In El Paso County nearly 40% of its’ population are without access to health insurance. In some colonias the rate of uninsured approaches 60%. Despite this high percentage of underinsured for profit healthcare systems have flag ship hospitals located in El Paso and our taxpayer supported Thomason Hospital reports they are in the best financial position than they have been in recent years. Clearly even with our high rate of underserved healthcare is big business in our community.
It is estimated in 2005 between the for-profit hospitals and the public sector facilities nearly $900 million in net patient revenues was generated. While the percentage of uncompensated care averaged 4.72% for the Tenet and HCA hospitals, Thomason provided 37.6% uncompensated care and still reported net operating income totaling for the past two years of nearly $70 million.
The Obama plan calls for coverage for all Americans. If an individual has insurance under his proposed plan individual premiums will decrease. Every individual will be able to buy into a health insurance plan similar to those provided to Federal employees including our enjoyed by our Congressional delegation.
No one will be turned away because of pre-existing conditions, employment status or ability to pay. No longer will an individuals’ health status or history be the basis for denial of health coverage.
Obama’s health plan will require a full range of services including mental health and disease management requirements. A significant component will be supporting health promotion and disease preventions strategies with proven effectiveness. Our public health system long neglected will see a revitalization to insure programs and surveillance systems are in place to protect our nation’s health. Hopefully this means we will no longer need to be concerned about clean water that is free of pollutants, or foods contaminated with salmonella.
A major initiative will be on supporting the continuing development of our infrastructure for disaster response. Katrina revealed the serious challenges that our existing disaster response system faces. While substantial progress has been made through a variety of Homeland Defense programs aimed to improving local, state, and national responses to both terrorist and natural disasters challenges remain. The Obama economic stimulus plan (being considered at press time) provides up to $100 million to prepare for a national health disaster.
Like plans in Japan small business will be able to purchase insurance from low risk pools and not have to pay high premiums because of the inability to purchase coverage at reasonable rates.
The Obama plan will provide tax credits that will cover up to 50% of the costs. The secondary insurance pool will provide coverage for those with catastrophic health problems.
The free market insurance system will continue with individuals having the option of purchasing private insurance plans that will provide more options for those desiring such. This is similar to private plans in Australia and Canada. Individuals with these plans (depending on the benefit and payment options) can select plans that allow more flexibility.
Obama also promises to take on the big insurance, pharmaceutical and medical supplies/equipment companies in addition to other special interest groups who spend millions of dollars lobbying against reform of the healthcare system to maintain generous profits. No longer will the US subsidize the costs of developing new drugs, emerging technologies, and other innovations while the same products/drugs are sold in other countries sometimes for a less than 25% of the cost charged in the US.
High standards for quality will be required and will be achieved in part through implementation of electronic medical records and more efficiencies in the delivery of health services and in the administration of the health plans. Obama is already moving forward with his plans to encourage the adaption of IT innovations in health care. In the administration’s economic stimulus package (being considered at press time) allocates more than $20 billion for the implementation of IT enhancement such as electronic medical records.
Physicians who agree to participate in the IT enhancement would be eligible for higher reimbursement rates from Medicare and Medicaid as well as payments between $45,000 and $65,000 once they can prove they are using IT effectively. In addition, hospitals would also be eligible to receive millions of dollars for IT adaptations.
Image the impact on our local economy if the 40% of our citizens without insurance are suddenly eligible for health care. Assuming Obama’s health reform plan is passed or something similar by the end of 2012, El Paso will benefit from this tremendous growth that will occur when our large population of uninsured individuals are suddenly eligible for health care.
As a community we are already challenged with a having adequate numbers of hospital beds, nurses, physicians, and other health care providers. The impact of the growth at Fort Bliss has facilitated significant increase in the number of military personnel, their dependents, and retirees. With this growth alone we will need by 2012 another 2,300 nurses, a significant increase in the number of physicians, and other healthcare provider.
The existing infrastructure is not ready for the current growth let alone the increase demand that could come from increasing health care coverage for all citizens. Schools of Nursing and Medicine will need to significantly increase their capacity. The number of residency positions for new medical school graduates will need to be increased to assure the new physicians will stay in El Paso. Other health professionals including ancillary health related occupations will also need to gear up to help meet the workforce needs.
The existing practice acts particularly for advance practice nurses, optometrists, podiatrists, physical therapists, pharmacists, psychologists to name a few must be updated and scope of practice enlarged. The restrictions while in the past perhaps were warranted are no longer justified given the current educational preparation of these non physician health care providers, The demands for high quality health services are going to be unrelenting and the practice acts for non physician providers will need to amended to insure the public will receive quality care.
The economic impact of forthcoming health care reform will have a significant impact on El Paso in the near future. We must plan now to insure we are ready for this new growth. High school students need to be encouraged to seek health career so they can be academically prepared for health care professional education. Fast track educational preparation for health care professions needs to be incorporated into early college programs that are available to high school students.
We will have an unprecedented demand for hospitals beds, home health care, primary care, and specialty care. Unfortunately as with most countries with universal coverage longer waiting times for elective procedures as well as delays in obtaining appointment from specialists will probably be the norm. Those who purchase the private insurance options will most likely have quicker access to care due to their ability to pay the higher fees associated with private care.
The bottom line is that El Paso will experience substantial growth in its healthcare industry. Significant economic opportunities will emerge given our pent up demands for health care. The growth will come with challenges and perhaps a change in how those who now have health insurance will be able to obtain such in a timely manner.
As a community we need to be aggressive in our planning to insure our citizens will have the health resources needed. This means an active engagement in strategic planning to assure we ready to meet this challenge. Are we committed?
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