It's no news to anybody that our country is in a major health-care crisis. It may be news to some, however, that Texas tops all other states in the nation with our number of uninsured residents: According to the state demographer, one in four Texas residents are without health insurance. Why aren't these people running out and buying insurance, those other three out of four might wonder? Well, it's the same reason most people aren't running out and buying new SUVs: They can't afford to. The way the system is set up now, most people have health insurance through their jobs, and if you aren't enrolled in a group plan through your employer, you alone are left to foot the weighty bill. Time for more news: According to the Texas Department of Insurance, 41% of Central Texas businesses do not offer health insurance to their employees. And guess why not? They can't afford it, either.
"We struggle because we just don't have the wallets that the big companies do," says Mike Wilke, who started CFO Advantage Inc., a part-time accounting and consulting firm, last March. He now employs two people, to whom he does not offer insurance. "I employ college-educated, experienced people, and for them, offering health insurance can be a deal breaker. I need to be able to offer standard benefits to get qualified people interested in working here." For his part, Wilke doesn't necessarily want the federal government swooping in and trying to solve the problem. "Frankly, I'd like to see the private sector and local interests take a crack at this instead of Washington. We need affordable insurance, not more red tape."
Sharon Mays, who owns the South Austin restaurant Baby Greens, agrees. "I don't particularly like the federal government poking around in my business affairs, either. Given our current economic situation, I just feel like anything they touch turns into a clusterfuck." That said, Mays believes every citizen, regardless of his or her employment status, should have access to affordable health care. "It shouldn't be a benefit, like days off. This is real life we're talking about. People get sick, they get hurt, and they deserve to be able to go to the doctor." Mays doesn't have health insurance herself, let alone feel flush enough to be able to offer it to the 12 people in her employ. Just the other night, as she lay awake in her bed at 3 in the morning, her throat closing from allergies, she knew she ought to get herself to the emergency room. "But as I was lying there, practically asphyxiating, all I could think about was how I couldn't afford to go to the emergency room," she recalls. "Meanwhile, I own a successful business. It's crazy."
Enter the Central Texas Regional Health Coverage Project, a nascent nonprofit corporation hoping to ease the pain, somewhat, for a portion of Texas' working uninsured. By offering a basic, low-cost health plan for small employers (ideally, the premium payments would be from $70 to $228 per month per employee, depending on age and gender), the group's goal is to get at least 10,000 of those currently uninsured folks covered by 2011. Both Mays and Wilke participated in a focus group, along with 30 other local business owners, to offer their opinions on exactly what kind of coverage they'd like to buy for their employees. Also, Mays volunteered her staff for an employee focus group, to better determine the kind of coverage they would like to receive. "Most of my employees were like, 'Podiatry? Who goes to a podiatrist?' They want coverage for prevention and stuff like chiropractic care. Meanwhile, I'm like, 'Let's also make sure we have emergency coverage, because there sure are a lot of knives in that kitchen.'"
"The plan is more focused on prevention than anything else, though there is emergency coverage," says former state Rep. Ann Kitchen, who is heading up the project as part of her role as the executive director of Integrated Care Collaboration (formerly Indigent Care Coalition)*, the nonprofit that helped bring us programs such as Medical Assistance Program and Project Access. Kitchen, who has a long history of working to grant Texans access to affordable heath care, says that under the proposed project plan, Mays' midnight run to the emergency room would have been covered, and she'd only have to fork over a $250 co-pay instead of the roughly $1,000 it would have cost her currently. Also, she'd be able see an allergist to help identify the trigger that caused her allergic reaction. The goal of the plan, which Kitchen hopes will launch in January, is actually to keep people out of the hospital and emergency rooms by allowing them to go to a doctor for regular checkups. "But the plan has sufficient coverage to pay for the procedures most people end up in the hospital for, like broken bones, pneumonia, chest pain, normal childbirth, heart attack," Kitchen explains. Given a potentially catastrophic diagnosis such as cancer, Kitchen admits that the plan "will not get you all the way," explaining that "hospital coverage has a limit that would cover some, but not all, of the cost for complicated illnesses like significant trauma [i.e., reattaching an arm], heart bypass surgery, or cancer. For example, a total mastectomy [would be] covered but not all chemotherapy."
Another thing Kitchen admits the Health Coverage Project plan does not do is anything to weaken the bind between insurance and employment. But, she adds, rather convincingly, "It's a whole lot better than nothing." So, to the folks employed by a small business here in Texas, this is good news for you. And for the folks who aren't, well, stay healthy.
For a full breakdown of the CTRHCP plan and its benefits, see www.healthcarecentraltexas.com.
Uninsured? Underemployed? There are people out there who believe that you deserve access to medical care, believe it or not. Here is a list of resources to help get you in the examining room.
• Project Access provides volunteer physician care, hospital care, and diagnostic services for uninsured people who are at or below 150% of the federal poverty level. (For an individual, that is set at $10,400 annual salary.) More information about Project Access can be found at the Travis County Medical Society's website, www.tcms.com.
• Insure-a-Kid helps you navigate the maze that can be Medicaid and apply for Children's Health Insurance Program for low-cost health insurance. www.insureakid.org.
• People's Community Clinic offers primary care for the underinsured, as well as the uninsured: www.austinpcc.org.
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