By Joseph J. Wang
The May 5, 2002 issue of the Houston Chronicle features a front page article entitled "Health care: Crisis at the border" which identifies poverty and lack of health professionals as the primary causes for dismal health care in border regions of Texas.
According to the article, 27 percent of the border population lives below the poverty line and the per capita income is the lowest in the nation. Consequently, 25 to 35 percent of these people have no health insurance or coverage of any kind. Those living in the borderís colonias fare even worse with nearly 64 percent lacking health insurance. Further, there are not enough health care providers serving in border communities. In 2000, 31 of the 32 border counties were designated as medically underserved.
The combination of poverty, diseases, and lack of health insurance in border communities is tragic. In the Rio Grande Valley, for example, cervical cancer kills up to 8 per 100,000 per year and diabetes up to 32 per 100,000 per year. These figures represent more than twice the national rate for each disease! Serious birth defects including anencephaly, spinal bifida, hydrocephaly, craniosynostsis, ventricular septal defect, patient ductus arteriosus, and pyloric stenosis also are occurring along the border at alarming rates.
With the upcoming legislative session, Texas legislators and policymakers have an opportunity to tackle border health problems and serve the health care needs of all Texans. Several approaches should be considered to improve the state of health insurance coverage and increase the number of health professionals providing care in border regions of the state.
Promote Economic Development
The population of border regions in Texas continues to grow faster than the national average. To ensure that old and new border residents alike have access to basic health services, policymakers should consider options that will stimulate economic development in these regions. State support for infrastructure, education, research grants, and other strategic initiatives will create favorable conditions for the creation of new jobs and investment of private sector capital. With greater employment and more wealth in border areas, residents can secure jobs with health insurance coverage and afford the benefits.
Expand Medicaid and CHIP
Even for the many border residents who work, finding health insurance coverage thorough public and private channels is daunting. In the private market, many employers simply cannot afford to offer health insurance as a benefit to their employees. And if offered, many employees cannot afford to share the costs of the plan, which come in the form of premium payments, deductibles, and co-pays. Yet these low-income adults make too much to qualify for Medicaid. Policymakers should consider expanding existing public health coverage to the working poor. For example, the LBJ School of Public Affairs at the University of Texas-Austin has proposed taking advantage of Section 1931 of the Social Security Act to cover parents and Medicaid Section 1115 HIFA (Health Insurance Flexibility and Accountability) Waiver Expansion to cover childless adults. State planners at the Texas Department of Insurance have suggested a CHIP (Childrenís Health Insurance Program) buy-in expansion to cover the parents of CHIP kids.
Increase Medicaid Reimbursement Rates
Border regions of Texas are critically underserved and are in need of more health professionals. Unfortunately, few doctors are attracted to border counties where reimbursement rates for Medicaid and other federally funded programs are comparably lower than in other parts of the state. Doctors serving border communities end up working harder and for less money. The economic reality under existing reimbursement rates is that it will be difficult to attract new doctors to border areas and to retain those who are there already. Policymakers should consider the possibility of boosting Medicaid rates to ensure a steady supply of doctors and other health professionals in border regions.
Although attracting providers to border areas may be difficult for economic and other reasons, the provision of health care to these populations need not suffer. Telemedicine provides a viable option that allows doctors anywhere in the country to consult with and treat border patients. In fact, telemedicine may provide a more cost-effective solution to providing indigent care than face-to-face visits because many border residents live far from any health care facility. Policymakers should consider the use of telemedicine in addressing border health issues; however, they must also be aware of current barriers to telemedicine, including reimbursement for such services.
None of these policy options is automatic or simple. Policymakers must pursue them with unwavering vigor and make difficult tradeoffs along the way. They may find elusive a politically acceptable and economically feasible solution to border health problems. Without a doubt, it will take clear vision, strong leadership, and positive action at the state and local levels to ensure that border communities are empowered and able to protect the most sacred resource in the region, their own health. The stakes are high. Our border health is at risk.