Tuesday, April 16, 2013

"Texas" Solution Needed to Improve Health Care Coverage

Athens family physician Doug Curran, MD, a Texas Medical Association (TMA) Board of Trustees member, testified in support of a bill by Rep. John Zerwas (R-Simonton), MD, to create a “Texas” solution for the working poor in Texas. Dr. Curran said for both economic and human reasons Texas must find a way to improve coverage to low-income Texans. A one-size-fits-all approach will not work in the diverse state of Texas.

Dr. Curran told lawmakers that the Medicaid system is broken and must be fixed. “The most recent TMA survey found only 31 percent of Texas physicians accept all new Medicaid patients,” he said. “That number has plummeted from almost 67 percent since the turn of the century. … My colleagues and I want to care for low-income Texans, but we also run small businesses that have to pay our staff and overhead. Plain and simple, pitifully poor Medicaid payments are driving physicians out of Medicaid.”

Dr. Curran said under the current system, many working poor Texans do not qualify for Medicaid or Medicare, and struggle daily with health conditions they cannot afford to treat. He told the story of a 59-year-old uninsured female patient with chronic congestive heart failure. Dr. Curran cares for her at a local free clinic, except, he says, “on those all-too-frequent occasions when she can’t afford her blood pressure medicine, and then I also see her in the hospital — where the bill to county taxpayers is much, much higher than the cost of paying for her prescription would have been.”

Texas physicians strongly support a homegrown solution that:
  • Requires all patients contribute, even a little, to the cost of their care through modest copays;
  • Establishes a Texas-specific benefit package that makes sense for this patient population;
  • Simplifies the  enrollment process and cuts through red tape for patients and physicians;
  • Sets fair physician payment rates and allows us to test innovative new approaches to health care delivery; 
  • Uses a federal funding mechanism that recognizes Texas’ rapidly growing population and diverse health care needs; and
  • Ensures the state receives its maximum share of federal dollars, which in turn we can use to modernize and improve the Medicaid program.
Read More: Expand Medicaid, But Fix it First

1 comment :

Vincent Fonseca, MD, MPH, FACPM said...

Actually, the evidence shows that even "modest copays" can pose barriers for medication adherence. So modest copays will create unnecessary adherence problems.

To get better health and better care at a better value we need to lower barriers to adherence for the cost-effective services (high-value services) and have copays for lower value, less cost-effective services.

No copays for USPSTF recommended services and no copays for ACIP recommended vaccines will decrease underuse quality problems, lead to better care and better health at a better value.

Similarly, no copays for provider-prescribed generics for chronic conditions off of the $4/month formularies will also lead to better care and better health at a better value.

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