Address the social issue of healthcare reform in Texas. Focus on the number of uninsured residents, including the rise due to pandemic. Also, it is still one of the few states that have opted not to expand Medicaid, and how this affects low-income families.
Focus on government policies and tools to address the issue.
Identify, analyze, and provide policy suggestions for the issue. The paper should be 13 pages not including references, title, and abstract.
- Title Page
- Abstract
- Introduction
- Background of the Social Problem and Negative Consequences
- Existing Policy Solutions to the Problem
- Select the “Best” Policy Solution
- Why to choose a certain policy as the “best”
- Limitations of the “Best” Policy Solution
- Suggestions for Policy Change
- References
Texas Healthcare Reform
Abstract
Health care in Texas experiences numerous challenges due to its huge population and limitations in the current policy. The current health care challenges have been worsened by the COVID-19 pandemic, which increased the demand for health care services and reduced the ability to pay for services. The current policy in the country that addresses the needs of the uninsured in Texas is Medicaid. The policy provides health coverage to millions of people but has limitations that led to its expansion under the Affordable Care Act in 2010 as the best policy option. While the proposed policy will improve the number of covered Texans, it could create new challenges, such as poor management and a financial burden. Thus, significant policy changes are necessary if the proposed best policy, including better administration of Medicaid, addressing the government dependence by reducing the cost of some prescription drugs, requiring transparency in medical billing, and availability of telehealth and broadband services.
Introduction
Health care in Texas faces numerous challenges emanating from the ability of a considerable part of its population to pay for services. The current problem relates to the considerable gap between those who can pay and those who cannot pay for health care services due to lack of insurance coverage. The current analysis focuses on the current policy, which includes Medicaid as a source of payment plans for low-income individuals in the state. However, the policy remains inadequate, especially in the wake of the COVID-19 pandemic, which increased the demand for health care services while reducing the ability to pay due to economic lockdowns and loss of employment. Thus, a need exists to change the current policy environment to improve health access and close the health care gap, one of the options being Medicaid expansion. The state is one of the 12 in the United States that did not implement the expansion under the Affordable Care Act in 2010. While the state has numerous possible policy options, implementing the Medicaid expansion is the most effective and likely to address the current health care challenges, including a gap in access.
Background of the Social Problem and Negative Consequences
Texas is one of the largest states in the United States in terms of population and landmass. As a result, it faces a serious challenge in filling the health care gaps. The COVID-19 pandemic has worsened the situation in the state, with the gap in access to health care increasing. According to the Chief Executive Officer of the Texas Association of Health Plans, Jamie Dudensing, “more than 7 million Texans lived in a primary care shortage area, and 15 million lived in a behavioral health shortage area” (Shaheen, 2021, para3). A related challenge is the high number of uninsured in the state. The uninsured population in Texas is the highest in the United States, with almost one-third of its residents being uninsured. In terms of the volume of the uninsured, the state is still the leading in the country. The situation creates a crisis relating to access to quality health for the residents and widens the gap between those who have and those who lack access to quality care.
The COVID-19 pandemic widened the gap and worsened the situation of the uninsured in Texas. The pandemic, which emerged towards the end of 2019, has changed the state’s health care system completely. The state witnessed a pandemic-induced economic contraction that increased the number of people who could not pay for their health care. Besides, many lost their jobs and could not pay for their medical services even as the pandemic increased the number of ailing. The response to the pandemic, including the need for social distancing, demanded more significant use of telehealth. Unfortunately, a majority of the rural residents do not have access to the internet, meaning that they cannot access the much-needed medical services (Catalyst, 2018). While telemedicine holds great potential for the future of health care in the United States, many states have to improve their internet infrastructure first. As at present, many areas remain underserved, increasing the number of people who have difficulty getting access to health care.
Due to the high cost of care and the limited disbursement due to lack of adequate insurance, the state has been unable to acquire and retain adequate members of medical staff. While health care staffing challenges are common across the country, they are worse in some states, such as Texas, than others. The problem has been common in Texas health care facilities and has become worse due to the pandemic. A Republican representing San Angelo, Drew Darby, suggested that the increasing health care gap in the state could affect the staffing problem. Although the state has among the most significant number of individuals graduating from medical schools, it has problems retaining talent. Many of the staff move out of the state due to compensation challenges; they prefer to move to states with better remuneration. The state’s poor health care infrastructure lacks the incentive for professionals to work there.
