charge to task force

Access to Health Care in Texas: Challenges of the Uninsured and Underinsured
Approximately one in four Texans does not have health insurance. In some portions of the state the ratio of the uninsured population is one in three. Although the provision of health care for this population is often characterized as indigent care, the population is extremely heterogeneous with only a portion of the population truly living in poverty. As well described in the recent series of six reports from the Institute of Medicine, the population includes a large proportion of working individuals who can support themselves quite satisfactorily but cannot afford the rapidly rising cost of health insurance. In this society in which health insurance is most commonly employer-based, those who work for organizations with few employees or who move from employer to employer often cannot maintain health insurance coverage. A significant portion of the population receives coverage through Medicaid or through the state Children's Health Insurance Program (SCHIP). These individuals often have limited access to care. Limited access is available to migratory farm workers, undocumented aliens, individuals between jobs and certain ethnic and racial groups.

In Texas, care for the medically indigent is largely a responsibility of the individual counties while the state has a major financial commitment in support of Medicaid and SCHIP. Eligibility for county-financed care varies widely, with many counties providing such care only for those with extremely low or no income. On the other hand, certain communities such as those in Dallas, Houston, Galveston, San Antonio and Austin must finance and provide care for significant numbers of individuals coming from other parts of the state.

Institute of Medicine studies have clearly documented the negative impact of the uninsured on the health of individuals and families; the negative economic consequences of inadequate healthcare for medically indigent patients on their communities; the extraordinary stresses imposed upon health providers, particularly hospitals who are providing increasing amounts of uncompensated care; and the overall cost to society of a system which focuses on providing emergency care rather than primary care for the medically indigent. A combination of demographic changes and continued rise in healthcare costs suggest that these challenges will progressively increase for the foreseeable future.

Because of the current importance and impending challenges confronting Texas in dealing with the problem of medically indigent individuals, 10 of the major academic health institutions in the state are sponsoring a task force to identify strategies for confronting medically indigent care in Texas. These institutions include the six health campuses of The University of Texas System, Baylor College of Medicine, Texas A & M, North Texas State, and Texas Tech. The task force will consist of 19 individuals selected for their expertise and perspective in regard to the problem of indigent health care in Texas. Members of the task force serve as individuals and do not represent any organizations or special interests. The task force and its staff will collect data, much of which will be based on previous high-quality analyses of the various issues supplemented by substantial primary information gathering by the task force and its staff. The task force will hear from individuals knowledgeable of the issues; members of the staff may interview other important sources. The analysis is to be an objective evidence-based consideration without political partisan nor advocacy orientation. The intent is to provide a high-quality analysis available to policymakers, interested groups and organizations and the public. The full report is expected to require 12 to 15 months for preparation, although the task force will be urged to provide some preliminary insights in 8 to 10 months. The final report will be subject to anonymous peer review by other experts in the field, in order to validate the quality of the analysis from additional sources. Financial support for the project will be derived from the sponsoring institutions supplemented by not-for-profit foundations.

The Task Force on the Financial Barriers to Health Care in Texas is charged with the following tasks:

• to assess the current magnitude of the problem of the uninsured and underinsured in Texas, including populations at risk, the cost to providers, local and state governments, and impacts upon health
• to evaluate the effects upon other aspects of society, including social and economic impact.
• to identify the trends and the magnitude, scope and direction of the problem of medically indigent care for the state.
• to examine alternative strategies which might be employed to address the problems of uninsured and underinsured in Texas.

The task force will provide an evidence-based analysis of the advantages and disadvantages of each strategy for Texas, with special attention to costs.