Healthcare Financing in Texas: Case Study

An article in the NYTimes illustrates part of the problem with healthcare financing in America today. Dee Dee Dodd is a 38 year old woman who lives on a country road in Hays County, Texas. Among the working poor, the Dodd family makes too much money to qualify for Medicaid under stringent Texas laws (if a working parent of two or more makes more than $3696 a year, he or she is ineligible). With between 150-250% of the federal poverty limit, the Dodd family cannot afford private health insurance. Ms. Dodd was diagnosed as a “brittle diabetic” ten years ago when her weight fell to 82 pounds. Years of low access to health care had weakened her and led to preventable side effects like esophageal ulcers. Additionally, repeated episodes of ketoacidosis were life-threatening. In one 18-month period, Ms. Dodd accumulated over $191,000 in unpaid hospital bills for emergency room visits and time spent in the intensive care unit. As a result, Ms. Dodd was classified as a “frequent flier,” or a repeat patient whose disease and expenses could be decreased with more regular medical care. The Seton Family of Hospitals enrolled Ms. Dodd in their charity program, where she now receives free primary care. The use of a $3,200 insulin pump and access to an endocrinologist and home counseling have helped reduce the severity of Ms. Dodd’s ailments. Her health has improved, her medical bills have been cut, and the hospital’s costs have been cut as well. In 18 months, her care cost Seton $104,697—significantly less than the previous period when Ms. Dodd was not a part of Seton’s charity program.

For individuals with chronic conditions, better care not only decreases disease, but may also decrease patient and hospital costs. Seton's charity program is among others that have taken novel approaches to curb hospital costs in Texas. Recognizing the many problems with healthcare financing in America today, states are taking the lead on developing plans that better address health/financial/ethical complexities. One recent example is Massachusetts’ plan to have 99 percent of adults covered by health insurance. With healthcare financing on the state and national agenda, it will be interesting to see how things change within the next decade.