Sunday, April 15, 2007

The Real Story of The Uninsured in Texas

The Houston Comical treated their readers to a page one story on the uninsured in TX. Here are a few of the facts presented.


The Texas Health Institute, a nonpartisan health advocacy group, described them this way in a report that was released in January:

They work. At least 72 percent live in households where one or more family members work full time.

They are young. Twenty-three percent are children, and an additional 36 percent are between 18 and 34.

They are not all poor. Forty percent of families without coverage have incomes of $40,000 a year or more.

Geography matters. Almost half of the uninsured live in Texas' five largest urban centers, and Harris County leads the pack with about 1.1 million, according to state estimates.

Ethnicity matters. Hispanics are three times more likely to be uninsured than whites; blacks are twice as likely.

Now the Comical neglected to include some of their very telling demographic charts on the uninsured population in this online version but if memory serves me the magnitude of the uninsured Hispanic population in Texas under age 45 is in the neighborhood of 70%.

What they did include is that in South Texas 1/3 of the Hispanic population is uninsured. i would call that figure extremely conservative as noted below.

'Mecca of uninsured'

An even greater percentage of Texans are uninsured in the Rio Grande Valley. In Hidalgo, Cameron and Webb counties, all on the border, roughly one of every three residents is uninsured.

"We are ... the mecca of uninsured in our state," says Linda Villareal, an Edinburg physician and chairwoman of the Rio Grande Valley Health Service District. "We have the fastest-growing population but the lowest in terms of socioeconomics."

Medicaid is far and away the largest insurer here. The South Texas Health System, the largest health care provider in Hidalgo County with six hospitals, reports that 51 percent of its patients in 2006 were Medicaid recipients and only 10 percent had private insurance.

"South of San Antonio, if a doctor doesn't take Medicaid he's going to lose his business," Villareal said.

The Valley also has a large population of people who earn just enough to be disqualified from Medicaid. A family of four, for example, cannot earn more than $20,650 annually to get Medicaid coverage for children older than 6.

And there are thousands who qualify for Medicaid or CHIP but are not enrolled either out of ignorance or because they find it too difficult to keep up with the programs' myriad requirements.

Some legal residents are afraid to apply for aid because they have undocumented family members.

So you have half the the uninsured in TX living in the 5 largest Metropolitan areas and 90 of the patients in deep south Texas' Hidalgo County lack private insurance although 51% have Medicaid coverage. In this area people historically go across the border for free coverage, a point that is not referenced in the article. I know this because I have seen the loss ratios on valley accounts and it has historically been highly profitable for insurers. Why pay a deductible or coinsurance when you can cross the border and get treated for free? It remains to be seen what effect the new passport requirements will have on border crossings on foot. In the 5 largest metropolitan areas of Texas people without coverage regardless of citizenship access free coverage through hospital districts often in the ER. By the way, most of the best paying jobs for unskilled or semi-skilled labor are in the 5 largest metropolitan areas

Now understand I am making no value judgement here but it should be noted that there is a safety net in place. Further, when Comical reporters begin to put out wire service stories like this one its time to call them out on general laziness for not presenting the whole picture. I was once a paperboy for the Comical in my youth and must admit the only redeeming components are the paper today are the comics, the sports page and the obituaries. They certainly do not cover items like this story.

Property taxes are already an enormous political issue in Texas so when Health Care becomes free as a basic human right for all regardless of citizenship, expect more reporting as the masses initiate pilgrimages to Mecca. Be careful what you wish for over at TPM Cafe . How are senior citizens in Texas on fixed incomes going to stomach additional property taxes to fund free or subsidized health care for non U.S. citizens? This is not time for another unfunded federal mandate.

You ain't seen nothing yet folks.

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