Monday, April 06, 2009

Deleveraging San Angelo's Health Care Resources

Once upon a time, area leaders leveraged resources. San Angelo's Health Access Coalition leveraged federal and local dollars to improve access to care for the uninsured, nearly 30% of our local population. Esperanza Clinic received two expansion grants, an additional $1.4 million a year. That brought federal annual support to $2.0 million. The San Angelo Health Foundation funded a new facility and a pediatrician. Shannon Medical Center donated Esperanza's original primary care building.

The HAC mobilized expertise to stretch Tom Green County indigent health care dollars, such that more people could be helped by coverage for the poorest of the poor. The Coalition ceased in 2003, but further attempts at leverage continued.

Just as area hospitals and TGC Indigent Health got close to implementing a program to leverage Texas Medicaid money, the federal government pulled the plug on supplemental reimbursement.

During this time County Judges and Commissioners Association of Texas (CJCAT) worked to get indigent health pulled from their area of responsibility. The CJCAT legislative position stated:

Indigent Health Care

NOW, THEREFORE, BE IT RESOLVED that the County Judges and Commissioners Association of Texas opposes any attempt to impose a mandatory assessment upon Texas counties to fund a regional or statewide health care system.

Federal Funding for Indigent Health Care

NOW, THEREFORE, BE IT RESOLVED that the County Judges and Commissioners Association of Texas requests that the state of Texas expand its Medicaid program to obtain federal matching funds for indigent health care and relieve the property taxpayer of this unfair burden.

While the county had the laudable goal of getting $2.54 in federal dollars for every indigent health dollar, the leverage plan languished. The reality is TGC IHP spent an average of $1.7 million a year from 1998-2000. From 2001-2006 it spent an average of $950,000 a year, a $750,000 a year decrease. Less money was spent on care for the poor, a deleveraging.

Esperanza's federal grant in 2009 is half the rate of the last six years. It will fall from $2.2 million to $1.1 million. More deleveraging. The county is trying to ease the pain. It approved higher reimbursement for a clinic visit. Using last years visit statistics, Esperanza could get an additional $77,500 from the TGC IHP. That helps, but doesn't backstop the loss of $1.1 million.

At a time when players need to step up to the plate and cover the uninsured, Tom Green County has key players stepping back. It's symbolic of the national discussion, where few want to pay. That's the current fight in Congress and struggle faced by state legislatures.

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