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  
       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  
       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  
       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  
       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  
       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