Existing Policy Solutions to the Problem
The current policy action that addresses the problem of the high number of uninsured in Texas is Medicaid. Medicaid is an insurance program provided by the United States government and provides health coverage to millions of people, including low-income families. The federal government recognizes that some people are completely incapable of meeting their health care needs. Some qualifying people are eligible children and adults, pregnant mothers, the aged, and people with disabilities (Shaheen, 2021). Although it is a federal insurance program, states administer the program according to federal requirements. The state and the federal government pay for the program. The Texas Medicaid program remains limited regarding coverage for medical services. The number of medical services and eligibility for non-disabled adults is among the limitations inherent in the current Medicaid program in Texas. The robust economy and welfare reform in the state led to a decline in the enrollment for the program in the 1990s (Wiener and Brennan, 2002). However, after the decline, the enrollment started to improve again, leading to considerable pressure due to factors, such as an increase in prescription drug costs and efforts by providers to increase payment rates.
Regardless of having adopted Medicaid to provide access to health care to the low-income population, the state did not adopt Medicaid expansion, which was implemented as part of the Affordable Care Act in 2010 (Shaheen, 2021). The lack of expansion in the programs makes the policy more limited in coverage. It meant that many of the Texans were left out of the necessary medical care. For example, the program failed to expand eligibility for adults, especially those from low-income families and are not legible under the disability category. Besides, under the current policy, as many as 1 million people, mostly blacks, are left out of the system because they are considered ineligible for the public insurance cover. Under the policy, some individuals are categorized as making too much to qualify for subsidies, even if they are poor working class.
Under the current policy, many Texans are required to pay for their private insurance cover since they are considered as making too much to qualify for the publicly-funded program. Private insurance coverage means that some Texans have access to employer-sponsored coverage, in which the employer pays some part of the entire premiums to an insurance company on behalf of an employee (Berchick et al., 2019). Another percentage of the population buys and pays premiums for health insurance cover out of their pockets. Some are employees who receive their salaries and pay their premiums or business people who purchase their private medical covers. While a considerable part of the working population uses private insurance to pay for their medical services, another considerable part of the population is left out since they cannot afford the expensive policies. As a result, the current policy fails to address the wide gap in health care.
One of the significant trends in employer-sponsored and other private insurance coverage has been rising premiums, deductibles, and co-payments for the health care provided to patients. Another notable trend has been the growing costs of using out-of-network care providers instead of in-network providers. The changes are making it hard for a huge number of people in the state to be unable to afford such health care plans. In addition, private insurance providers are quite costly and competitive under the market terns, which a huge part of the population cannot afford. At the same time, they cannot pay for medical services through out-of-the-pocket plans due to their working-class salary. Texas’s current health care policy leaves out many people without access to quality care due to the lack of health insurance. Such as the people who could benefit from changes in the current health care policy.
The “Best” Policy Solution
While various policy actions could help to address the problem, expanding Medicaid is the best since it will increase the number of people insured under the publicly-funded insurance program. Since the state is one of the 12 that did not adopt the Affordable Care Act in the 2010 Medicaid expansion, a change in the direction will improve how people receive care (Shaheen, 2021). Implementing the expansion is believed to be a step in the right direction as it would be a cost-effective measure to close the gap in health care access. The policy decision would transfer most cost burden to the deferral government instead of being borne by the state. The move would also expand health care coverage for the many Texans who are currently left out. The current debate seeks to expand the coverage to ensure that as many Texans as possible are covered.
Medicaid expansion programs are necessary since they will help to reduce the number of low-income individuals in Texas without access to adequate health care. The proposed policy targets the working poor Texans, who would benefit from the federal funds to improve their access to health care services. Also known as the “Cover Outstanding Vulnerable Expansion-Eligible Residents Now Act,” the proposed law is a “homegrown solution to a decade of resistance by a handful of red states to allow more people who are struggling financially to access the federal health care program” (Harper, 2021, para 3). Expansion of Medicaid through the Affordable Care Act is anticipated to solve many of the current problems facing health care services in the state. The bill is also the pathway to improving the health of the Texans through access to better services at the health care organizations and telehealth. It is meant to address the prevailing gap worsened by the COVID-19 crisis.
According to the proponents of the proposed policy change, “for many of our most disadvantaged citizens, this bill offers a pathway to access a family physician, necessary medicine, and other essential coverage that thirteen States continue to deny” (Harper, 2021, para 4). Besides, The COVER Now Act will empower local leaders that the barriers to health care access that have been experienced at the policy level can no longer harm those at the bottom of the ladder. Under the proposed change, the United States Centers for Medicare and Medicaid Services will be the direct source of funds for the medical services. Thus, the state will no longer have the opportunity to decline to fund for some groups, as is the current case. Besides, it will ensure that the state cooperates and authorizes access to state Medicaid programs for the entities. The penalties for failing to cooperate will discourage is a form of complacency and improve access to many Texans.
