MINUTES
SENATE COMMITTEE ON BLUE RIBBON TASK FORCE ON UNINSURED
Tuesday, June 27, 2000
9:30 a.m.
San Elizario High School, San Elizario, Texas
*****
Pursuant to a notice posted in accordance with Senate Rule 11.18, a
public hearing of the Senate Committee on Blue Ribbon Task Force on
Uninsured was held on Tuesday, June 27, 2000, in the San Elizario
High School, San Elizario, Texas
*****
MEMBERS PRESENT: MEMBERS ABSENT:
Senator Chris Harris Senator David Bernsen
Senator Eliot Shapleigh Boone Powell
Representative Garnet Coleman
Representative Craig Eiland
Representative Bob Glaze
Dr. Nancy Dickey
Dr. John Goodman
*****
The chair called the meeting to order at 9:40 a.m. There being a
quorum present, the following business was transacted:
Senator Harris thanked Senator Shapleigh, his staff and the
community of San Elizario for hosting the meeting. He stated how
important he felt it was for the committee to have a good
understanding of the health care issue on the border and in turn how
to extrapolate that information into a statewide report and
recommendations.
Senator Shapleigh stated in English and Spanish that there was
translation equipment for any that needed it during their testimony.
Representative Glaze moved adoption of the minutes from the previous
hearing held on May 10, 2000; without objection, it was so ordered.
Senator Harris stated that the committee had a time line in front of
them for the task force. There have been meetings in Harlingen,
Austin, Houston, Dallas and now El Paso and scheduled to hold
another on September 13, 2000 in Gilmer. The committee has received
a lot of input from these hearings as to the problems and extent of
the uninsured in Texas. In addition the committee has requested
recommendations from interest and advocacy groups as to the best
way to address the problem of the uninsured. He wanted the
committee to start thinking about each of their ideas and
recommendations that they might want to have included in the final
report.
Senator Shapleigh assumed the chair and called the first witness.
Listed in order of testimony are the following:
Dr. Tom Fullerton, Department of Economics & Finance, University of
Texas at El Paso (Testimony attached)
Pete Duarte, El Paso Hospital District, testified with Mr. Della
Rosa
Jose Manuel Della Rosa, Texas Tech University H.C. at El Paso,
testified with Pete Duarte
Tim Lubbers, Community Voices, West Texas Collaborate for CHIPS
program
Jose G. Moreno, Executive Director, Community Voices a 501.C3
organization to help facilitate different groups to come together
and work on the uninsured problem.
Frank Apodaca, Apodaca Health Care Associates/Community Voices
(Charts attached)
Irene Chavez, El Paso Regional Advisory Committee, (Notes for the
Workgroup on Border Rate Issues for Medicaid and CHIP meeting May
23,2000 attached)
John Romero, Executive Director, Centro San Vicente
Representative Norma Chavez, Representative from District 76
(Testimony attached)
Maria C. Alen, M.D., Chair, Texas Diabetes Council, a twelve-member
council appointed by the Governor of Texas (Testimony attached)
Don Gilbert, Commissioner, Texas Health & Human Services Commission
(Figures attached)
There were many questions and much conversation between the speakers
and task force members during the above testimony. After the
invited testimony public testimony was asked for.
Listed in order of their testimony are the following:
Irma Sales, came to share her personal observations as a tax payer,
a voter and native El Passion. She was sorry that more members were
not present to hear her convey what she believes to be the deepest
sentiments of the people in her community. Our Country says it
values human rights and life and deplores the likes of those that
gag and murder. Texas is one of the last states to implement the
CHIP program. Many health care agencies in her community expected
that they would deliver on the great promise of this insurance
program because Texas would surely avail itself of all the research
and all those lessons from all the other states in this great
country that have implemented a statewide children's health
insurance program. Frankly, what is really going on is that Texas
is playing a time game with the CHIP roll-out. The CHIP program has
really only served a minuscule of the big population need in El Paso
and Texas. She believes that the committee needs to research the
rumors that one of the CHIP vendors, the Texas Healthy Kids Program,
is going bankrupt.
Mary Davis, member of the Mission Valley Steering Committee an
organization that came together about a year and a half ago to help
establish priorities of about eight communities in the Mission
Valley area. When they held their summit to help establish the
priorities they thought they'd hear that the first priorities would
be water and sewage but to their surprise they found the first to be
transportation and second to be health care or the lack of.
Maria del Refuge Knaveries, needs surgery, a substance abuse program
and she is homeless.
