The decision by the U.S. Supreme Court on health care reform could affect all Texans, including the nearly six million without health insurance. Local health care experts say the required coverage for everyone could make people healthier, but clog waiting rooms. And it could ultimately change the way health care is paid-for and delivered.
25% of Texans do not have health insurance. That’s higher than any other state.
Doug Hawthorne, CEO of Texas Health Resources, says it would be great if everyone were required to get insurance.
Hawthorne: Certainly those of us who have been on the health care delivery side have promoted the advancement of coverage for people in this country. Everyday, inside Texas Health Resources we provide a million dollars a day of care to people who cannot pay for their own care.
The million dollars a day is for charity patients, costs not paid by Medicare and Medicaid, as well as a variety of community no-cost health programs. That cost is spread throughout more than a dozen Texas Health Resources hospitals in North Texas, including Presbyterian in Dallas and Harris Methodist in Fort Worth.
Hawthorne says if everybody had insurance, it would help shift the focus from “sick care” to well care, or preventive care, orchestrated by primary physicians. He says people could afford to see a doctor regularly instead of waiting too long to take care of a problem and winding up in the emergency room with the most expensive care.
But not everyone agrees. Dr. Forney Fleming teaches healthcare management at UTD’s Naveen Jindal School of Management. He says having insurance does not equal having access to healthcare. Dr. Fleming says the Massachusetts insurance mandate program got off to a rough start when too many people carrying new insurance cards wanted to see too few primary care doctors.
Fleming: You now have all these insured patients and so they’re going to shift out of the emergency room environment and they will be absorbed in the medical community. But you didn’t increase your primary care base. So, your emergency room utilization actually went up. Your wait time to see primary care physicians in Massachusetts went up.
Fleming’s colleague at UTD, Dr. John McCracken predicts the state would face the same doctor appointment backlog as Massachusetts, as well as other unintended consequences.
McCracken: If you increase the demand for something but don’t increase the supply, one of two things has to happen: either the cost goes up or it’s rationed. Which one it’s going to be, no one knows. There’s going to be an effect.
Texas Health Resources’ Doug Hawthorne admits there will be pressure on the family practice end of the healthcare delivery system. He anticipates limited resources for a period of time. But Hawthorne says we’re seeing more med students choosing primary care specialties.
Dr. Forney Fleming says regardless of what the U.S. Supreme Court decides, there will be changes. He says the current U.S. healthcare system – with ever-escalating costs – is not sustainable.
Fleming: Ultimately down the road the two areas that we are going to have to totally revise: the organizational structure, how we deliver healthcare; and the financing side of it, how we pay for it. The fee for service is the norm today.
Fleming says the changes could include global payments: one insurance check for an episode of care split among the various providers: or capitation – a fixed monthly amount for an individual’s care, whether the patient had one, or ten office visits that month.
Dr. John McCracken says however the changes are made, it won’t be pretty.
McCracken: I believe it’s going to be a train wreck. But, the good news is that after they bandage the wounded and get the train gets back up on the track, it’s going to be a better system.
A 2010 Census analysis of Texas cities shows Dallas #2 for uninsured residents at 33%. Fort Worth is number 5; and Arlington ranks 7th.