A New Healthy Texas


Five Steps to Improving the Health Care Safety Net in Texas

The future of our health care system may be uncertain right now, but the way I see it, here are the five major things we need do to dramatically improve the health care safety net here in Texas.  Over the next few blogs, we will explore each of these steps more thoroughly.

  1. Increase coverage for those who need public health insurance; reduce the number of people who need it:  We need to increase eligibility for public health insurance and subsidies for those who are not being caught by the safety net.  In the same vein, we must work to make sure that fewer people need the net in the first place. Capping enrollment in safety net programs does not solve the problem.
  2. Maximize and streamline funding: Between the current Medicaid fund and new money in the Affordable Care Act (ACA), there are plenty of funds to cover more people… if only we stopped to figure out how to claim our share of the pot.  At the same time, we need to combine the fragmented funding streams of existing programs: Medicaid, CHIP, mental health authorities, public hospitals, state hospitals, special programs for women and children, etc.
  3. Make the health care safety net easier to use while building personal accountability into the system: We need Washington to allow Texas to simplify Medicaid and ACA rules down to the common sense basics, rather than maintaining overly complex requirements.  At the same time, we need to build personal accountability into these programs through financial and educational means, such as co-payments, enrollment fees, and rewards for healthy behaviors.
  4. Reduce waste, increase efficiency, and improve care: It is imperative that we figure out how to decrease the per capita cost of safety net health care.  Rather than simply reducing fees to providers, we need to figure out how to streamline administrative burdens of public programs, incentivize the most cost-efficient, evidence-based care possible, and better utilize managed care organizations in the private market to improve quality and to control costs.
  5. Enhance philanthropic efforts by building private/public partnerships: Texans are a very generous group.  We need to capitalize on that generosity by coordinating charity services with public programs in ways that get donors and recipients the biggest bang for their buck.

In Texas’ last legislative session, we started down the right path with Senate Bill 7.  We now need to continue working to improve the lives of the least fortunate in the state, while moving to a sustainable, rational, and coordinated program.


  1. Have you looked at the Mayo Clinic’s Rochester Facility and their program of having a team of diagnosticians from many disciplines assess the patient so that tests are not repeated and others can be combined? It has been very cost effective to have the whole body treated as opposed to not taking into account overlapping symptoms and having to go to several appointments with doctors who may or may not communicate with the others.

    I have some form of Myasthenia Gravis, Polymiositis, and Fibromyalgia. They share many of the same symptoms. I also have Osteoarthritis and am losing bone density because I cannot exercise. I am a shut in when the weather is 84 and above and the humidity is rising. I have many side effects that would be diagnosed as something else if the doctor was unaware of the other disease processes.

    I am on Medicare. In January 2014 all of my doctors dropped my insurance plan and stopped seeing Medicare patients unless they were willing to pay the full cost of an office visit. I was not. It took 6 to 10 months to find replacement doctors. I had to change insurance coverage to get doctors. There was only one plan available. The main doctor I depend on is a neurologist. He informed me that he will try to find me another neurologist because he doesn’t deal with neuromuscular autoimmune disorders. The plan doesn’t have a neurologist who does, so I will be forced to drive 35 miles, pay for parking, and go to either the Neurological Institute or the MDA. I live less than a mile from a satellite medical center which is part of the Houston Medical Center. I can’t use any of the hospitals there, they aren’t in my network. I have to go 15 miles to the nearest network hospital. If I have a myasthenic crisis, that 30 minute drive is too long.

    Anyway, I just wanted to remind you of some of the other stumbling blocks that are thrown in our way. I won’t even mention how they are cutting off pain meds to chronic pain sufferers. It just seems too ridiculous for words. Get the bureaucrats and politicians out of our medical decisions, please. They are making us sicker.


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