Senator Eliot Shapleigh - El Paso, Texas

Dr. Hector Gonzalez

AUSTIN - Texas’ public health infrastructure is crumbling under the weight of the uninsured, the Texas Border Coalition’s legislative conference was told Wednesday.

Dr. Manny Alvarez, chair of the Border Health Caucus, warned that the state’s economic health and well-being was at risk because of the growing number of uninsured patients and demographic changes.

“The outlook for Texas is grim,” Alvarez said. “A rapidly increasing population with a burgeoning number of baby boomers who suffer from more costly, chronic diseases will severely strain our health care delivery system.”

Alvarez pointed to a recent study by the Primary Care Coalition titled 'Fractured: the State of Health Care in Texas.' He said it outlined “dangerous trends” that have converged to create a health care delivery system that, if left unchecked, could "drown the state’s economy in a flood of debt and disease."

Alvarez said around 24.6 percent of Texans have no health insurance. That is 5.6 million people. He said Medicaid now insures 2.7 million Texans, or 12 percent of the state’s population.

Alvarez said several recent studies had conclusively shown the effectiveness of primary care in lowering health care costs and improving overall quality care. However, Texas faced an impending shortage of primary care physicians, he said.

In 2000, 67 percent of Texas physicians were willing to accept new Medicaid patients, Alvarez said. Today, that figure has dropped to 38 percent.

“Primary care is the backbone of our health care infrastructure and if it fails, our whole system fails,” Alvarez added. “Patients won’t stop getting sick, but if they are unable to access much-needed and less-expensive preventative and primary care services, they will be forced to seek more costly care in our already overcrowded hospital emergency rooms.”

Alvarez said the Texas Legislature must address the “crisis.” He said safety net health care programs had to be “shored up” by giving patients the tools they need to be smart health care consumers. 

State Sen. Eliot Shapleigh, D-El Paso, used pie charts to show how Austin’s private payer mix was far higher than border counties like El Paso and Hidalgo. Border elected officials could improve this, Shapleigh said, by insisting that when they ask for bids for government contracts, they require check that the bidding companies provide health insurance for their employees.

Shapleigh said the “core issue” is that Texas is 50th in what it spends on its own people. “You have a tax structure that is by design dead last. 48th mental health, last in insured, most children without health insurance. The Texas health report card is an F,” Shapleigh said.

Shapleigh said that when state officials fail to take responsibility for state issues, the burden is shifted to local governments and local taxpayers. “And that shift is nowhere more dramatic than the Texas border because we live in the lowest per capita tax base in the country,” he said. “That’s why your property taxpayers are going bananas.”

Shapleigh called for a complete restoration in CHIP funding, improved reimbursement rates for physicians, and a significantly larger investment in the El Paso medical school and the Rio Grande Valley’s Regional Academic Health System.

Dr. Hector Gonzalez, director of public health for Laredo, said that when the under-insured were added to the uninsured, the percentage of people in Laredo lacking access to health care was over 50 percent.

Gonzalez said his city boasted a state-of-the-art cardiovascular facility that people from all over the world come to use. The problem was that local folks cannot access it because they cannot afford to, he said.

Gonzalez said public health was “critical,” referring to it as the “pillar” of disease control, and surveillance and preventative programs. He said he wished state and federal leaders realized it.

“Today, our state and nation still has not committed to accepting our role in prevention. It is much cheaper to invest in health promotion, keeping people healthier, than in treating the ill,” Gonzalez said.

“Until our policy makers at the federal level change that paradigm, we are going to be investing in curative health and we can never have enough money. We have got to invest in the wellness part of it.”

Gonzalez also lamented this year’s cut in tuberculosis control along the border. He said Laredo’s funding had been cut by $150,000, El Paso’s by $60,000, and Hidalgo County’s by almost $200,000.

He said that because Waco had one case of TB, funds were shifted from Laredo – even though Laredo had 28 cases. He said that was a short-sighted move because the border was the gateway to the rest of the state and the nation.

Gonzalez gave an example of two multi-drug resistant brothers, one living in Laredo and one in Nuevo Laredo. When his department investigated it found 13 other family members had been exposed. They lived in San Antonio, Dallas, Houston, McAllen, and Chicago.

“If we don’t invest in public health for detection and early intervention then we are going to have more rampant disease,” Gonzalez said.