The Texas Hospital Association wants to help the 5.7 million people - almost as many as the number of people living in the Dallas-Fort Worth Metroplex - who are without health insurance in Texas.

The group's latest campaign will focus on gathering ideas and feedback from business communities around the state. The hospital association hopes to compile the information by October and present it to Legislature during the 2009 session, said Dan Stultz, Texas Hospital Association president and chief executive officer, who spoke last week to San Angelo's Rotary Club.

"This health care system is hurting," Stultz said. "It's sick, and it needs fixing."

The number of uninsured San Angeloans is about 1 in 4.

Getting feedback from business leaders is important, Stultz said, because they are the ones who offer or could offer employer-sponsored health insurance. Working families comprise 82 percent of the state's uninsured. About 53 percent of Texas employers offer employer-sponsored health insurance, Stultz said. From 2000-04, the state saw a 5.5 percent drop in employer-sponsored health plans.

Rep. Drew Darby, R-San Angelo, said legislators are aware of the problems posed by the increasing number of uninsured Texans. "It's a difficult issue," Darby said. "We need to explore ways to get people covered, and we're going to have to be creative."

One option may be to give tax breaks to employers who offer health insurance plans, Darby said.

Stultz said part of the challenge is making people aware of how serious the uninsured situation is. People who have their own health insurance aren't protected from the problems caused by the growing ranks of the uninsured.

By law, hospitals must assess everyone who comes into the emergency room regardless of ability to pay. Growing numbers of uninsured Texans are clogging emergency rooms for health care that could better be addressed in primary care clinics.

In 2007, Shannon Medical Center wrote off $47.9 million in uncompensated care costs to the uninsured and underinsured, said a spokeswoman for the hospital.

The hospital is a nonprofit hospital and serves patients regardless of ability to pay.

Having health insurance at a time when a growing number of people don't have insurance will not save people from the effects of shortages of nurses and available physicians, nor from a lack of available hospital beds, Stultz said.

Esperanza Health and Dental Centers in San Angelo, which has clinics designed to provide health care to the medically underserved, is making efforts to address problems caused by the growing number of uninsured.

A big reason Esperanza has raised money to build its third clinic, set to open in February, is to cut down on the number of people using emergency rooms for primary care, said Mike Campbell, Esperanza chief executive officer.

As of 2006, about 28 percent of San Angeloans were uninsured, Campbell said.

Last year, Esperanza treated 13,500 individual patients, Campbell said.

About 52 percent of Esperanza patients have Medicaid, Medicare or a third-party insurance. The rest are uninsured.

"Something needs to be done," Campbell said.

"The first thing is that people need to understand how grave the situation is."

Writing off debt

Every year, Shannon Medical Center incurs the expense of providing uncompensated health care to the uninsured and the underinsured. Here are the hospital's combined charity care and uncompensated care numbers for the past three years:

    * 2005: $36 million.
    * 2006: $35.8 million.
    * 2007: $47.9 million.

Hospital association goals

During the 2007 legislative session, the Texas Hospital Association began advancing a series of proposals to address the uninsured rate. Several of these proposals will be studied by legislators during the next year for possible consideration during the next legislative session, which starts in January 2009. These proposals include:

    * Creating access to a new, more affordable minimum benefits package that provides preventive and primary care health coverage with a low deductible for Texans and their families.
    * Making health insurance products affordable and accessible to regional or statewide pools and cooperatives of individuals and small employers.
    * Providing incentives for businesses - including hospitals - to pay a reasonable percentage of an employee's health insurance premium or pay into a state pool providing health care coverage for uninsured individuals.
    * Requiring that companies receiving state enterprise fund assistance or local tax rebates, as well as those companies that do business with local and state government, provide adequate and affordable health insurance to their employees.
    * Establishing a personal mandate - similar to auto insurance - that requires individuals to have at least a minimal level of health insurance coverage, with premium assistance for certain low-income populations and the disabled.
    * Allowing parents to cover adult children on their health insurance policy, regardless of age or student status.
    * Leveraging federal matching funds for Medicaid more effectively and efficiently at the state and local levels.
    * Allowing adult family members of children enrolled in government insurance programs like CHIP, to buy into these programs and become insured, based on their ability to pay.