Health Care and Texas: - PDF Free Download

Health Care and Texas: Where We ve Been & Where We re Going Kevin C. Moriarty President and CEO May 4, 2011

Overview Introduction Determinants of Health The Health Care Dilemma Chronic Disease Texas Legislative Session Health Care Reform Health Care and Bioscience Industry

About Methodist Healthcare Ministries Our Mission: Serving Humanity to Honor God by improving the physical, mental and spiritual health of those least served in the Southwest Texas Conference area of The United Methodist Church. Who We Are: Dedicated to providing medical and health-related services Low income families and the uninsured 242 authorized sites throughout South Texas Largest private funding source for health services in South Texas Half owner of Methodist Healthcare System

About Methodist Healthcare Ministries What We Do: Budgeted expenditure of $60,000,000 in 2011, to provide over 500,000 client encounters. This is achieved through programs owned and operated by MHM and through contracts with partners who have similar missions. MHM Programs/Services: Wesley Nurse Health Ministries Grants management Church Based Counseling Advocacy and Public Policy Parenting Programs Family Wellness Programs Health Education Behavioral Health Services School Based Health Centers Charity Care Clinical Services (Primary and Medical)

Determinants of Health Health Care 10% Lifestyle (Smoking, Obesity, Str ess, Nutrition, Blood Pressure, Alcohol, and Drug Abuse) 51% Environment 19% Human Biology 20%

Determinants of Health 19% What's Really Killing Us? Half of all deaths can be attributed to these factors Heart Disease 14% Causes of Death Cancers Respiratory Disease Infant Deaths Heart Disease Cancers Diabetes Infant Deaths 5% Heart Disease Cancers Injuries Infant Deaths 12% Heart Disease Cancers Diabetes All Injuries Respiratory Disease HIV/AIDS Infant Deaths Tobacco Use Diet/Activity Alcohol Use Other*

High Cost of Care

HCR: High Cost of Care & Access It is ALL Connected!

Access to Care Percent Uninsured U.S. Average: 15.1% Mass. 4.1% Texas 24.1%

Texas Demographics: The Uninsured Currently in Texas: 4.5 million uninsured adults 1.2 million uninsured children 5,745,286 people South Texas Uninsured: Bexar County: 352,944 (22.3%) Webb County: 85,696 (36.2%) Hidalgo County: 273,887 (38.0%) Cameron County: 139,388 (35.7%)

Why Health Care Reform is Critical: Access Percent Persons with No Health Insurance Coverage (2008) 29.4% -38.0 %

Why Health Care Reform is Critical: Access Texas Businesses Offering Coverage by Size Percent off fering coverage 120% 100% 80% 60% 40% 20% 0% Less than 10 10-24 25-99 100-999 1,000 or more Number of employees

Texas Uninsured by Income Today 88% of 6.4 million uninsured <400% FPL 300-400% FPL $66,200-$88,200 >400% FPL >$88,200 <100% FPL <$22,100/yr for family of four 250-300% FPL $55,100-$66,200 200-250% FPL $44,100-$55,100 100-150% FPL $22,100-$33,100 150-200% FPL $33,100-$44,100

Obesity in Children Texas ranks 7 th highest in the nation for obesity in 10-17 year olds 42% of 4 th graders in Texas are obese or overweight Obesity associated annual hospital costs among children (x3) in the past three years due to a (x2) of diabetes cases, a (x3) of gallbladder disease and a (x5) in sleep apnea. The US Surgeon General s Office reports that overweight children have a 70% change of becoming overweight or obese adults 34.1% low-income children (2-5) are overweight or obese in Texas. Sources: Texas Health Institute, Obesity in Texas: Reaching Epidemic Proportions and Responding to the Epidemic: Strategies for Improving Diabetes Care in Texas, Center for Diseased Control and Prevention, National Hospital Discharge Survey National Initiative for Children s Healthcare Quality, 2008 Pediatric Nutrition Surveillance System

Diabetes in Texas Diabetes is the 6 th leading cause of death in Texas 4 th leading cause among Hispanics and African Americans Diabetes is the leading cause of kidney failure, non-traumatic limb amputations and blindness Approximately one in every 400 to 600 Texas children and adolescents has Type I diabetes. In 2009, Children s Health Insurance Plan (CHIP) payments for diabetes related services were estimated at $3.8 million Sources: Texas Diabetes Council, Diabetes: A Comprehensive Approach, 2010 Texas Health Institute, Responding to the Epidemic: Strategies for Improving Diabetes Care in Texas, 2010.

