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Today in Texas and the U.S., the foundational questions regarding health care are questions of justice: Is health care an optional commodity, a necessity, or a right? Should all people have access to the exact same level of care in every situation? Should resources be distributed within the community to ensure that all members of the community receive the same quality of goods and services? Who gets to decide? All of...
Today in Texas and the U.S., the foundational questions regarding health care are questions of justice: Is health care an optional commodity, a necessity, or a right? Should all people have access to the exact same level of care in every situation? Should resources be distributed within the community to ensure that all members of the community receive the same quality of goods and services? Who gets to decide? All of these questions relate to the core issue of just distribution of resources. If resources were inﬁnite, everyone could have everything they want all the time—but because they are limited, we must develop systems as a community to ensure that resources are divided in ways that meet our collective and individual needs without unduly burdening some members of the community. In the area of health care, justice questions are primarily questions of health care ﬁnance.
Ensuring affordable access to quality healthcare is one of Texas' biggest challenges. For two decades, Texas has led the nation in the percentage of the population without health insurance.
Almost 6 million Texans—one out of every four people in our state—lack any kind of health insurance.
Texans have seen health insurance premiums jump forty percent in just five years—ten times faster than Texas household incomes.
More than eighty percent of uninsured Texans are in working families, and three quarters of them make incomes above 200 percent of the Federal Poverty Level.
Health insurance is too integral to the state’s health care infrastructure to be treated as an optional commodity. Texas has a responsibility to enact legislation that will enable its residents to get the health insurance and healthcare that they need and should frame health care as a project of community and balance:
Health care ﬁnance system should provide a level of care to every member of the community that those with the most means would consider necessary for themselves and their loved ones.
Every member of the community should contribute to the system relative to their means.
The system should serve the community as a whole, not individual members of the community.
- The system should create expectations of personal responsibility while acknowledging the certainty of irresponsible behavior by individuals.
Health insurance remains the Achilles heel of Texas’ economy. More than one out of every four nonelderly adult Texans is uninsured, rendering Texas the most uninsured state in the nation.
While health insurance alone cannot guarantee good health or long life, research confirms that access to coverage is associated with a number of positive health related impacts such as having a regular doctor; receiving timely preventive care services; better management of chronic health conditions; improved health status, particularly among people with chronic health problems; greater workforce participation; and longer life expectancy. Health insurance also protects families financially.
Widespread lack of health insurance results in distortions in public spending. A primary concern is the impact on local government, where tax revenues often go to pay for indigent care at the expense of infrastructure, education and other priorities. At the state level, lawmakers allocated about $1 billion in general revenue in the current biennium to treat diseases and conditions for specific low-income populations that would be covered under a typical health insurance policy.
Texas has the opportunity to cover more than a million nonelderly adults using federal funds made available through the Affordable Care Act (ACA). The ACA provides federal Medicaid funds at an enhanced 90 percent match rate to allow states to provide health insurance to low-income adults. States have the option to use the funds to expand their existing Medicaid programs to non-elderly adults with incomes below 138 percent of the federal poverty level, or to implement other coverage expansions that provide quality health insurance to the same population.
Legislators also can help to improve health insurance conditions for individuals above 138 percent of the poverty level. Texans will benefit from these provisions as well, but they will benefit far more if lawmakers direct the Texas Department of Insurance (TDI) to protect health insurance consumers by intervening in rate increases and to ensure that consumer health insurance information is accessible and useful. Legislators also should direct TDI to use existing fund balances from now-defunct programs to strengthen Texans’ health insurance, through strategies such as establishing a grant program for local communities to improve health insurance conditions.