Senator Eliot Shapleigh - El Paso, Texas

People without health insurance, a big and growing problem in Texas, suffer poorer health than the insured and drive up health care costs for everyone, the president of the Texas Hospital Association said.

But the bulk of the 5.7 million uninsured Texans are working people or have at least one working family member, Dr. Dan Stultz said Wednesday, so it would help a lot to find ways to make health insurance easier for small businesses to offer.

“In spite of the myth you may hear, this is not a problem of illegal immigration,” Stultz told members of the Rotary Club of San Antonio. Nor, he said, is it “the people under the bridge.”

That and other factors, such as obesity and an aging population, contribute to the problem, but Stultz, a former hospital system CEO from San Angelo, laid the bulk of the responsibility on rising insurance costs.

He called for more state oversight of insurance companies.

Both Texas Department of Insurance officials and an insurance industry spokeswoman named obesity and an aging population as culprits in rising costs, along with pricey medical advances.

“Affordability is an issue and the cost of health care is a big factor, so that's not all in the carrier's control,” said associate insurance commissioner Katrina Daniel.

Along with those factors, said Margaret Jarvis, spokeswoman for Blue Cross Blue Shield, “costs in general are going up, and thus the cost of health care is increasing as well.”

Daniel and Deputy Commissioner Doug Danzeiser noted that insurance companies are subject to greater scrutiny under a bill passed during the last legislative session, and they're gathering data for that now.

The insurance department did not have specific figures on the question of undocumented immigrants weighing on the health care system, but they could talk about noncitizens.

“Only 26.4 percent of the uninsured were not U.S. citizens,” Danzeiser said. “What percentage of that were undocumented, I could not say.”

Stultz suggested legal changes to make it easier for small businesses to provide insurance and legal for parents to cover children older than 25, and an aggressive expansion of the Children's Health Insurance Program.

He also called for individuals to be held more responsible for how well they care for themselves. For instance, a person who has heart surgery and makes no lifestyle changes ends up back in the hospital sooner than the patient who follows the doctor's orders.

“Somehow there has to be some accountability in the system for that person's expense,” he said.

Another idea was to re-examine which patients should have their medical procedures covered by insurance.

The resources poured into treating a terminally ill person, Stultz said, would be better spent on a person with years to live. One way to approach that would be giving an insurance discount to people who have set up advance directives, such as do-not-resuscitate orders.

“That's the kind of debate we need to have,” Stultz said. “We have to make a business model, and right now it's an emotional model.”