West Texas Legislative Summit: Health Care Challenges and
Solutions in West Texas Dr. Barbara Breier, Asst. Vice President
for Strategic Initiatives & Director, Center to Eliminate
Health Disparities August 9, 2007 Slide 2 The Uninsured in Texas
Texas has the highest percentage of uninsured residents in the
nationTexas has the highest percentage of uninsured residents in
the nation 2/3 of the uninsured in Texas are working adults who
either do not have access tohealth insurance or cannot afford
it.2/3 of the uninsured in Texas are working adults who either do
not have access tohealth insurance or cannot afford it. 44% of all
working uninsured in Texas work for companies with fewer than 25
employees44% of all working uninsured in Texas work for companies
with fewer than 25 employees 2 million uninsured Texans have income
above 200% of the federal poverty level and could contribute to the
cost of health coverage if it were at an affordable rate.2 million
uninsured Texans have income above 200% of the federal poverty
level and could contribute to the cost of health coverage if it
were at an affordable rate. Slide 3 Uninsured in Galveston
Galveston County has a population of approximately 250,000, of whom
30% are working uninsured.Galveston County has a population of
approximately 250,000, of whom 30% are working uninsured. 60% of
working uninsured earn less than $35,000 per year.60% of working
uninsured earn less than $35,000 per year. Lack of health benefits
for such a large percent of the population creates a crisis in the
health care delivery system and impacts all members of the
community.Lack of health benefits for such a large percent of the
population creates a crisis in the health care delivery system and
impacts all members of the community. Slide 4 What is the 3-Share
Plan? A collaborative effortA collaborative effort UTMB Galveston
County Chambers of Commerce Member businesses A program to provide
coverage for the working uninsured, modeled after a successful
effort in Muskegon, Michigan.A program to provide coverage for the
working uninsured, modeled after a successful effort in Muskegon,
Michigan. Slide 5 Galveston 3-Share Plan Provide health benefits
for working individuals & familiesProvide health benefits for
working individuals & families Focus on primary and preventive
care needs Emphasizing the improvement of health status through
managing chronic diseases and involving individuals in managing
their own care Costs of the coverage split betweenCosts of the
coverage split between employer employee Governmental entities and
philanthropic funds Allow for low monthly health premiums, thus
improving accessibilityAllow for low monthly health premiums, thus
improving accessibility Slide 6 Funding Options Pending State
Waiver to use SCHIP FundsPending State Waiver to use SCHIP Funds
SB10- Authorization of 3-share programs and creation of HOPSB10-
Authorization of 3-share programs and creation of HOP TDI Planning
Grant- $750,000/year over 2 yearsTDI Planning Grant- $750,000/year
over 2 years Local and philanthropic fundingLocal and philanthropic
funding Federal Bill HR 1637, Communities Building Access Act,
Reps. Pete Hoekstra and Bart Stupak (R, MI; D; MI)Federal Bill HR
1637, Communities Building Access Act, Reps. Pete Hoekstra and Bart
Stupak (R, MI; D; MI) Slide 7 Community Activities 21 Focus Groups
(CHAT) 21 Focus Groups (CHAT) Galveston Employers SurveyGalveston
Employers Survey Galveston County Chambers of CommerceGalveston
County Chambers of Commerce Civic OrganizationsCivic Organizations
Cover the Uninsured Week:Cover the Uninsured Week: Letters to the
editor, Lecture Series, & Religious Leaders Breakfast Outside
Validation Saurage Marketing Study: Representative Sample of
Galveston County Employers n=160 Media Coverage Galveston Daily
NewsGalveston Daily News Houstons FOX NewsHoustons FOX News Texas
Medicine MagazineTexas Medicine Magazine Guidry News WebsiteGuidry
News Website Development Process Slide 8 Employee Profile Average
age of employee: 41 54% Male 46% Female 53% White Non Hispanic 26%
Hispanic 22% African American 1% Asian Galveston Employer Survey
248 Employers Surveyed 4819 Employees Slide 9 CHAT Software Program
Choosing Health Plans All Together created by the U. of Michigan
and NIHChoosing Health Plans All Together created by the U. of
Michigan and NIH Utilizes national averages to compute cost of
health care coverageUtilizes national averages to compute cost of
health care coverage Players are allotted 50 markers to purchase
health benefitsPlayers are allotted 50 markers to purchase health
benefits 15 benefits are available full range15 benefits are
available full range 4 Rounds of game played individual, small
group, community, and individual4 Rounds of game played individual,
small group, community, and individual Slide 10 CHAT Game Board
Slide 11 CHAT Preliminary Results Top Priorities 1.Pharmacy
2.Primary Care 3.Hospitalization 4.Specialty Care 5.Tests 6.Other
Medical (ambulance, equipment) 7.Long Term Care/Last Chance (tied)
Lowest Priorities 9. Dental 10. Mental Health 11. Uninsured 12.
Home Health 13. Vision 14. Infertility (N/A) 15. Alternative Med
(N/A) Slide 12 Actuarial Analysis Can achieve $180 pmpm with
limitations:Can achieve $180 pmpm with limitations: Primary
care/Specialty care 12v/yrPrimary care/Specialty care 12v/yr
Hospitalization 30 day annual maximumHospitalization 30 day annual
maximum Pharmacy - $1200/yrPharmacy - $1200/yr Mental Health
20v/yrMental Health 20v/yr 10% coinsurance w/$1000 annual
maximum10% coinsurance w/$1000 annual maximum $50,000 Annual
Maximum$50,000 Annual Maximum Exclusions of high risk,
experimental, vision, dental, etc.Exclusions of high risk,
experimental, vision, dental, etc. Care limited to UTMB HMO
providers in Galveston CountyCare limited to UTMB HMO providers in
Galveston County No ER coverage outside of Galveston CountyNo ER
coverage outside of Galveston County Slide 13 Eligibility Criteria
for Businesses Has been conducting business operations for at least
one year (verified by IRS statements.)Has been conducting business
operations for at least one year (verified by IRS statements.) Has
a minimum of 2 employees (including self) that have been employed
in the business for one year (does not have to be the same
employee).Has a minimum of 2 employees (including self) that have
been employed in the business for one year (does not have to be the
same employee). Has filed appropriate IRS documentation for the
reporting of income.Has filed appropriate IRS documentation for the
reporting of income. Has filed W-2s for eligible employees noted
above.Has filed W-2s for eligible employees noted above. Slide 14
Eligibility Criteria for Businesses Has its principle business
location in Galveston County.Has its principle business location in
Galveston County. Employs 50 percent of its employees in Galveston
County if employer has locations outside the county;Employs 50
percent of its employees in Galveston County if employer has
locations outside the county; Has a median income of $50,000 per
year or less for all employees;Has a median income of $50,000 per
year or less for all employees; Has not offered group health
coverage for the previous 12 months.Has not offered group health
coverage for the previous 12 months. Slide 15 Eligibility Criteria
for Employees -Employee eligibility is determined by income level
and assets. -The eligibility criteria is established by the funding
entity. Slide 16 Market Potential for Statewide Model Program can
serve as a statewide model as an increasing number of businesses
seek viable alternatives.Program can serve as a statewide model as
an increasing number of businesses seek viable alternatives.
Individuals involved in decisions about their own healthcare create
healthier workforces and communities.Individuals involved in
decisions about their own healthcare create healthier workforces
and communities. Other communities have expressed strong interest
including Harris, Travis, Dallas, Bexar, Midland and El Paso
Counties.Other communities have expressed strong interest including
Harris, Travis, Dallas, Bexar, Midland and El Paso
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