September 8, 2008

Some Should Be Taken From Health Care Lists

Nothing's more critical to a correct diagnosis than accurate information. That's even true in matters of public policy.

Former state Rep. Arlene Wohlgemuth, writing for the Texas Public Policy Foundation, says the usual statistics offered on the issue of the uinsured might not be the best answer.

"Hardly an article or research paper about health care is written that does not focus on the uninsured rate, either in the nation or the state," she says. "It is frequently pointed out that Texas leads the nation in the percentage of uninsured, currently reported at about one-fourth of the population. 'Insure the uninsured!' is the battle cry, pushing and prodding our legislators to find ways to remove that stigma."

Yet is insuring everyone really an option -- or even desirable?

"In 2006, the U.S. Census Bureau calculated Texas' uninsured rate at 23.4 percent, or 5.5 million residents," Ms. Wohlgemuth says. "But policymakers are rightfully hesitant to accept that number as the basis for decisions when they find out that it includes persons who were only temporarily uninsured on the day of the survey. But since 'temporarily uninsured' is nowhere quantified, we are left with using 5.5 million."

In fact, there are three categories of persons within that number that should be taken out, she says: illegal immigrants, those who qualify for but aren't enrolled in existing government programs such as Medicaid and Children's Health Insurance Program (CHIP), and those who make enough money to buy insurance, but choose not to. Ms. Wohlgemuth lists that group as those making more than 200 percent of the federal poverty level.

"Health care is provided every day for those three categories -- through public health clinics, private doctors' offices, and through Emergency Medicaid in hospital emergency departments," she says. "But regardless of one's opinion on illegal immigration, Texas taxpayers do not and should not purchase an insurance policy for those not legally in this country."

There's little question about the next category, as well.

"It would be nonsensical for the state to purchase another insurance policy for people already eligible for, but not enrolled in, Medicaid or CHIP," she says. "This group of people has already been offered one policy; what good would be served by providing them a second?"

The third group includes people who can, in many cases, afford to purchase their insurance.

"There is no consensus for taxpayers footing the bill to provide insurance to higher-income families; studies conclusively indicate that doing so causes a larger percentage of enrollees to drop private coverage for tax-funded programs," she says.

Removing these three uninsured populations from the calculation leaves only 4.7 percent of the population, she estimates.

Ensuring health care for these people is a far more realistic goal.

"Clearly, the objective should be to provide access to health care for the uninsured in the most efficient way possible," Ms. Wohlgemuth says. "The answer will not be easy. But Texas should look for new ideas and innovations and also promote what is already working here."

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