Wednesday, January 30, 2019

It’s Going to Hurt All of Us

Editor's Note: The following article is the second of six stories TMA's Healthy Vision 2025 advocacy plan, highlighting TMA's priorities for the 86th Legislative session. In this story  Douglas W. Curran, MD, president of TMA, describes caring for an uninsured patient in her time of need so she can avoid a serious health condition and stay healthy, so she can continue to work and support her family. He says Texas' fiscal health hinges on helping physicians care for Texans' personal health.

In a rural Texas town where one-third of the patients admitted to the local hospital have no insurance, Athens family physician Douglas Curran, MD, does all he can to keep women like Rose (not her real name) out of the hospital.

Rose is part of what Dr. Curran calls “this massive group of working poor who have no access to care.” She doesn’t make enough to afford private insurance. She makes too much to qualify for Medicaid.

“She’s one of the strategic breadwinners in the family,” he said. “So when she’s not working, they’re struggling just to buy food.”

Rose just can’t afford to get sick, says Dr. Curran. And Texas can’t afford for Rose to get sick either. Not Rose and not the men and women who tend our ranches, build our office towers and highways, or serve our meals — the 4.5 million Texans who put our state at the top of the nation’s list of uninsured residents.

Video: It's Going to Hurt All of Us

TMA President Douglas Curran, MD, explains why good access to quality health care is crucial for the state economy.



“Right now, we have a state that’s really moving business-wise, a lot of things are happening,” he said. “If you keep people healthy, they’re producing, they’re generating, they’re keeping things going. But if that populace is not properly cared for and supported and empowered, then we’ll see the people that we really need to keep our business environment pristine begin to drift away. It’s going to hurt all of us.”

Dr. Curran was on call the night Rose was wheeled into the emergency room. She was short of breath, had “big swollen feet,” and the oxygen level in her blood was dangerously low. He drained 50 pounds of fluid from her body and released her on aspirin and three generic medications —
 “three, $4 drugs” — to treat her congestive heart failure and high blood pressure.

Thankfully, Dr. Curran also was able to refer Rose for follow-up to a local, physician-run, volunteer clinic for the working poor.

“We take care of the people who can pay a little bit there,” he said. “They pay $15. It goes into the pot to keep the clinic going. The nurses are all volunteers. My wife’s an RN; she volunteers there a day a week. You do what you have to do.”

At the clinic, doctors and nurses can check Rose regularly to make sure the medicines are keeping her healthy — and to make sure the drugs’ side effects aren’t making her sicker. Without those check-ups, neither Dr. Curran nor any other physician could safely refill her prescriptions. Nor would they.

“Nobody’s going to refill those medicines, so she’ll re-accumulate that fluid, and she’ll be back in the hospital, and it costs $25,000 to get her back to a stable state on those $4 medications,” he said. “At the end of the day, that raises your insurance rates, my insurance rates, and everybody else’s insurance rates because she’s back in the highest cost place to get care there is (the emergency department).”

After passage of the Affordable Care Act in 2010, 33 states expanded eligibility for their Medicaid programs to include people like Rose. Texas did not, and all of the state’s top leaders remain strongly opposed to expansion.

Dr. Curran supports finding ways to get more Texans insured, but he says his practice can’t afford to accept too many Medicaid patients. With operating costs of $41,000 a day for 17 family physicians and Texas’ notoriously low payment rates for primary care services, Medicaid is a losing proposition.

“It’s not enough to pay my bills or to keep the lights on and to pay my employees,” he said. “A visit for a sore throat pays me about $27, and it costs me about $48 to see the patient in my office. I’d be better off [financially] giving a Medicaid patient 10 bucks and sending her to the emergency room.”

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