THA – Who We Are

1. THA – Who We Are • The Texas Hospital Association is a nonprofit trade association representing Texas hospitals and health systems. • In addition to providing a unified voice for health care, THA serves its 500+ members with advocacy, timely information, data analysis, education on essential operational requirements, networking and leadership opportunities.

2. Top Three Concerns - Tom Green County* • Health Issue- • Not having enough money to pay the doctor, buy Rx drugs, or get medical insurance (most serious) • Health Issue- • Prevalence of anxiety, stress and depression • Economic Issue- • Unemployment, finding it difficult to budget • * Concerns identified by 2,015 households in the 2004 Comprehensive Needs Assessment of Tom Green County

3. Why Health Care Matters to Everyone • A health care system brings employers and professionals to community • Hospitals are one of biggest employers in each community • Responsibility of providing health care to uninsured increases costs to everyone • $1551 of you health insurance premium is paid to cover the cost of care for uninsured • Cutting health care funding ≠ less sickness… only shifts burdens to local governments, hospitals and people of Texas

4. Access to Health Care Matters Here • 50% of households served by hospitals report an avg. income of $35K/yr=working poor • 50% of these households have a high school diploma or less • Major community health issues: • -Lack of affordable medical care • -Alcohol and/or drug abuse • -Teen pregnancy • -Lack of adequate medical care or lack of MDs • -HIV/AIDS • -Mental illness or emotional illness • *2004 Comprehensive Needs Assessment for Tom Green County

5. Economic Losses from Cuts to Texas’ Medicaid Program and CHIP* • For every $1 cut in state funding for CHIP and Medicaid: • $2.32 in lost Federal health care funding • $6.92 in gross state product losses • $1.59 in increased insurance premiums • $0.58 in local government cost increases and revenue losses * The Perryman Group, February 2005, THA commissioned report

6. Local Economic Losses from Cuts to Texas’ Medicaid Program and CHIP* • State of Texas-Health Services Alone ($ 1.5B) • County Total Expenditures Losses • -Tom Green ($ 32,500,000) • -Coke ($1,000,000) • -Concho ($810,617) • -Irion ($ 388,863) • -Runnels ($3,400,000) • -Sterling ($ 274,941) • Planning Region-Concho Valley-($44,400,000) • * The Perryman Group, February 2005, THA commissioned report –Total expenditure loss figures include Gross Product, Personal Income and Retail Sales categories

7. The Crisis Is Real - Putting It in Perspective • Texas leads the nation in the percent of uninsured residents—Nearly one in four=about 5.6M lives • The number of uninsured Texans could fill the UT football stadium more than 70 times • There are more Texans without health insurance than the entire population of the DFW metroplex • 79% of the uninsured work or have a working family member—however, insurance is either not available or unaffordable

8. The Challenge of the Uninsured in Texas* • Over 50% of the uninsured are poor—incomes at or below $41,300 for family of 4 • Roughly 75% of the uninsured are US citizens • Almost 60% of the uninsured are under age 34 • Small businesses = 72% of all private employers, but only 24% offer insurance--citing affordability and complexity of the market as barriers • More than 75% of part-time employees in Texas work in jobs that offer insurance, but only 23% of these workers qualify for coverage • *Texas Dept. of Insurance Data on Uninsured Texans

9. The Challenge of the Uninsured in Texas More Uninsured Texans = Higher $ Premiums = More Uninsured Texans = Higher $ Premiums = More Uninsured Texans = Higher $ Premiums = More Uninsured Texans = Higher $ Premiums ∞

10. 80th Legislative Session • THA’s #1 Priority • Increasing Access to Affordable Health Insurance and Health Care

11. Legislative Solutions to Discuss • Interim work to educate; develop reform principles • Thinking “Outside the Box” on Solutions for the Uninsured • Medicaid Reform and Provider Payment Restorations • Access for Children to Healthcare • Workforce Shortages Addressed • Transparency of Health Care Costs