Maria de Jesus, works for the largest substance abuse agency in West
Texas. She works with a population that is not only uninsured but
also homeless. Her figures show that in the El Paso area and across
the border in Juarez they are looking at 30,000+ heroin addicts,
20,000 cocain abusers; and another 20,000+ inhalant abusers. At
least 90% are uninsured. A large portion of these substance abusers
are also infected with some kind of sexually transmitted disease.
It seems to her that Texas has an epidemic/plague and no one is
really paying any attention to this population. Under medicaid
managed care, they have seen a drastic drop in reimbursement rates
and the problems seems to be getting worse. Her agency has signed
up for every managed care program available but they have faced so
many barriers. The pre-certification process for most patients is
unrealistic. She feels that all managed care providers should have
the same guidelines and rules.
Dolores Brines, a County Judge, has an idea for piloting a new
formula for state wide reimbursement. The county is charged with
providing indigent health care and they do so through the hospital
district, doing business as R.E. Thomasina Hospital. She thanked
the committee for holding the meeting in El Paso the largest border
metroplex in the world. El Paso and Juarez are geographically
isolated from other urban centers. Austin, the state capital, is
550 miles east and in another time zone. El Paso is an
international community whose location and population give it a
unique character and unique needs. It is the 19th largest MSA in
the United States and the Texas Department of Mental Health and
Mental Retardation data projects growth to 778,000 by the end of
2000. Juarez is rapidly approaching the 2 million mark. The
population in El Paso county is expected to continue to expand
rapidly at a rate of over 2% a year. The fertility rate in El Paso
county is 92.4%/per thousand versus 72.4 %/per thousand for the rest
of the state. In addition El Paso has the youngest population with
1/3 being under the age of 18. El Paso county is the 3rd fastest
growing community in the United States and the 2nd youngest in the
nation. In 1996, 31% of the county's population fell below the
federal poverty level including 42% of all children. The rural
areas of the county encompass six cities and townships besides the
city of El Paso and several unincorporated areas or colonias which
mirror third world conditions of extreme poverty and health risks;
10% of the county's families reside in the unincorporated
communities. Despite the perception that they are un-documented
immigrants, a majority are actually legal residents or citizens,
especially the children. As you can see geographic isolation;
small labor force participation (partly because of the youth,
undereducated population); low educational level; and high
unemployment all contribute to a depressed economy that is in
transition in a global environment. She asked for relief and equity
for the children and families of El Paso County. She asked that as
the committee implemented their stated goals that they consider the
way the goals are executed because as it now stands, especially with
regard to medicaid reimbursement rate and the CHIP reimbursement
rates, it would serve to render them impotent with regard to
improving their economic and health status. She had many other
facts and opinions as to the many reasons for the inequities
experienced by El Paso County and asked for the same consideration
given to other parts of the state.
Manny Najera, State Representative from District 75. Representative
Najera thanked the committee for being in El Paso. He stated that
those that live along the Mexican American border are almost being
told that they do not deserve equal treatment because they can go
the Mexico to get treatment. He hopes that payments to doctors and
hospitals for treatments under the CHIP program would not, in fact,
take into consideration that the citizens on the Mexican American
border can go to Mexico. When El Pasoans take there children to
Mexico for treatment, it is as a last resort and then the children
usually end up in the emergency room because the illness is so
advanced. It is a misconception that you can just go across the
border and get a prescription. Federal law requires that if you go
to Mexico and bring back medicine you must have a written
prescription from an American doctor. Now many pharmacies in Mexico
are requiring a prescription from a Mexican doctor before they will
fill a prescription. He stated that until we can assure the people
that any information they give on applications, such as CHIPS, will
not be given to the INS, we are not going to get them to apply for
CHIPS or any other program. It is a fact that if people have
received welfare from the State of Texas they can not become an
American citizen. People fear Federal officials and he sees this as
a HUGE problem. Senator Shapleigh wanted to see documentation that
the above is happening.
Gordon McGee, M.D.,an El Paso physician in practice for the past 35
years. He was representing practicing physicians. The El Paso
County Medical Society has about 1200 members in the community with
approximately 700 in the active practice of medicine. This is the
core of professionals that deliver over 80-85% of the medical care
in the community. These are the physicians that care for your
medicare and medicaid patients in this town. These are the people
that live here; devote their lives here; and practice medicine in
our community. The medicaid reimbursement rate for physicians has a
gross disparity. For example, a physician in Houston receives
$588.00 for a delivery and a physician in El Paso receive $368.00.
That is not fair. They call disparity the "D" word here. Some
people think that's discriminatory. Some people think this is state
sponsored discrimination but they think that is crassly inequitable.
