State Priority Issues

Uninsured/Access to Health Care Coverage

With one in every four Texans lacking health insurance coverage, the state has the highest rate of uninsured residents in the nation. This problem affects everyone, including those who have health insurance as well as business owners and local governments. For the state’s hospitals, reducing the number of uninsured and making health insurance more affordable and accessible are a top priority. The Texas Hospital Association is working to educate policymakers, as well as local civic and community leaders and the news media about this important issue. More information and potential solutions may be found online.

Medicaid/CHIP

State funding of health care programs, including Medicaid and the Children’s Health Insurance Program, always are important for Texas hospitals. Both programs provide opportunities for the state to draw down matching funds from the federal government and maximize local and state tax dollars spent on health care for low-income individuals. Texas hospitals urge lawmakers to budget for these programs realistically, with accurate caseload and utilization projections. At the same time, legislators should ensure adequate reimbursement to providers, at least covering their actual costs.

Quality/Patient Safety

Hospitals routinely collect and use data internally to improve patient care. They constantly strive to acquire innovative technology, share data about the effectiveness of treatment methods and consistently use proven interventions to reduce adverse outcomes. While many quality initiatives are national in scope, Texas has adopted a number of data reporting requirements. The Texas Legislature should be cautious in establishing new data reporting requirements to avoid duplication. Data should not be collected unless the state is willing to invest in the personnel and equipment to perform an appropriate analysis and make the information available publicly in a useful format. Strong confidentiality provisions will ensure the continued sharing of information and encourage the reporting of mistakes and potential errors.

Workforce

Despite the Legislature having allocated more money for nursing education each of the three previous sessions, a nursing shortage still persists. With a population growing more than twice as fast as the national average – and people living longer and having more chronic illnesses – the demand for health care has never been greater. Hospitals are expanding facilities to provide more space, but the state’s health care workforce is not keeping pace. One of the major barriers continues to be the lack of faculty to teach all the qualified applicants each year. The health professions need to be priorities in terms of higher education funding.

End-of-Life Care

Passed with broad, bipartisan support in 1999 and signed into law by then-Gov. George W. Bush, the state’s Advance Directives Act has been a model for the nation since its inception. Despite broad agreement that the law generally works well, Right-to-Life advocates are seeking major changes. These advocates support continuation of life support indefinitely if requested by the patient and/or family members, even if further treatment is of no benefit to the patient, as determined by the physician and medical ethics panel. Intended to help guide families and health care providers in one of life’s most difficult times, the law should be preserved, although improvements and clarifications may be appropriate.

Insurance/Managed Care

With the Texas Department of Insurance under sunset review in 2008-09, the Legislature has the opportunity to remove regulatory barriers that contribute to making health insurance coverage unaffordable or inaccessible. The regulatory environment for insurance carriers should be reviewed and modified to make it more efficient for carriers to do business in Texas, and to provide appropriate incentives or requirements to encourage carriers to write a wide range of affordable policies.

Emergency Room/Trauma

Since 1993, the Designated Trauma Facility and EMS Account has helped offset uncompensated trauma care costs in designated trauma facilities. A portion of the proceeds from the Driver Responsibility Program have been the main source of funds for the account since 2004. Since 2006, only a portion of the funds collected have been appropriated and distributed. Currently some $100 million is languishing in the account – rather than helping support the state’s safety net hospitals. The red light camera program approved in 2007 created a dedicated regional trauma account to help support uncompensated trauma care. Again, the funds to be collected were not appropriated. Having a statewide trauma system benefits everyone, and the state should support this resource with funds intended for that purpose.