One may look to Massachusetts, as that state’s health reforms might be a precursor to what could occur in Texas, on an even grander scale. Before it enacted universal coverage in 2004, an estimated 416,000 Massachusetts residents lacked health insurance.110
By comparison, Dallas County alone last year had about 660,000 uninsured residents.111
Many newly insured Massachusetts patients continue to use EDs as their primary source of care. Patients with the lowest incomes — and the highest subsidized coverage — used ED services at a rate one-third higher than other insured.112
in Massachusetts increased by 9 percent.113 ENDNOTES
99 U.S. Securities and Exchange Commission filings. Available at http://
searchwww.sec.gov/EDGARFSClient/jsp/EDGAR_MainAccess.jsp. Accessed April 2012.
100 Potter, Wendell. Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans. Bloomsbury Press. November 2010. Page 72.
From 2004 to 2008, hospital ED visits To
control costs, Massachusetts is implementing what Forbes has called the first step toward price controls. Massachusetts could impose a “luxury tax” on “pricey” hospitals.114
The hospitals that will be subject to the tax are those that charge more than
“20 percent of the state median price for a given service.”
The number of physicians in Massachusetts has not kept pace with the increased number of insured persons. That state is experiencing severe shortages in the number of primary care physicians and those practicing in dermatology, urology, neurology, and vascular surgery.115
If Texas sees an identical 9-percent increase in ED visits, we can expect about 800,000 additional visits per year to our already-crowded emergency departments.116
Seniors and other Texans would
then be competing with the newly insured for a limited resource — the time and availability of physicians. Texas already ranks behind all of the other most-populous states in the number of patient care physicians per capita. Physicians’ time, especially in primary care, is in high demand. Increased wait times for appointments or practices closed to new patients will become even more commonplace. A practice can serve only a finite number of patients safely.
As Senate Bill 7 authorizes, Texas is beginning to redesign the health care system through health care collaboratives. However, to build a system that avoids delivering expensive acute care in hospitals, Texas must first guarantee that office-based physician services are within reach of all Texans. The bottom line is this: Access to financing does
64 TEXAS MEDICINE February 2013
101 Potter, Wendell. Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans. Bloomsbury Press. November 2010. Page 73.
102 Girion, Lisa. Blue Cross praised employees who dropped sick policyholders, lawmaker says. Los Angeles Times. June 2009.
103 Mattioli, Dana. More Small Firms Drop Health Care. Wall Street Journal. May 2009.
104 Texas Medical Association. 2010 Survey of Texas Physicians: Research Findings. 2010. Available at
http://www.texmed.org/Template. aspx?id=16236&terms=TMA%20physician%20survey. Accessed April 2012
105 Dotter, Jay and Manley, Mike. Oregon Department of Consumer and Business Services. 2010 Oregon Workers’ Compensation Premium Rate Ranking Summary. October 2010.
106 Texas Medical Association. TMA March 2012 Survey of Texas Physicians. Preliminary Findings Availability. March 2012.
107 Congressional Budget Office. Updated Estimates for the Insurance Coverage Provisions of the Affordable Care Act. March 2012.
108 Kaiser Commission on Medicaid and the Underinsured. Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL. May 2010.
109 American Association of Medical Colleges. The State of the Physi- cian Workforce: With Medical School Expansion Underway, What’s Next? November 2008.
110 Massachusetts Division of Health Care Finance and Policy. Health Care in Massachusetts: Key Indicators. May 2009.
111 United States Census Bureau. Small Area Health Insurance Esti- mates: SAHIE Interactive Data Tool. Available at
http://www.census.gov/ did/www/sahie/data/interactive/. Accessed September 2012.
112 Lazar, Kay. Costly ER Still Draws Many Now Insured. The Boston Globe. October 2008.
113 Kowalczyk, Liz. Emergency Room Visits Grow in Mass. The Boston Globe. July 2010.
114 Roy, Avik. Massachusetts Moves Toward Health Care Price Controls. Is America Next?
Forbes.com. May 6, 2012.
115 Massachusetts Medical Society. Physician WorkForce Study. October 2010. Available at
http://www.google.com/url?sa=t&rct=j&q=&esrc=s& frm=1&source=web&cd=2&ved=0CDAQFjAB&url=http%3A%2F%2Fw
ww.massmed.org%2FAM%2FTemplate.cfm%3FSection%3DResearch_Re- ports_and_Studies2%26TEMPLATE%3D%2FCM%2FContentDisplay. cfm%26CONTENTID%3D36166&ei=loqMT7eKOuKC2wWb0f3tCQ&usg
=AFQjCNHRqi-0hhlf3Sz-m3M7kfoSsPrISA&sig2=FzWw1rnpGh7191i3uYt G7w. Accessed April 2012.
116 The Henry J. Kaiser Family Foundation. State Health Facts. Org. Texas: Hospital Emergency Room Visits per 1,000 Popula- tion, 2009. Available from
www.statehealthfacts.org/profileind. jsp?cat=8&rgn=45&ind=388. Accessed April 2012.
not equal access to medical services even with the increased use of physician extenders. Texas needs more physicians.
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