Health Care and Texas:

Where Weve Been & Where Were Going

Kevin C. Moriarty President and CEO

May 4, 2011

Overview
Introduction Determinants of Health The Health Care Dilemma Chronic Disease Texas Legislative Session Health Care Reform Health Care and Bioscience Industry

About Methodist Healthcare Ministries

Our Mission: Serving Humanity to Honor God by improving the physical, mental and spiritual health of those least served in the Southwest Texas Conference area of The United Methodist Church. Who We Are: Dedicated to providing medical and health-related services Low income families and the uninsured 242 authorized sites throughout South Texas Largest private funding source for health services in South Texas Half owner of Methodist Healthcare System

About Methodist Healthcare Ministries

What We Do: Budgeted expenditure of $60,000,000 in 2011, to provide over 500,000 client encounters. This is achieved through programs owned and operated by MHM and through contracts with partners who have similar missions.

MHM Programs/Services: Wesley Nurse Health Ministries Grants management Advocacy and Public Policy Church Based Counseling Family Wellness Programs Parenting Programs Behavioral Health Services Health Education School Based Health Centers Charity Care Clinical Services (Primary and Medical)

Determinants of Health
Health Care 10%

Lifestyle (Smoking, Obesity, Str ess, Nutrition, Blood Pressure, Alcohol, and Drug Abuse) 51%

Environment 19%

Human Biology 20%

Determinants of Health
What's Really Killing Us?
Half of all deaths can be attributed to these factors 19%
Heart Disease

14%
Causes of Death
Cancers Heart Disease

12%
Heart Disease Cancers Diabetes

Cancers Respiratory Disease Diabetes

5%
Heart Disease Cancers Injuries Infant Deaths

Infant Deaths

Infant Deaths

All Injuries Respiratory Disease HIV/AIDS Infant Deaths

Tobacco Use

Diet/Activity

Alcohol Use

Other*

High Cost of Care

HCR: High Cost of Care & Access

It is ALL Connected!

Access to Care
Percent Uninsured
U.S. Average: 15.1%
Mass. 4.1%

Texas 24.1%

Texas Demographics: The Uninsured

Currently in Texas:
4.5 million uninsured adults 1.2 million uninsured children 5,745,286 people

South Texas Uninsured:

Bexar County: 352,944 (22.3%) Webb County: 85,696 (36.2%) Hidalgo County: 273,887 (38.0%) Cameron County: 139,388 (35.7%)

Why Health Care Reform is Critical: Access

Percent Persons with No Health Insurance Coverage (2008)

29.4% - 38.0 %

Why Health Care Reform is Critical: Access Texas Businesses Offering Coverage by Size
Percent offering coverage
120% 100% 80% 60% 40% 20% 0%
Less than 10 10 - 24 25 - 99 100 - 999 1,000 or more

Number of employees

Texas Uninsured by Income Today

88% of 6.4 million uninsured <400% FPL
>400% FPL >$88,200 <100% FPL <$22,100/yr for family of four

300-400% FPL $66,200-$88,200

250-300% FPL $55,100-$66,200

200-250% FPL $44,100-$55,100 150-200% FPL $33,100-$44,100

100-150% FPL $22,100-$33,100

Obesity in Children
Texas ranks 7th highest in the nation for obesity in 10-17 year olds 42% of 4th graders in Texas are obese or overweight Obesity associated annual hospital costs among children (x3) in the past three years due to a (x2) of diabetes cases, a (x3) of gallbladder disease and a (x5) in sleep apnea. The US Surgeon Generals Office reports that overweight children have a 70% change of becoming overweight or obese adults 34.1% low-income children (2-5) are overweight or obese in Texas.
Sources: Texas Health Institute, Obesity in Texas: Reaching Epidemic Proportions and Responding to the Epidemic: Strategies for Improving Diabetes Care in Texas, Center for Diseased Control and Prevention, National Hospital Discharge Survey National Initiative for Childrens Healthcare Quality, 2008 Pediatric Nutrition Surveillance System

Diabetes in Texas
Diabetes is the 6th leading cause of death in Texas 4th leading cause among Hispanics and African Americans Diabetes is the leading cause of kidney failure, non-traumatic limb amputations and blindness Approximately one in every 400 to 600 Texas children and adolescents has Type I diabetes. In 2009, Childrens Health Insurance Plan (CHIP) payments for diabetes related services were estimated at $3.8 million

Sources: Texas Diabetes Council, Diabetes: A Comprehensive Approach, 2010 Texas Health Institute, Responding to the Epidemic: Strategies for Improving Diabetes Care in Texas, 2010.

