevalence of dental disease Education and Prevention

17. Is Now the time for Texas to take bold 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 ? Conclusion