A related proposal is to expand access to the marketplace to low-income Texans who will not have access to the publicly-funded program. If the government implements the policy to expand medical coverage through Medicaid, more Texans will be covered, some of whom could purchase private insurance. The decision will increase competition with private insurance providers (Barnett & Vornovitsky, 2016). The policy will have reduced the pool of potential customers for the private companies. As a result, the companies could be forced to reduce the cost of their medical insurance plans to compete for the remaining Texans without insurance coverage. Reducing the cost of their premiums could attract some of the remaining uninsured, even in the working class (Begley et al., 2017). Another option would be to create alternative plans (lower cost than the current ones) to take advantage of the remaining people without medical cover. Such changes will improve access to health care and reduce the current health care gap in Texas.
Why the policy as the “best”
The choice of the policy as the best is informed by the need to improve the state’s current funding for health care. Notably, the current policy is not effective in ensuring that as many as possible of the poor working class in the state are covered under public health insurance. Thus, the most effective policy is one that will provide adequate funding for insurance coverage. The proposed policy is effective since it will ensure that Texans who lack access to medical insurance are covered through a policy funded by the federal government. The proposal is necessary and ensures that finances are enough to close Texas access to medical services. Notably, the current policy is limited by funding, which will be eradicated by bringing the federal government into the picture.
Another factor behind the choice of the policy is the eradication of policy and political barriers that have prevented those at the bottom from accessing quality health care in Texas. The current policy has been largely financed at the state level, allowing local leaders to create hindrances to the provision of health care, especially to the people of color. They have experienced discrimination in how the program is administered. However, through the expansion of health care, the current public health insurance, and the federal government’s increasing role in the program, such barriers will be eradicated. The obstructionists at the top will no longer have the opportunity to harm those at the bottom of the ladder (Harper, 2021). The state will have the chance to apply directly to the United States Centers for Medicare and Medicaid Services for financing, eradicating the danger of being declined like was the case with the current policy.
The selected policy will expand Medicaid to approximately one million Texans, a significant leap in the right direction. If implemented, the policy will ensure that many people suffering from health disparity due to lack of access have better services. One of the consequences of lack of coverage is an increase in disease burden for the people left out of the current program. Many Texans suffer from preventable diseases and bear a considerable burden of disease because they are lack insurance cover. While the problem has always been experienced, it became worse during the COVID-19 pandemic, when more people became sick and lacked the resources to seek medical care. The state also experienced a risk of a high number of deaths from the virus and other diseases because of poor access. Thus, expansion of coverage to another one million Texans will play an essential role in addressing the health care crisis.
Limitations of the “Best” Policy Solution
Regardless of the seemingly positive side of the proposed policy, it has some limitations that should be addressed to improve it and access to quality care for Texans. One of the major concerns for the opponents of the new policy is the cost of maintaining the expanded Medicaid program. Some of the opponents feel that the expanded Medicaid to approximately one million Texans will be financially unsustainable. They also feel that the new policy change will create a more significant burden to the current Medicaid program. Some claim that the current system is already “a poorly performing program which leaves millions of low-income and disabled Americans without real access to quality care” (Harper, 2021, para 13). Thus, making changes to the same program will worsen the situation, create a worse crisis, and increase the healthcare delivery gap.
Another limitation of the best policy is potential poor management, just like has been the case with the current policy. Notably, the current proposal does not include any suggestions for changing the current administration of the Medicaid program. Creating a policy change in the current environment might not change the underlying management, meaning that the new system will replicate the issues inherent in the prevailing system. The federal government could provide the funds for implementing the expanded Medicaid, but the money will pass through the same state administration, creating a loophole for mismanagement. The policy change could be well-meaning, but the current programs for their administration will hinder the effectiveness, maintaining the health crisis or even making it worse. Therefore, poor management is a factor that should be considered when implementing the expansion of Medicaid in Texas.
Another limitation of the best policy is the possibility of crowding out children and people with disabilities, who are more deserving of Medicaid. When the policy is implemented, there is a risk of increasing the number of low-income adults. The change could overstretch the current government’s ability to meet the health care needs of Texans. As a result, some people who are incapable of competing with abled low-income adults, such as children and people with disabilities, could miss out on the chance to get medical coverage and treatment. As a result, the proposed change could cause poor health outcomes for a considerable population of Texans. While expected to address the health care gaps in the state, the policy could widen the gap.
Suggestions for Policy Change
Significant policy changes are necessary if the proposed best policy effectively addresses Texas’s current health care crisis. One of the changes should be in the administration of Medicaid in the state. The proposed changes should be accompanied by changes in how the health care program is administered in the state. For example, the federal government should manage the program to prevent the bureaucratic issues that bar legible Texans from access to medical care. The federal government should also ensure that the funds provided for medical services are used well to close the health care gap in the state. Proper monitoring and surveillance will improve Medicaid-related service delivery and improve Texas’s overall health care situation.