Projected Diabetes Percentages in Bexar County

2010
Bexar County State of Texas 13.5 % 11.9 %

2020
19.0 % 17.1 %

2030
22.6 % 20.8 %

2040
25.7 % 23.8 %

County Projections of Diabetes in Texas

Source: Texas Health Institute, Responding to the Epidemic: Strategies for Improving Diabetes Care in Texas

Ratio of Providers per 100,000 Population 2008, by geographic location

Occupation Primary Care Physicians Physician Assistants Dentists Dental Hygienists Registered Nurses Licensed Vocational Nurses Pharmacists Psychologists Social Workers Texas Border 68.4 17.3 37.2 38.8 671.3 277.5 77.0 25.9 67.1 52.8 13.5 16.5 18.4 483.1 202.9 42.7 8.7 45.0 Urban Non-Border 72.7 18.5 41.8 42.9 730.9 257.2 84.9 30.3 73.4 Border 35.4 16.0 11.9 8.8 230.6 298.8 31.5 6.2 20.4 Rural Non-Border 55.0 12.8 25.3 30.3 470.1 473.9 56.4 11.7 46.9

$27 Billion Shortfall in Texas State Budget

General Revenue Fiscal 2011 Ending Deficit Set aside for Rainy Day Fund TOTAL GR AVAILABLE Minimum needed for current services, considering population growth & health cost inflation GAP: 2012-13 Forecast $77 billion - 4 billion - 1 billion $72 billion $99 billion

$27 billion

Source: Center for Public Policy Priorities

GR Shortfall in HB 1 as Introduced
Requested GR Recommended GR $ 20.0 b 41.7 b 7.5 b 4.1 b $ 73.3 billion General Revenue Shortfall - $11.0 b - 14.7 b 1.7 b 2.1 b

HHS Education Criminal Justice The rest Total

$ 31.0 b 56.4 b 9.2 b 6.2 b $ 102.8 billion *

- $29.5 billion

Source: Legislative Budget Estimates, HB 1: * excludes $4 billion requested by TXDoT

IN THE COMPANY OF POOR STATES

Worst States for Children State Median Household Income in 2009 % of Children in Poverty in 2009

Arkansas South Carolina Texas Oklahoma New Mexico Mississippi Louisiana

$38,815 $43,625 $50,043 $42,822 $43,508 $37,790 $43,733

26% 21% 23% 22% 25% 29% 27%

http://everychildmatters.org/resources/reports

Health Care Reform

The Patient Protection and Affordable Care Act (HR-3590) Expands health coverage to 32 million previously uninsured citizens. Includes Medicaid Expansion to 133% FPL. Creates a State-Based Insurance Exchange System Employer and Individual Mandate Puts in place Insurance Reforms: No lifetime limits on coverage No exclusion based on pre-existing conditions No penalty based on health status No rescission of coverage

Health Care Reform

Improves Prevention and Wellness Programs Medicare beneficiaries will be provided annual physicals Created the Prevention and Public Health Fund Provide grants to small employers for wellness programs Invests in Health Care Workforce Establishes a multi-stakeholder Workforce Advisory Commission Increase the number of Graduate Medical Education positions Provides additional scholarships & loans to increase workforce Supports the development of training programs.

Health Care Reform

The Patient Protection and Affordable Care Act (HR-3590) To date: Increased funding for Community Health Centers ($11 Billion) Increased dependent age to 26 years old. Created medical home pilot programs. Provided grants for employer wellness programs. Created reinsurance for early retirees. Medical loss ratio limitation (85%) Cobra extension until the Exchange is fully functional (2014) Ban on Lifetime Limits Prevent Health Insurance Rescission Pre-Existing Condition Exclusion for children Initiated the closing Medicare Part D, doughnut hole Provided a small business tax credit (35%)

Health Care Reform

The Patient Protection and Affordable Care Act (HR-3590) IN 2011 Eliminates barriers in Medicare Low-Income Subsidy. Increases reimbursement for primary care (10%) Establishes a free annual wellness test for Medicare beneficiaries Additional funds to states with high unemployment costs. IN 2012 Improves low-income protections in Medicare Directs CMS to track hospital readmission rates Extends months of coverage of immunosuppressive drugs for kidney transplant patients.

Health Care Reform

The Patient Protection and Affordable Care Act (HR-3590) IN 2013 Begin paying physician based on value not volume. Comprehensive health insurance reforms initiates. Creation of health insurance exchange. Subsidy (tax credits) made available. Individual and employer mandate effective. IN 2014 Health insurance exchange expands. Medicaid expansion to 133% FPL. Open exchange to individuals with employer based coverage. Reduces overpayments in Medicare advantage.

Health Care Reform

The Patient Protection and Affordable Care Act (HR-3590) What results? Significantly reduces the federal deficit: o $138 Billion (2010 2019) o 1.3 Trillion over the next decade (2019 2029) Reduces costs and improves outcomes for consumers Extends solvency of Medicare, which protects senior citizens. Establishes a competitive marketplace for consumers to shop for insurance coverage. (Health Insurance Exchange) Establishes pilot programs for continued innovation.

Source: The Greater San Antonio Chamber of Commerce, San Antonios Health Care and Bioscience Industry

Source: The Greater San Antonio Chamber of Commerce, San Antonios Health Care and Bioscience Industry

Source: The Greater San Antonio Chamber of Commerce, San Antonios Health Care and Bioscience Industry

Source: The Greater San Antonio Chamber of Commerce, San Antonios Health Care and Bioscience Industry

Source: The Greater San Antonio Chamber of Commerce, San Antonios Health Care and Bioscience Industry

DO ALL THE GOOD YOU CAN, BY ALL THE MEANS YOU CAN, IN ALL THE WAYS YOU CAN, IN ALL THE PLACES YOU CAN, AT ALL THE TIMES YOU CAN, TO ALL THE PEOPLE YOU CAN, AS LONG AS EVER YOU CAN.
~ John Wesley Founder of Methodism

For More Information Contact: Methodist Healthcare Ministries www.mhm.org (210) 692-0234

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