Sam Huenergardt, president of Central Texas Medical Center in San Marcos, said federal health care reform has “not materially impacted” CTMC’s emergency room volume. But the hospital’s chain of specialty clinics—many of which have opened in the past five years as a way of helping the hospital comply with new federal regulations—has helped improve the way it serves the community, he said.
Seton Healthcare Family is making similar adjustments. In 2014 the hospital system launched a co-branded insurance product in Hays, Travis and Williamson counties with insurance company Aetna known as Aetna Whole Health-Seton Health Alliance. The program puts an emphasis on reducing costs and caring for patients beyond the hospital setting, said Stephen Bekanich, interim CEO of Seton Health Alliance, a network of more than 2,000 physicians and specialists.
“The insurance companies want to figure out how to cut these costs down,” Seton spokesperson Steve Taylor said. “Otherwise we’re all going to go broke.”
Covering the uninsured
Providing coverage for uninsured and indigent residents cost taxpayers throughout Texas $308 million in 2011.
In an effort to curb costs locally, Hays County and CTMC have partnered to provide care for the uninsured at the Live Oak Community Clinic at 401 Broadway St., San Marcos.
Lon Shell, chief of staff for Hays County Judge Bert Cobb, said the clinic aims to provide care to Hays County residents who would otherwise only receive treatment in the emergency room—often thought to be the most expensive place to receive care.
Hays County utilizes a federal Medicaid program known as the 1115 Waiver to provide care to the county’s uninsured population, which in 2013 included 29,177 people, according to the U.S. Census Bureau.
In 2011, the first year of the five-year agreement, 88 percent of the waiver’s $4.2 billion—about $3.7 billion for the entire state—was to fund uncompensated care. In 2015, the final year of the initial agreement, 50 percent—about $3.1 billion—was to fund uncompensated care.
The other 50 percent of the waiver funds Hays County receives in 2015 are intended to finance improved health care support and delivery systems. In Hays County these funds—known as Delivery System Reform Incentive Payments, or DSRIP—have been used to expand mental health services and fund the Live Oak Community Clinic.
Clinic Director Regina Henderson said the number of uninsured and indigent patients the clinic is seeing has actually risen since the Affordable Care Act’s insurance exchanges opened in 2013. Henderson attributes the rising number of patients to word-of-mouth publicity from the community and the hiring of the clinic’s first doctor on staff.
The future of the waiver
With the waiver expiring next year, Texas must submit its application for renewal to the federal government by Sept. 30. What the program will look like if the federal government approves the renewal is anyone’s guess, said Anne Dunkelberg, associate director of the policy research group Center For Public Policy Priorities.
The federal government is looking at how to tweak the system under a new agreement, she said. There is a chance the pool of money dedicated to uncompensated care could be cut, which would stick Hays County, CTMC and Seton with more of the health care bill for the county’s uninsured and indigent populations.
“The good news is that the feds definitely recognize how beneficial and popular the DSRIP projects are,” Dunkelberg said. “But they also say, ‘[The waiver] was supposed to be a capacity-building exercise, not an ongoing way to finance care for your uninsured population.’”
The ACA’s intended long-term solution to caring for Texas’ uninsured population was Medicaid expansion, but when the Supreme Court ruled in 2012 that the expansion was optional, Texas was quick to opt out.
Medicaid expansion could provide the state with $6.2 billion annually to treat indigent and uninsured populations, according to the Texas Health and Human Services Commission. Hays County’s cut of the money would be about $19.9 million annually. Huenergardt said expansion would ease some of the financial burden on the hospital and county for providing care to the county’s uninsured population.
But Cobb and Hays County commissioners have voiced hesitance to support Medicaid expansion, citing inefficient government bureaucracy and a successful use of the 1115 Waiver as reasons to maintain the current program.
At a meeting June 9, commissioners discussed potential adjustments they could make to their use of the 1115 Waiver, which could mean the hospitals get reimbursed more for providing care to indigent populations.
“If there wasn’t a lot of trust between CTMC and Hays County or Seton and Hays County I’m sure this wouldn’t happen,” Shell said. “But we have a lot of trust.”
