May 13, 2007
Tired of waiting for national health care reform, some states are vaulting past the federal government and seeking universal health insurance on their own. California, Massachusetts, Maine, Vermont and Illinois are creating and implementing state plans to cover everyone.Do not postpone your appendectomy waiting for Texas to follow suit.According to the Texas Health Institute, this state has the highest rate of uninsured residents — 5.59 million, or nearly 25 percent. Houston’s rate is higher yet, at one in three adults. But would-be Texas reformers must maneuver past some roadblocks that have been eliminated elsewhere.Many states, regardless of majority party, recognize the economic sense of allowing the federal government to do some heavy lifting. They invest in Medicaid and the Children’s Health Insurance Program to maximize the flow of matching federal dollars that place people on the insurance rolls.In Texas, even the popular CHIP faces an uphill battle each session. The Legislature has yet to change the enrollment period from six months to a year, streamlining a flawed bureaucratic process that knocked thousands of eligible children off the program. With this degree of resistance, it would take a sea change to expand CHIP coverage to single mothers, as some states have done. Expanding Medicaid coverage is all but impossible as Texas legislators seek to reduce costs.Without maximum federal help that is basic in other states, reform-minded advocates here are seeking change in the private sector. Yet obstacles to change in the private insurance market are equally formidable.Most of the uninsured in Texas are people who work for small businesses that cannot or will not provide health insurance. In a Texas Department of Insurance survey, 54 percent of small employers said they could afford premiums of $100 or less per month, compared to an average premium of more than $300 per month — though 81 percent said they would provide coverage if it were affordable.Reform efforts are concentrated on that gap between willingness and affordability. It’s a huge gap, and employers must shop in a market only minimally regulated by the state. Industry practices rarely favor the buyer. In order to get a final price quote, companies are often required to pay one month’s premium. That hardly encourages comparison shopping.Without a sturdy regulatory environment — Texas insurers have few reporting requirements and are virtually free to charge what they will — the kind of concessions that would foster universal coverage are as out of reach as another galaxy.To help more small businesses obtain insurance, the Harris County Health Care Alliance hopes to create a new type of basic health insurance at a price small employers can afford through an innovative purchasing alliance in which employers, employees and other funders share the cost.This kind of flexibility in the private market requires new legislation. SB 922, sponsored by state Sen. Kirk Watson, D-Austin, would allow one or more counties to participate in this type of purchasing alliance. The bill has passed in the Senate, and Watson is optimistic it will become law. He said it faces little opposition from the insurance industry.The Alliance pilot program is not a panacea for the problem of the uninsured, said Dan Wolterman, CEO of Memorial Hermann Healthcare System. But, he said, such innovative, low-cost solutions are a good start and an important part of the solution.Effecting change at the state level in Texas will be a slow process. On May 30-June 1, the University of St. Thomas’ Young Institute presents “Health Care for All,” a seminar intended to promote the moral imperative of universal health care. Meanwhile, officials of the Catholic Archdiocese of Galveston-Houston are trying to raise public awareness of the huge unmet needs of Houston and outlying small towns undergoing particular stress.Given Washington’s gridlock and the Texas Legislature’s indifference to the plight of the uninsured, real change will begin at the local level with innovations like the Alliance project.