The reimbursement rate hurts the community is many ways. He wanted
the task force to understand what the reimbursement rate does to
the infrastructure of the community. Take for example when he came
to El Paso in 1965, there were 25 pediatricians with a population
of about 300-350,000. Thirty five years later with the population
doubled there are still only 25 pediatricians. El Paso is the 5th
largest population in Texas. Every other major population area has
a children's hospital; El Paso has none. A doctor who sees a
medicare patient receives about sixty cents on the dollar on average
and about twenty five cents on the dollar for a medicaid patient.
So saying it politely, physicians loose money taking care of
medicaid patients. This can be seen by the number of physicians who
no longer take medicaid patients or cap their practice and take only
a fixed percentage of medicaid patients. In addition, you have what
the physicians call "harassment from the bureaucracy" that is not
considered physician friendly or user friendly. This comes in the
form of investigations or denials or paperwork that goes on
infinitum. What he would really like to see is practicing
physicians to be involved in the programs. Strange as it may seem,
those who have spent their professional careers in delivering
medical care, do know something about it. It seems they are being
managed by people who have never worked in the health care delivery
system; and don't really understand how health care delivery is
practiced; therefore resulting in bizarre off the wall regulations.
He believes a good public/private relationship, whether it be a
regional academic advisory committee or medical advisory committees,
would go a long way in helping the medicaid problem in becoming
very effective. He gave the state of Iowa as an example that the
committee should look at.
Lelia Onsurez, testified in Spanish
Lorenza Frairo, a middle class citizen of the United States who
doesn't qualify for Medicare or Medicaid. She wanted the committee
to know and understand why people have to go to Mexico to seek
dental and medical care. She is an example of the working poor.
She and her family work but do not have medical insurance; they do
not make enough money to pay for medical care but make to much to
qualify for aid. She does not want to be on welfare but feels as if
in some ways her family is being punished by being members of the
working class and feels, that by working and not being on welfare,
she and her family should not be penalized by a government that
doesn't appreciate the sacrifice they are making.
Sofino M. Carrillo, testified in Spanish
Sonia Deras, is a native El Pasoian, has her degree in Chicano
Studies and works for Superior Health Plan as a member advocate.
Superior Health Plan administers the Medicaid managed HMO care in El
Paso. Sonia had a very unique outlook on some of the problems due
to her work history.
Olaya Lares, is a medical assistant and works as an outreach worker
for Superior Health Plan. She primarily works with people that have
no medical insurance. They usually work at jobs that employee them
for less than 40 hours so that they don't have to pay for benefits
and most of the people have second jobs. This in turn causes them
to earn to much money to qualify for any of the assistant programs.
This is an example of the problems of the working poor.
Lorenza Zuniga, is a Promotores de Salud/community health worker.
She is a survivor of low social economics. She is a survivor of a
cancer and is living with diabetes. She considers herself
privileged that when she was diagnosed with cancer she was working
in the apparel business and had health insurance. She feels
privileged that she can pay for her prescriptions and the correct
food to eat. However, she understands what it is like to not have
those privileges. She spoke about her work in 1998 with Texas Tech
under the office of Border Health and the difficulty of educating
people about the CHIP program.
Guadalupe E. Ramos, works as a Promotores de Salud. Spoke about
some of the problems with the CHIP program and enrollment. For
example, when the children are born as citizens but the mother is
not a documented citizen, they are afraid to enroll their children
for fear of being sent back to Mexico or whatever country they are
from. There needs to be a clear cut answer for these parents about
the effect enrolling their children will have on them.
Maria Alvarado works as a Promotores de Salud. Testified in
Spanish.
J.P. Rogers, an attorney who lives on the west side of El Paso and
primarily practices Family Law. Spoke about her personal experience
with moving from a major corporation with insurance to going into
private practice and having Cobra for a cost of $107.00 monthly.
When Cobra expired the only insurance she could get was through the
Texas Risk Pool at $278.00. When she moved to El Paso her premiums
went to $308.00 a month. In addition to the $308.00 a month, she
must pay for visits to the doctor in full because there is no co-pay
with her insurance and each of her eight prescriptions cost $25 a
month. Because she is a sole practitioner she can not always pay
the total of $508.00 a month plus doctor visits. She also feels
that Austin treats El Paso as if they are another country.
Art Rodriquez, is the Community Development Director under the Kella
initiative. He is a retired Marine with 30 years of service. His
experience is in community service. He spoke of the CHIP program and
the lack of media attention to the program. He stated that his
community health workers are underpaid and overworked.
There were many questions, comments and conversation between the
task force members and speakers tee during the above testimony.
There being no further business, Senator Shapleigh moved that the
Committee stand recessed subject to the call of the chair. Without
objection, it was so ordered.
______________________
Senator Chris Harris, Chair
______________________
Myra J. Schmitt, Clerk