Houston & Texas News
Since she doesn't qualify for county assistance, Jennifer Holliday drives three hours twice a week to Galveston for limited care of her arm, torn apart by a shotgun blast. She still needs surgery.
MAYRA BELTR?N PHOTOS: CHRONICLE
Aug. 10, 2007, 2:06PM
MEDICAL CONCERNS
Caught in the limbo of a troubled health care system
After losing her insurance, attack victim, like a growing number of Texans, had to turn to state facility due to a lack of county care
By HARVEY RICE
Copyright 2007 Houston Chronicle
Caught in limbo
A journey through a troubled system
GALVESTON ? Jennifer Holliday is too wealthy to qualify for indigent medical care in Angelina County, but poor enough to qualify for limited care at the University of Texas Medical Branch.
So Holliday, her arm mangled by a shotgun blast from a man who attacked her, must make the three-hour, 175-mile drive from her Lufkin home to Galveston for physical therapy twice a week.
Holliday is among a growing number of Texans without health insurance and Medicaid who are streaming to metropolitan areas and state-funded hospitals such as UTMB to get care that is not available at home.
The single mother of a 7-year-old son still has shotgun pellets in her arm and needs surgery to restore the use of it. She lost her job and her health insurance after the 2005 attack, and now lives on $900 a month.
She and others turn to UTMB because most Texas counties do not provide care to anyone earning more than 21 percent of the federal poverty level, according to a January report by Morningside Research and Consulting Inc. of Austin, a consultant to county indigent-care programs.
Compounding the problem is the Legislature's reluctance to increase funding for the state's indigent, and also a county-based, indigent-care program that a state task force has called inadequate and inequitable.
About 70,000 poor and uninsured patients received medical care at UTMB last year, but more than 35,000 were turned away, said Dr. John Stobo, whose term as UTMB president ended last month.
The Legislature this year denied the hospital's request for about $50 million to meet the rising costs of care for those who can't pay, said Dr. Ben G. Raimer, UTMB vice president for county outreach.
Patients who can't pay are driving up insurance rates and taxes in a broken health care system, studies show.
Dismal numbers
Poor access to medical care and the highest percentage of uninsured in the country contributed to Texas ranking 49th in a nationwide survey of state health care systems, according to a June report by the Commonwealth Fund Commission on a High Performance Health System, a private foundation that promotes better access and quality of health care.
Harris County alone has more than 1 million uninsured, said Dr. Lewis Foxhall, chairman of the Harris County Health Care Alliance, a group designed to help the indigent and uninsured.
The uninsured find it much easier to get care in metropolitan counties. The Morningside report says urban counties provide care at 100 percent or more of the federal poverty level, which costs more than $20,000 per year for a family of four. The Harris County Hospital District ? which includes Ben Taub and LBJ general hospitals ? charges patients based on their ability to pay rather than using the federal poverty level as a guideline, said Dr. Ken Maddox, chief of staff at Ben Taub General Hospital.
Applying for medical care under county programs is so difficult that many counties provide nothing. The Morningside report shows that 14 counties and 15 hospital districts reported no expenditures on indigent care last year.
A stranger with a shotgun
Before becoming one of the uninsured, Holliday earned $40,000 per year as a paramedic for a Lufkin ambulance service.
Her life changed the morning of May 29, 2005, as she and her 18-year-old cousin, Anna Franklin, drove along Texas 69 in Angelina County. Eric Stephen Parnell, of Pollok, a man she had never met, pulled up next to Holliday and fired a shotgun into her Ford Explorer.
One blast struck her cousin in the head, killing her. Another nearly blew off Holliday's arm. Parnell abducted and beat her. He received two consecutive life sentences. Holliday said she received rapid and efficient treatment under her employer's insurance policy, and then under Medicaid after the ambulance service went bankrupt, canceling her insurance.
Then a quirk in the law left her without any insurance at all. Her qualification for $900 monthly Social Security disability payments, her only income, made her ineligible for federal medical assistance for two years.
Holliday says she was treated differently once she lost her insurance. "Even the way you get looked at and treated, it's unbelievable," she said.
The Social Security payment also made her ineligible for the Angelina County indigent-care program, which limits assistance to those earning no more than 25 percent of the federal poverty level. That meant Holliday could earn no more than $340 per month, she said.
"It does cause a hardship on a lot of individuals," Angelina County case worker Gala Collins said about the income requirement. Angelina County's requirement is more generous than the 21 percent limit in most of Texas' 254 counties, according to the Morningside report.
After losing her insurance, a life-threatening infection that ate a hole through her bone sent Holliday to the Lufkin Memorial Hospital emergency room last year.
The hospital expenses forced Holliday into bankruptcy. She lost her car and home, and now lives in a trailer. A collection agency calls incessantly demanding to know when she will pay her hospital bill, she says.
The financial pressure is piled on top of the emotional scars from her attack. "Some days I will completely break down," Holliday said. "There is no doubt I'll need counseling the rest of my life."
She finally made the three-hour drive to UTMB, where she has received limited medical care, such as occupational therapy and drugs, but no surgery for her arm.
UTMB diverted about $60 million last year from other programs to pay for uninsured patients, many of them unable to qualify for help in counties where UTMB has contracts for indigent care, Raimer said.
"This is not just a UTMB issue," Stobo said. "This is a Galveston, Houston, state issue."
A 'Code Red' to lawmakers
Stobo was vice chairman of a task force that laid out the severity of the problem in an April report last year sponsored by 10 academic health institutions. The report's title, "Code Red," was meant to convey the dire condition of Texas health care. It said, in part, that Texas "faces an impending crisis regarding the health of its population, which will profoundly influence the state's competitive position nationally and globally."
The Legislature this year passed a number of health-related bills influenced by Code Red, but none significantly changed the way the poor and uninsured receive health care, said state Rep. Jim Jackson.
The Carrollton Republican unsuccessfully tried to pass a bill raising minimum eligibility for indigent care to 100 percent of the federal poverty level.
When UTMB asked for money to take care of the uninsured, Stobo said, legislators responded that the counties were responsible under state law for taking care of the poor.
State law allows counties to refuse medical care to anyone with more than $2,000 in assets or earning more than 21 percent of the federal poverty level.
Counties can raise the 21 percent level, but few do, according to the Morningside study.
That means a single person can earn no more than $179 per month and a family of four no more than $362 per month to qualify.
"The whole system is lousy and we shouldn't be depending on the county tax base to furnish indigent health care in Texas," Jackson said.
http://www.chron.com/disp/story.mpl/metropolitan/5042732.html