12. 80th Legislative Session Atmosphere • No $10B shortfall or school finance reform as in past • The bolo tie proclaimed the Official State Tie • Athens officially named the origin of the cheeseburger • Speakers Race and then House attempted to move to vacate the chair of the Speaker • Senate gets Feisty • Conflict with fiscal conservatives and the reality of Texas’ expanding health care demographics

13. Hospitals Think “Outside the Box” for Solutions • Regional or statewide premium assistance programs for small employers --$ 1M Budget impact (SB 922 moved to SB 10) • Require companies receiving Texas Enterprise Fund to provide insurance to employees -$0 Budget impact (SB 1023-died) • In awarding government contracts, give preference to companies that provide insurance -$0 Budget impact (HB 1182-died) • Allow parents to carry coverage for children on their policy without regard to age -$ Budget impact undetermined (HB 3361-died) • Health Care Coverage for Texas Omnibus Bill -$3.2B Budget impact (HB 2863-died)

14. Reform Medicaid - Possible Solution • Medicaid Reform – SB 10 • Authorizes THHSC to develop “multi-share” models for premium assistance • Allows establishment Health Opportunity Pool to preserve federal dollars for uncompensated care (Medicaid Dispro Dollars and Upper Payment Limit Funds) • Requires THHSC to standardize reporting of uncompensated care in hospitals • Creates Legislative Oversight Committee • Creates Committee on Health and Long-Term Care Insurance Incentives • $17M Budget impact

15. A Real Solution – CHIP, CHIP Hooray vs. CHIP Away! • CHIP Restorations – HB 109 • 127,000 children added to program • 12-month continuous eligibility w/ 6-month income check for >185% FPL • Deduction for child care expenses • Modification of asset test • Removed 90-day waiting period for most cases • $69.2 M Budget impact--but $2 from feds for every Texas $1 spent

16. A Real Solution – Addressing Nursing Shortage • Nursing Shortage in Texas is critical: • By 2010 Texas will be short 27,000 nurses • Texas hospitals average 11% RN vacancy rate • Average age of nurse is 46, nurse faculty is 54 • 11,000 qualified students turned away from nursing schools in 2006 • SB 992 and HB 1—almost $20 million to address faculty shortage • SB 993—improve the workplace for nurses so they will stay in the profession We must recruit AND retain nurses!

17. A Real Solution – Addressing Physician Shortage • Graduate Medical Education (GME) Funding • Battle of the Budgets—Higher Ed vs. HHSC • No funding for GME in the Medicaid budget • Residency slots in Texas lower than other states— TX-5900, CA-9500, NY-14000 • 45% of Texas medical students go to residency slots out of state Code Red Report Recommendations: • ⇑ the number of annually graduating MDs from Texas medical schools by 20% over the next decade • State support of residency programs should ⇑ slots by 600/biennium for the next decade

18. Transparency of Health Care Costs to Consumer – A Real Solution • SB 1731 by Senator Duncan: • Expands consumer access to health care information – TDSHS and TMB • TMA, TAB, TAHP, TASCS collaboration • Information on facility and physician pricing practices • Addresses balance-billing by facility-based physicians • Health plans required to report provider reimbursement rates to TDI for aggregate reporting to public • Website for Texas Hospital Inpatient charges- http://www.txpricepoint.org

19. So, What’s Next??? • The 81st Legislative Session is 16 months away!!

20. THA will continue to: • Work with the SB 10 committee to study ways to reduce uninsured • Make health care an issue in upcoming elections • Educate business community that funding Medicaid and CHIP is a good thing • Support and promote legislation that expands health care coverage • Support and promote legislation that funds the state’s health care workforce

21. Words to Ponder • “To preserve health is a moral and religious duty, for health is the basis of all social virtues. We can no longer be useful when we are not well.” • Samuel Johnson, English Poet/Writer