The vast majority of my Social Security Disability clients either receive services through the Harris Health System, or attempt to and are denied from seemingly intentional denial of service reasons. While the care administered is excellent the wait time to receive care is significant. Over the past decade of observing clients interactions with the system I’ve never kept statistics, but the overall impression is access is more difficult to obtain and service wait times are longer. These are signs of a system having difficulty coping with demand, and with the COVID effects the stress on the system is about to significantly increase.
Unemployment is up nationwide, and the local situation is no different. The Bureau of Labor Statistics for Houston-Sugarland-Baytown March preliminary numbers are released and they paint a grim picture: unemployment increased by 42,100. While this is a preliminary number it should be roughly accurate. April numbers are not out, but nothing suggests this trend did not continue in April. Making matters worse a quick search on job recruiting web pages shows the ongoing low oil price has led to very little opportunity in the oil and gas sector. In short, while some of the unemployment may reverse as businesses reopen many of the job losses are going to be ongoing and the oil and gas sector isn’t going to be able to offer any significant relief.
With the job losses insurance losses have followed. The Affordable Care Act has provisions for a special enrollment period related to a job loss. However, that is a 60 day window from the point that individuals lose their health insurance. Once that window closes the loss of insurance is in effect until the next open enrollment period. When that happens, the only option available for the newly unemployed and uninsured is turning to the Harris Health System for coverage.
Harris Health provides services to both the indigent and not indigent. The 2019 demographic information is as follows:
VOLUME STATISTICS – FY2019
Cases occupying hospital beds – 43,438
Births – 5,407
Emergency visits – 169,719
Outpatient clinic visits – 1,764,025
HARRIS HEALTH FINANCES – FY2019
Ad Valorem Tax – $739 million
Net Patient Service – $477.8 million
Medicaid Supplemental Programs – $194.5 million
Investment and other revenue – $53.7 million
Total Net Revenue: $1.465 billion
HARRIS HEALTH CHARITY CARE
Harris Health System provided $650 million in charity care in Fiscal Year 2019.
HARRIS HEALTH PATIENT PAYOR MIX
Uninsured – 54.1%
Medicaid and CHIP – 22.9%
Medicare and Medicare managed – 10.9%
Commercial and other funding – 12.1%
The case load is unsustainable. The system already services 1.7 milling clinic visits a year. This causes significant wait times for necessary treatment. The amount of income needed to sustain the operation is also stressed. Of the $1.4 billion budget, $739 million comes out of taxes. Property values are going to fall in the wake of COVID if for no other reason than simple supply and demand issues. More unemployment and general financial uncertainty will lead to less demand, and with job losses some migration away from the city to obtain employment elsewhere will increase housing supply.
This will cut into the ad valorem tax revenue. Right now the system already provides 87% of the ad valorem tax revenue as charity services. With enhanced need and a lower upcoming tax base (though this may take a year to appear since we are at the property tax protest deadline) any significant increase in charity care need will simply over stress the system in both capability and financial resources.
It’s important the City and County act, and act now, to protect the system. The most simple way to do so is to launch a public information, and if needed assistance, campaign to make the newly unemployed aware of the ability to access the health insurance marketplace during the special enrollment period. The City and County have already made several questionable expenditures as a response to COVID. This is one expenditure that would be saving resources in the long run.
The window to stave off this impending crisis is quickly closing. Mayor Turner, City Council, Judge Hidalgo – you need to act and act now.