Another policy change to improve the health care situation in Texas is addressing the government dependence situation. While Medicaid expansion sounds like the best policy for Texans, it breeds government dependence and creates a more significant burden for taxpayers. Thus, new policy measures could be implemented to address the issue and improve the situation in the state. These measures include reducing the cost of some prescription drugs to reduce the cost of care for most Texans. The change would ensure that even some of the uninsured patients can afford drugs. According to Watanabe et al. (2018), the highest proportion of the health care budget goes to prescription drugs. Thus, reducing the cost of the most commonly used drugs will ease the burden for Texans as well as the state and federal governments.
Another policy change that will improve the health care situation in Texas without overburdening the government is requiring transparency in medical billing. The government has always lost a lot of funds due to poor management of Medicaid and other government-funded medical programs (Blavin et al., 2018). The issue emanates from corrupt bulling systems that exaggerate the cost of medical services. The united states, including states like Texas, continue to face the problem of increasing the cost of health care (Papanicolas et al., 2018). Unfortunately, the cost does not reflect the actual cost of medical services provided to patients. Providers and pharmaceutical companies collaborate to exaggerate the cost of treatments and drugs, increasing the cost. At the same time, they deny deserving people the opportunity to have medical coverage since the current funds cannot cater to more patients. Thus, improving monitoring and surveillance to enhance accountability in billing will close the current loopholes through which Medicaid funds are lost.
Another significant policy change that could address the current limitations in health care and reduce the cost of services is expanding the availability of telehealth and broadband services. Telehealth is the future of health care and will help Texas address some of the current limitations in the prevailing and proposed policy changes (Tuckson et al., 2017). The government should invest more in improving internet access in the state, especially in the rural areas, to ensure more people have access. With the change, people will get medical services online instead of coming to the health care organization and hospitals for the same services. Telehealth will address the current problem in many ways. First, it will improve preventive care, which will reduce the number of people seeking medical treatment for diseases. Disease prevention has proven to be the most cost-effective solution to the current health care challenges in the United States (Dorsey & Topol, 2016). Secondly, it will reduce the cost of having to come to the hospital for services that can be provided via the internet or phone. Lastly, telehealth will improve disease management, which is necessary for positive health outcomes. The benefit applies to people with chronic conditions to avoid many trips to the hospital. Thus, the change will reduce the cost of care for the patient, health care organizations, and the state.
Conclusion
The state of health care in Texas needs significant improvements to meet the needs of all its people equitably. The state is the largest in the United States, creating a dire need for an effective health care system to meet the demand. However, the current state of healthcare is inadequate, creating a huge gap. Besides, the state did not implement the expansion of Medicaid under the Affordable Care Act of 2010. The state needs major policy changes, one of the best options being the expansion of Medicaid to improve coverage and reduce the gap. However, the expansion proposal, although it sounds like the best option, has some limitations that should be addressed. Apart from the potential expansion of the program, the government should implement other changes and measures to improve the overall health care system in the state, including reducing the cost of common prescription drugs, proper management, monitoring and evaluation of the billing system, and investment in telehealth and improving internet access. The most effective policy change should integrate all the proposed changes and measures to address the current situation and improve the state’s health care outcomes.
References
Barnett, J. C., & Vornovitsky, M. S. (2016). Health insurance coverage in the United States: 2015. Washington, DC: US Government Printing Office.
Begley, C., Hall, J., Shenoy, A., Hanke, J., Wells, R., Revere, L., & Lievsay, N. (2017). Design and implementation of the Texas Medicaid DSRIP program. Population health management, 20(2), 139-145.
Berchick, E. R., Hood, E., & Barnett, J. C. (2019). Health insurance coverage in the United States: 2018 (p. 2). Washington, DC: US Department of Commerce.
Blavin, F., Karpman, M., Kenney, G. M., & Sommers, B. D. (2018). Medicaid versus marketplace coverage for near-poor adults: effects on out-of-pocket spending and coverage. Health affairs, 37(2), 299-307.
Catalyst, N. E. J. M. (2018). What is telehealth?. NEJM Catalyst, 4(1).
Dorsey, E. R., & Topol, E. J. (2016). State of telehealth. New England Journal of Medicine, 375(2), 154-161.
Harper, K.B. (2021). Texas congressional Democrats propose bill to let local governments expand Medicaid without state consent, The Texas Tribune
Papanicolas, I., Woskie, L. R., & Jha, A. K. (2018). Health care spending in the United States and other high-income countries. Jama, 319(10), 1024-1039.
Shaheen, M. (2021). Experts discuss strategies to close Texas health care gap. Retrieved from https://stateofreform.com/featured/2021/02/experts-discuss-strategies-to-close-texas-health-care-gap/
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