Not Stepping Up to the Plate on the Concho Valley's Uninsured

Concho Valley health care providers see patients from a huge geographic area. It happens to have large numbers of uninsured people, from 23% to over 40% of various county populations. The U.S. Census Bureau estimates:

Coke County-29.7% uninsured
Concho-28.6
Crockett-33.6
Irion-30.6
Kimble-32.6
McCulloch-26.5
Mason-43.5
Menard-40.2
Reagan-33.2
Runnels-25.9
Schleicher-37.3
Sterling-34.6
Sutton-30.7
Tom Green-23.2%

Representative Mike Conaway (R-TX) held a health care open house. He failed to mention the staggering rates of uncovered residents in the Concho Valley. His handout indicated nearly one quarter of the uninsured qualify for Medicaid, government insurance for low income citizens. The obvious solution? Mass enroll the Medicaid eligible, 23% of those without coverage.

"Implied Medicaid Expansion" Conaway counts on the public having a short memory. Not long ago, Mike railed against expanding Medicaid with a faulty income qualification level. Rep. Conaway has done virtually nothing to address the problem.

How determined is he to keep up this record? Consider his questioning of Dr. Christina Romer, Chair of the President's Council of Economic Advisers. The House Budget Committee meeting occurred on June 19. Mike made the following statement:

REP. CONAWAY: Well, far be it for me to make a political suggestion to the White House, and I know you do empirical work and analytical work, you're not into politics, but I do think that it's very -- (inaudible) -- that we not allow people who only want to focus on a number in terms of health care reform to ignore the other number, the cost of doing nothing. And I urge you to come up with a number that reminds the American people of what that would be if we in fact do not have health care reform.

"Do Nothing" Mike serves Texas. It has long held the top one or two spots in the nation for the uninsured. How might it react to a major expansion of Medicaid? The Texas Hospital Association position paper on health reform provides insight. It cites:

The limited ability of Texas to finance federally required expansions of the state’s Medicaid program

Continuation of resources to cover significant Medicaid and Medicare payment shortfalls

THA's Dr. Dan Stultz suggests Texas is not ready to play with Rep. Conaway's implied solution. This is the same State of Texas that tampered with Children's Health Insurance, sending hundreds of thousands of kids off the roles. How did that play out locally? All data is for Tom Green County. It reveals the number of children enrolled as of September each year.

2002-2,593
2003-2,580
2004-1,742
2005-1,383
2006-1,356
2007-1,346
2008-1,914
2009-1,899 (August data)

Despite growing numbers of uninsureds, the number of CHIP covered kids is less than 2002-2003. What happened with other programs intended to provide care for the poor and near poor? Tom Green County Indigent Care behaved like State CHIP. The average annual spending for the period specified is:

1998-2000 $1,709,085 (This includes $417,591 in annual state subsidy)
2001-2003-- $923,374

Three year savings amounted to $1.7 million. They continued to grow for the next four years, reaching a total $5 million. One might expect these savings to result in a higher income qualification than "dirtiest of the dirt poor." It didn't. That's a nice windfall for the County's reserves.

During this time, Judge Mike Brown advocated to the Texas Legislature that indigent care should not be a county responsibility. The judge felt it a federal responsibility, one that should be shouldered by Medicaid.

Is anyone confused as to who is responsible, federal, state or local officials? It's similar to the burn one gets when trying to resolve a computer technical problem. The software maker blames the hardware people and visa versa. Usually, people get angry or they give up. It's your choice. Just remember it at the ballot box, should you go. Remember Mike Conaway, the Odessa-Permain football player who failed to suit up, much less "tackle" health care.

Update 8-12-12:  While politicians dither and employers cut back on health insurance coverage, Texas physicians treat fewer poor people.