Senator Eliot Shapleigh - El Paso, Texas

Health and Human Services Executive Commissioner Albert Hawkins is backing off a plan to provide health care to thousands of low-income, uninsured Texas adults by the fall.

The uninsured probably would not receive access to the program — a draft of which had been criticized by hospitals, doctors and advocates for people with low incomes — until 2010 or 2011, commission spokeswoman Stephanie Goodman said.

"The long-term vision doesn't change," Goodman said of the Legislature-mandated program designed to reduce the ranks of Texas' 2.1 million low-income adults who do not have health insurance — those who earn less than 200 percent of the federal poverty level, but too much to qualify for Medicaid. For a family of four, 200 percent would be $42,400.

Hawkins had hoped to make the program available first to some of the 482,000 uninsured parents of children enrolled in Medicaid or the Children's Health Insurance Program.

"We have now determined that limitations to this model outweigh the benefits," Hawkins wrote in a letter last week to two lawmakers who lead health committees, state Sen. Jane Nelson, R-Lewisville, and state Rep. Dianne White Delisi, R-Temple. The parents, Hawkins wrote, "would not have the level of consumer choice we believe is important for the Texas reform effort."

For example, he wrote, a healthy 26-year-old may want a plan that covers catastrophic illness or injury, and someone with diabetes may need a more comprehensive plan. The state's draft plan did not offer options.

The program, which needs federal approval, is part of a plan to shift health care costs away from emergency rooms and toward preventive care. It would do that by redirecting some of the federal Medicaid dollars that compensate hospitals caring for large numbers of uninsured patients toward a pool to pay for health insurance.

"I don't fault the agency for heeding the concerns of stakeholders," Nelson said.

Some hospitals had objected to the state's draft plan.

The draft of the program said up to five days of inpatient hospital care per year would be covered, which might be adequate for most patients, said John Hawkins, senior vice president of the Texas Hospital Association. But those who would need more care "are those really high-cost cases that are going to potentially create a financial strain on the system," said Hawkins, who is not related to the commissioner, "especially if you're talking about moving the money that's now funding that care into this insurance product."

Minerva Camarena Skeith, a leader of Austin Interfaith, a political organization of 30 congregations, schools and unions, said the state's delay doesn't change her group's concerns about the impact on hospitals.

"Public hospitals really serve a role in providing health care to many people who don't have health insurance," she said. "That's why we're so adamantly saying we have to make sure those hospitals are not hurt."