Wednesday, May 13, 2009

Tom Green County to Step Up for County Indigent?

The San Angelo Standard Times reported Tom Green County Commissioners joined a prescription drug discount program benefiting county residents. A discount card can save 20% off retail drug prices. The county spent $1,453 to join the National Association of Counties. Next year dues rise to $2,179 to participate.

The program will be helpful to some people needing prescriptions, but Tom Green County has nearly 30% of citizens with no health insurance coverage. With unemployment around 5%, it's not that people aren't working. They have jobs without insurance coverage or cannot afford the premium. A 20% price break is appreciated, but expensive medications could remain unaffordable for the near poor.

Tom Green County has an Indigent Health Care Program, which covers medical care for people below 21% of the federal poverty level. That's $4,600 in income for a family of four. The program helps the poorest of the poor. Apparently, Tom Green County had a lot of those folks from 1998-2000. The program regularly ran out of funds in late spring or early summer. Representative Rob Junell would ride into Austin and produce the money to get the program through September 1, to the start of the new budget year. During this period TGC IHP spent an average of $1.7 million a year on care for the poor.

San Angelo's Health Access Coalition, a community coalition made up of local health system stakeholders, consulted with Indigent Health to spend their money more effectively. The HAC hoped any savings could be used to cover more people, at a higher FPL cutoff. Savings happened galore, over $750,000 a year relative to budget.

The HAC lasted through 2003, when providers decided to collaborate more informally. Savings to the TGC IHP were significant. Three year savings amounted to $1.7 million, a year's worth of pre-HAC spending.

The County did not expand the eligibility criteria from 2004-2007. It saved another $3.3 million relative to budget. In total, Tom Green County saw $5 million dollars go from the Indigent Health budget to the general revenue fund. The County acted. They spent $1,453 to help citizens get cheaper drugs.

But there's more. Area providers are cooperating with the County to leverage federal Medicaid money. President Bush put the program on hold, but that moratorium has been lifted. I don't have specifics on any coverage expansion or how much the County will spend to leverage federal dollars. Hopefully, it's coming soon. Need has not gone down in the last decade.

Galveston County announced it would consider an expansion of their Indigent Health Care Program. They may cover people up to 50% of FPL, $11,025 for a family of four. They see it as a first step to creating a hospital district, one that would work as an insurance system for the poor.

Trusting that Tom Green County, Shannon Medical Center and Community Hospital of San Angelo would do likewise, I e-mailed a friend at a local hospital. That person said there are no plans to change the 21% eligibility figure. How disappointing...

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