THA Who We Are The Texas Hospital

THA – Who We Are The Texas Hospital Association is a nonprofit trade association representing Texas hospitals and health systems. In addition to providing a unified voice for health care, THA serves its 500+ members with advocacy, timely information, data analysis, education on essential operational requirements, networking and leadership opportunities. 2

Top Three Concerns - Tom Green County* l Health Issue. Not having enough money to pay the doctor, buy Rx drugs, or get medical insurance (most serious) l Health Issue. Prevalence of anxiety, stress and depression l Economic Issue. Unemployment, finding it difficult to budget * Concerns identified by 2, 015 households in the 2004 Comprehensive Needs Assessment of Tom Green County 3

Why Health Care Matters to Everyone l l l A health care system brings employers and professionals to community Hospitals are one of biggest employers in each community Responsibility of providing health care to uninsured increases costs to everyone $1551 of you health insurance premium is paid to cover the cost of care for uninsured Cutting health care funding ≠ less sickness… only shifts burdens to local governments, hospitals and people of Texas 4

Access to Health Care Matters Here l l l 50% of households served by hospitals report an avg. income of $35 K/yr=working poor 50% of these households have a high school diploma or less Major community health issues: -Lack of affordable medical care -Alcohol and/or drug abuse -Teen pregnancy -Lack of adequate medical care or lack of MDs -HIV/AIDS -Mental illness or emotional illness *2004 Comprehensive Needs Assessment for Tom Green County 5

Economic Losses from Cuts to Texas’ Medicaid Program and CHIP* For every $1 cut in state funding for CHIP and Medicaid: • $2. 32 in lost Federal health care funding • $6. 92 in gross state product losses • $1. 59 in increased insurance premiums • $0. 58 in local government cost increases and revenue losses * The Perryman Group, February 2005, THA commissioned report 6

Local Economic Losses from Cuts to Texas’ Medicaid Program and CHIP* l l l State of Texas-Health Services Alone ($ 1. 5 B) County Total Expenditures Losses -Tom Green ($ 32, 500, 000) -Coke ($1, 000) -Concho ($810, 617) -Irion ($ 388, 863) -Runnels ($3, 400, 000) -Sterling ($ 274, 941) Planning Region-Concho Valley-($44, 400, 000) * The Perryman Group, February 2005, THA commissioned report –Total expenditure loss figures include Gross Product, Personal Income and Retail Sales categories 7

The Crisis Is Real - Putting It in Perspective l Texas leads the nation in the percent of uninsured residents—Nearly one in four=about 5. 6 M lives l The number of uninsured Texans could fill the UT football stadium more than 70 times l There are more Texans without health insurance than the entire population of the DFW metroplex l 79% of the uninsured work or have a working family member—however, insurance is either not available or unaffordable 8

The Challenge of the Uninsured in Texas* l Over 50% of the uninsured are poor—incomes at or below $41, 300 for family of 4 l Roughly 75% of the uninsured are US citizens l Almost 60% of the uninsured are under age 34 l Small businesses = 72% of all private employers, but only 24% offer insurance--citing affordability and complexity of the market as barriers l More than 75% of part-time employees in Texas work in jobs that offer insurance, but only 23% of these workers qualify for coverage *Texas Dept. of Insurance Data on Uninsured Texans 9

The Challenge of the Uninsured in Texas More Uninsured Texans = Higher $ Premiums = More Uninsured Texans = Higher $ Premiums ∞ 10

80 th Legislative Session THA’s #1 Priority Increasing Access to Affordable Health Insurance and Health Care 11

Legislative Solutions to Discuss 1. Interim work to educate; develop reform principles 2. 3. Thinking “Outside the Box” on Solutions for the Uninsured 4. Medicaid Reform and Provider Payment Restorations 5. Access for Children to Healthcare 6. Workforce Shortages Addressed 7. Transparency of Health Care Costs 12

80 th Legislative Session Atmosphere l No $10 B shortfall or school finance reform as in past • The bolo tie proclaimed the Official State Tie • Athens officially named the origin of the cheeseburger • Speakers Race and then House attempted to move to vacate the chair of the Speaker • Senate gets Feisty l Conflict with fiscal conservatives and the reality of Texas’ expanding health care demographics 13

Hospitals Think “Outside the Box” for Solutions • • • Regional or statewide premium assistance programs for small employers --$ 1 M Budget impact (SB 922 moved to SB 10) Require companies receiving Texas Enterprise Fund to provide insurance to employees -$0 Budget impact (SB 1023 -died) In awarding government contracts, give preference to companies that provide insurance -$0 Budget impact (HB 1182 -died) Allow parents to carry coverage for children on their policy without regard to age -$ Budget impact undetermined (HB 3361 -died) Health Care Coverage for Texas Omnibus Bill -$3. 2 B Budget impact (HB 2863 -died) 14

Reform Medicaid - Possible Solution Medicaid Reform – SB 10 l Authorizes THHSC to develop “multi-share” models for premium assistance l Allows establishment Health Opportunity Pool to preserve federal dollars for uncompensated care (Medicaid Dispro Dollars and Upper Payment Limit Funds) l Requires THHSC to standardize reporting of uncompensated care in hospitals l Creates Legislative Oversight Committee l Creates Committee on Health and Long-Term Care Insurance Incentives l $17 M Budget impact 15

A Real Solution – CHIP, CHIP Hooray vs. CHIP Away! CHIP Restorations – HB 109 • 127, 000 children added to program • 12 -month continuous eligibility w/ 6 month income check for >185% FPL • Deduction for child care expenses • Modification of asset test • Removed 90 -day waiting period for most cases • $69. 2 M Budget impact--but $2 from feds for every Texas $1 spent 16

A Real Solution – Addressing Nursing Shortage in Texas is critical: • By 2010 Texas will be short 27, 000 nurses • Texas hospitals average 11% RN vacancy rate • Average of nurse is 46, nurse faculty is 54 • 11, 000 qualified students turned away from nursing schools in 2006 • SB 992 and HB 1—almost $20 million to address faculty shortage • SB 993—improve the workplace for nurses so they will stay in the profession We must recruit AND retain nurses! 17

A Real Solution – Addressing Physician Shortage Graduate Medical Education (GME) Funding • Battle of the Budgets—Higher Ed vs. HHSC • No funding for GME in the Medicaid budget • Residency slots in Texas lower than other states— TX-5900, CA-9500, NY-14000 • 45% of Texas medical students go to residency slots out of state Code Red Report Recommendations: • ⇑ the number of annually graduating MDs from Texas medical schools by 20% over the next decade • State support of residency programs should ⇑ slots by 600/biennium for the next decade 18

Transparency of Health Care Costs to Consumer – A Real Solution SB 1731 by Senator Duncan: • Expands consumer access to health care information – TDSHS and TMB • TMA, TAB, TAHP, TASCS collaboration • Information on facility and physician pricing practices • Addresses balance-billing by facility-based physicians • Health plans required to report provider reimbursement rates to TDI for aggregate reporting to public • Website for Texas Hospital Inpatient charges - http: //www. txpricepoint. org 19

So, What’s Next? ? ? The 81 st Legislative Session is 16 months away!! 20

THA will continue to: • Work with the SB 10 committee to study ways to reduce uninsured • Make health care an issue in upcoming elections • Educate business community that funding Medicaid and CHIP is a good thing • Support and promote legislation that expands health care coverage • Support and promote legislation that funds the state’s health care workforce 21

Words to Ponder “To preserve health is a moral and religious duty, for health is the basis of all social virtues. We can no longer be useful when we are not well. ” Samuel Johnson, English Poet/Writer 22