Texas’ Fragmented Safety Net


A frequent push-back against expanding health coverage to all is “the poor and the uninsured have a safety net,” and often accompanies the poor advice: “they can go to the ER.” Passing over, for a moment, the terrible consequences of using hospital Emergency Rooms as primary care providers, let’s actually look at Texas’ fragmented safety net for health care services.

We have created a graphic (BELOW) showing, in part, the confusion patients face — and the bureaucratic confusion providers experience — in our current fragmented safety net system. Not only is┬áthe system fragmented and piecemeal, most patients have a limited understand of how they can be helped; so providers have an added burden of determining which program a patient is eligible for and what funding source can be used to cover the cost of the service. All of which contributes to the gaps and contradictions that frustrate the goal of actually caring for patients.

If you’re seeing this for the first time, keep three things in mind:

  • This graphic is drawn from our experience in Texas’ safety net, and while not comprehensive it is accurate as a snapshot of current reality.
  • While this may be self-evident, let us clarify that the patient goes to the provider for care, and the provider is reimbursed in part via some of the sources we identify here.
  • These funding sources do not meet all the needs.

SafetyNet Fragmented Funding JPG
The correct and accurate reading of this graphic is: the current hodgepodge of funding is fragmented and insufficient, and diminishes the quality of care the safety net provides to our most vulnerable populations. Part of our push for health care reform is to consolidate and simplify funding so that the focus can move to improving quality and efficiency and not simply looking for access to needed services. For more on this topic, please watch this video featured via Managed Healthcare Executive.


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