Friday, March 04, 2011

Tom Green County's Indigent Health Fractal

Tom Green County spent $7.5 million less than the 8% general tax levy for Indigent Healthcare in the last decade.  In 1999 the county spent $1.96 million, needing assistance from the state.  The Indigent Health budget for 2011 is $458,579.  Contrast this $1.5 million decline with unrelenting increases in health insurance premiums.

The County does contribute $1 million, technically not part of Indigent Health, to Medicaid's UPL Payment Program.  Giving the County credit for this contribution raises the 2011 total to $1.46 million, still far below the 8% requirement of $2.01 million.  By the end of this fiscal year the Indigent Healthcare surplus could exceed $8 million.  What happens to these funds?  The County outlined their use in a recent document:

SURPLUS FUNDS - funds not expended during a budget year. Shall be maintained and accounted for using generally accepted accounting principles. May be used to increase yields to defer taxes.
The County pattern repeats elsewhere in fractal form.  The City of San Angelo took a similar line, deferring tax increases to fund retiree health insurance promises.  City Council increased premiums as high as 34 to 58% for retiree dependents.  As a result, 192 people dropped health insurance, 45 employees/retirees and 147 dependents.  The health insurance massacre occurred while the City participates in the fed's Early Retiree Reinsurance Program. 

Texas state legislators look to gut Medicaid and CHIP.  A recent report showed Medicaid paying hospitals 22% of charges for potentially preventable re-admissions.  How far below actual costs does Medicaid currently pay?  Under stressed state and federal budgets, UPL money must be at risk.  When that goes, virtually every healthcare funder, government and corporate, will be in retrenchment mode.. 

Chaos theory provides insight as to what may happen.  The system becomes increasingly unstable until it reaches a point of maximum instability, the bifurcation point, after which the system reorders at a new level.  Politically, this is occurring in the Middle East, where corrupt, heavy handed rulers hold billions in oil money and send business to close friends and associates.  Their people woke up and protested.  I don't expect Americans to do so anytime soon.

That leaves one question.  How might the slow motion collapse of health care financing express in San Angelo and Tom Green County?

A storm is coming.  Who will weather it?

Update 3-5-2011:  The Texas state legislature proposed a 10% cut in Medicaid funding.  Will Bishop Mike inform Lady Justice?  How long before she unleashes her sword on local and state officials?

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