Point Austin: Healthy Town Hall
While we wait for federal reform, the health-care work goes on
Although you might not know it, as the national political debate over health-care reform roils cable TV ranters, YouTube videos, and the headlines, visible progress is being made on the local front to make health care accessible to more people. Last week began the long-awaited rollout of the small-business health-benefits program known as TexHealth Central Texas. And on Saturday afternoon, the Travis County Healthcare District opened another storefront clinic, this one in a strip center on Rundberg Lane, a block east of I-35. Like the other 16 TCHD clinics of various sizes and specialties – from Northeast to Oak Hill, South Austin to Pflugerville – the newly christened "CommUnityCare" clinic is aimed primarily at low-income and uninsured residents, part of "a federally qualified health center system providing primary care, women's services, pediatrics, behavioral health services, and dental care." Last year the clinics served more than 50,000 patients, more than 90% of whom were women and children. With the addition of the Rundberg Health Center, and a much larger facility planned for Braker Lane, that number will steadily grow.
Not yet so ambitious is the TexHealth Central Texas program, the slightly redundant moniker reflecting that it is one of several similar "TexHealth" programs taking root across the state. In fact, Executive Director Jim Rodriguez is already managing TexHealth Galveston County, fully subscribed in its first year, with 500 clients and a waiting list. "Thus far, it's gone well," Rodriguez told me. The Galveston program is paying itself, with a medical loss ratio at 80% ("right on target") and no patients yet even approaching the $50,000 hospitalization limit. "We're going after those small businesses that have historically been neglected," Rodriguez said. "Small nonprofits, mom-and-pop businesses, lots of automotive businesses – but also quite a few professional groups, like small accounting firms." Once start-up financing from tri-county agencies gets the program off the ground, it's designed to be self-sustaining.
TexHealth – a project of the regional Integrated Care Collaboration hospitals, nonprofits, clinics, and various related agencies – has arranged doctors and hospitals via UnitedHealthcare and is recruiting clients from dozens of small businesses, many with fewer than 10 employees (the limit is 50) and priced out of standard insurance. For about $250 a month – ideally split 50-50 between employer and employee – the program offers what Rodriguez describes as "comprehensive but limited" benefits, with an emphasis on preventative care. If this area pilot works as well as it has in Galveston, Rodriguez says, the plan is to help it grow. And as both he and Ann Kitchen of the ICC pointed out, even if federal reform is finally put in place, it will be several years before we see the effects – and in the meantime, programs like TexHealth are filling the gaps.
Beneath the Noise
Such small but crucial advances have been largely swallowed up in all the manufactured hoopla over national health-care reform. That was almost literally the case on Saturday, when the grand opening of the Rundberg clinic and its Healthy Kids Fair was nearly overwhelmed by the attendance of Congressman Lloyd Doggett, Sen. John Cornyn, and state Rep. Elliott Naishtat. The dignitaries were on hand to welcome the clinic and delivered a few niceties to a small press conference inside – intermittently serenaded by a large crowd of citizens outside, who had turned up in anticipation of yet another TV battle in the health-care wars now raging across the country.
Cornyn spoke briefly and departed. Doggett noted the $2.9 million in federal stimulus funding (coincidentally opposed by Cornyn) that specifically helped underwrite this new clinic and thereby serve another 10,000 Travis County patients. Naishtat quietly described state legislation that he had sponsored to help fund community clinics and to financially assist doctors willing to care for underserved populations. It's the sort of thing, Naishtat said, that happens "away from the floodlights," with a nod to the agitated crowd outside. (The legislation also addressed underserved populations in rural areas and was consequently embraced by conservative West Texas Republicans.)
Although Naishtat tends not to crow about such things, he might also have added that it is the sort of government health-care program that works remarkably well, particularly for those people and regions that free-market health care ignores because there's simply not enough profit in it.
Let Us Reason Together
The press conference was only preliminary, of course, to the health-care reform rally that had gathered outside the doors. Remarkably, and in strong contrast to the South Austin debacle the week before – when Doggett was shouted down by an angry mob denouncing "socialist," "fascist," and "satanic" health-care reform – Doggett went to the podium and an actual town hall discussion broke out. In this crowd, reform proponents visibly outnumbered the "anti-Obamacare" ranters – indeed, the signs demanding "single-payer public option" alone outnumbered the relatively subdued antis. Nevertheless, the congressman made a point of alternating reform supporters and opponents at the microphone.
Doggett calmly described the pros and cons of the varying bills under consideration, and supporters and opponents alternated in addressing what they thought right or wrong about the legislation. Even a GOP precinct chair sporting a Ron Paul T-shirt seemed mollified by the civil engagement, and Doggett noted that while he and Rep. Paul tend to "cancel each other's votes" on many social issues, they largely stand together on foreign policy and civil liberties. "I'm glad to have him as a colleague," Doggett said. That was not the sort of reflection likely to entirely please anyone in this crowd, ranging from fiery Austin progs through yellow-dog Dems to suspicious GOPers, right onward to a couple of surly, defiant Info-Warriors. But it had the uncommon sound of actual community, as well as serious politics in action.
Nearby, families and kids were lining up for free health and heart screenings and nutritional planning, and on this celebratory day some snacks, games, and even magic. As Doggett had noted earlier, the pending federal plan would add "$38.8 billion in funding for community health care centers, to offer a medical home to an additional 35 million patients" – who will otherwise have nowhere to go but emergency rooms.
Call it socialism if you like. But it sounds even more like good, rational public policy – not to mention neighborliness, solidarity, and simple human decency.