Projected Diabetes Percentages in Bexar County 2010 2020 2030 2040 Bexar County 13.5 % 19.0 % 22.6 % 25.7 % State of Texas 11.9 % 17.1 % 20.8 % 23.8 % County Projections of Diabetes in Texas Source: Texas Health Institute, Responding to the Epidemic: Strategies for Improving Diabetes Care in Texas

Ratio of Providers per 100,000 Population 2008, by geographic location Occupation Texas Urban Rural Border Non-Border Border Non-Border Primary Care Physicians 68.4 52.8 72.7 35.4 55.0 Physician Assistants 17.3 13.5 18.5 16.0 12.8 Dentists 37.2 16.5 41.8 11.9 25.3 Dental Hygienists 38.8 18.4 42.9 8.8 30.3 Registered Nurses 671.3 483.1 730.9 230.6 470.1 Licensed Vocational Nurses 277.5 202.9 257.2 298.8 473.9 Pharmacists 77.0 42.7 84.9 31.5 56.4 Psychologists 25.9 8.7 30.3 6.2 11.7 Social Workers 67.1 45.0 73.4 20.4 46.9

$27 Billion Shortfall in Texas State Budget General Revenue Fiscal 2011 Ending Deficit Set aside for Rainy Day Fund TOTAL GR AVAILABLE Minimum needed for current services, considering population growth & health cost inflation GAP: 2012-13 Forecast $77 billion - 4 billion - 1 billion $72 billion $99 billion $27 billion Source: Center for Public Policy Priorities

GR Shortfall in HB 1 as Introduced RequestedGR Recommended GR General Revenue Shortfall HHS $ 31.0 b $ 20.0 b - $11.0 b Education 56.4 b 41.7 b - 14.7 b Criminal Justice 9.2 b 7.5 b - 1.7 b The rest 6.2 b 4.1 b - 2.1 b Total $ 102.8 billion * $ 73.3 billion - $29.5 billion Source: Legislative Budget Estimates, HB 1: * excludes $4 billion requested by TXDoT

Worst States for Children IN THE COMPANY OF POOR STATES State MedianHousehold Income in 2009 % of Children in Poverty in 2009 Arkansas $38,815 26% South Carolina $43,625 21% Texas $50,043 23% Oklahoma $42,822 22% New Mexico $43,508 25% Mississippi $37,790 29% Louisiana $43,733 27% http://everychildmatters.org/resources/reports

Health Care Reform The Patient Protection and Affordable Care Act (HR-3590) Expands health coverage to 32 million previously uninsured citizens. Includes Medicaid Expansion to 133% FPL. Creates a State-Based Insurance Exchange System Employer and Individual Mandate Puts in place Insurance Reforms: Puts in place Insurance Reforms: No lifetime limits on coverage No exclusion based on pre-existing conditions No penalty based on health status No rescission of coverage

Health Care Reform Improves Prevention and Wellness Programs Medicare beneficiaries will be provided annual physicals Created the Prevention and Public Health Fund Provide grants to small employers for wellness programs Invests in Health Care Workforce Establishes a multi-stakeholder Workforce Advisory Commission Increase the number of Graduate Medical Education positions Provides additional scholarships & loans to increase workforce Supports the development of training programs.

Health Care Reform The Patient Protection and Affordable Care Act (HR-3590) To date: Increased funding for Community Health Centers ($11 Billion) Increased dependent age to 26 years old. Created medical home pilot programs. Provided grants for employer wellness programs. Created reinsurance for early retirees. Medical loss ratio limitation (85%) Cobra extension until the Exchange is fully functional (2014) Ban on Lifetime Limits Prevent Health Insurance Rescission Pre-Existing Condition Exclusion for children Initiated the closing Medicare Part D, doughnut hole Provided a small business tax credit (35%)

Health Care Reform The Patient Protection and Affordable Care Act (HR-3590) IN 2011 Eliminates barriers in Medicare Low-Income Subsidy. Increases reimbursement for primary care (10%) Establishes a free annual wellness test for Medicare beneficiaries Additional funds to states with high unemployment costs. IN 2012 Improves low-income protections in Medicare Directs CMS to track hospital readmission rates Extends months of coverage of immunosuppressive drugs for kidney transplant patients.

Health Care Reform The Patient Protection and Affordable Care Act (HR-3590) IN 2013 Begin paying physician based on value not volume. Comprehensive health insurance reforms initiates. Creation of health insurance exchange. Subsidy (tax credits) made available. Individual and employer mandate effective. IN 2014 Health insurance exchange expands. Medicaid expansion to 133% FPL. Open exchange to individuals with employer based coverage. Reduces overpayments in Medicare advantage.

Health Care Reform The Patient Protection and Affordable Care Act (HR-3590) What results? Significantly reduces the federal deficit: o $138 Billion (2010 2019) o 1.3 Trillion over the next decade (2019 2029) Reduces costs and improves outcomes for consumers Extends solvency of Medicare, which protects senior citizens. Establishes a competitive marketplace for consumers to shop for insurance coverage. (Health Insurance Exchange) Establishes pilot programs for continued innovation.

Source: The Greater San Antonio Chamber of Commerce, San Antonio s Health Care and Bioscience Industry

DOALLTHEGOODYOUCAN, BYALLTHEMEANSYOUCAN, INALLTHEWAYSYOUCAN, INALLTHEPLACESYOUCAN, ATALLTHETIMESYOUCAN, TOALLTHEPEOPLEYOUCAN, ASLONGASEVERYOUCAN. ~ John Wesley Founder of Methodism

For More Information Contact: Methodist Healthcare Ministries www.mhm.org (210) 692-0234 page