Texas and the Future of Health Reform in America

The Texas economy grew by 3.3 percent in 2011, and the growth was broad based, not just in manufacturing.  Texas now accounts for 8.7 percent of the nation’s economy, up from 7.4 percent a decade ago.

Binyamin Applebaum, “Texas is the Future, “New York Times, July 1, 2012

July 1, 2012 – A few days ago I received a handsome 64 page brochure from the Texas Medical Association.  Its title was “Healthy Vision 2020: Caring for Patients in a Time of Change. “ 

Among other things, the brochure points out that Texas is the fastest growing state.  Its population is expected to boom from 25 million to 4- million in 2040.  It leads the nation in employment growth.  It is desperately short of physicians.  Nearly 6 million of its baby boomers will soon become eligible for Medicare. Of its citizens, 6.5 million lack insurance.   in 2010, it spent $23 billion on Medicaid, yet it pays doctors only 50% of commercial payments.  I will not be surprised if Texas is among the first of states of opt out of federal funds for expanding Medicaid.   Texas may be the prototype of what happens to health reform at the state level.

Texas physicians and their medical association have always impressed me.  Its physicians are tough, resilient, independent, and powerful politically and economically.   They persuaded the Texas legislature to pass tort reform in 2003, which brought 24,600 new physicians into the state.

Yet Texas has fewer physicians per capita than the national average in  36 of  40 medical specialties. Texas is a good example of a looming and inevitable political crisis  - lack of access  to physician services by Medicaid and Medicare recipients, as demand for medical services boom and as  more physicians drop out of these programs due  to,reimbursements so low physicians cannot  sustain their practices.  

Access to financing through the Affordable Care Act is not the same as access to physicians.   Indeed, what good is “universal coverage” without  doctors to evaluate and treat patients?  The brochure notes that spikes in numbers of physician assistants (+132%), advanced practice nurses (+114%), and registered nurses (+44%) will not fill the physician shortage gap.

In spite of these problems, Texas may be what the future will look like in the future.   Texas has a robust business climate.  It is drawing Californians to Texas in droves.  It is an energy-rich state. Americans are migrating from North to South in record numbers in search of jobs and affordable living.

Three fourths of Texas physicians are from other states.  They flock to Texas for various reasons - higher incomes,  a more favorable malpratice climate,   no state income tax, a lowc ost of living, its friendly business and professional environment.  Texas is an unshed proponent of physician entrepreneurship and innovation.  It favors physician ownership and investment in  hospitals.  In 2009, physician offices contributed $39.4 billion in direct and indirect wages and employee benefits.  On average each physician supported $924, 413 in total wages and benefits.

Texas physicians are a potent economic and political force,  and they are critical of federal regulations that impede their practices,  increase their expenses, slow productivity,  and stifle  innovation. Texas physicians are aware of what is happening i  in Massachusetts – long waits to see doctors,  shortages of primary care physicians,  the highest premiums in the land, and sharp increase in ER patients.

For more information on how the Texas Medical Association and its 46.000 physicians see the future, go to WWW. TEXMED. ORG or all 512-370-1300.

Tweet:   The Texas Medical Association has published a brochure outlining its vision of health reform challenges faced by  physicians and patients.