Chapter 8: Health and Human Services
Health Care and Human Services
Health and Human Services (HHS) spending in Texas has skyrocketed in recent
years. Medicaid spending, driven by the eligible population, federal
requirements, and health care costs is the fastest-growing element of these
expenditures and has shot up by 248 percent over the last decade. Yet despite
enormous increases in state funding for these services, some key indicators of
progress—such as the number of Texas residents without health
insurance—demonstrate that we still have challenges to meet.
Given that HHS costs are expected to continue to rise for the foreseeable
future, the state must inevitably face a fundamental choice: should we continue
devoting an ever-greater share of the state budget to health and human services,
at the expense of other vital needs such as education and transportation? Or can
we transform the way we deliver health and human services in ways that will
provide basic services without breaking the bank?
We believe the second option is a desirable and achievable goal that can be
met by enhancing the use of technology in the health and human service area and
adopting the following strategies and recommendations.
Reduce the Number of Uninsured Texans
Absent fundamental changes in policy and the health care market, the
uninsured population in Texas and throughout America is expected to grow. Those
without insurance need an alternative to expensive emergency room care.
One approach is to free the existing health care market from needless
constraints and inequities, ensure information is freely available, and allow
consumers to make their own choices. To reduce the number of uninsured Texans,
the state should work to change federal law to allow the health care market to
work more efficiently, change state law to allow the health care market to
operate more efficiently, and use technology to remove state obstacles to
Medicaid enrollment for uninsured Medicaid–eligible children.
Improve Children's Health Services
To further improve children’s health care, the state should fund the
expansion of the Seniors and Volunteers Program for Childhood Immunizations
(SVCI), a public-private partnership formed to reach more children among areas
and population groups that have low immunization rates. SVCI does outreach in
hospitals, educating new mothers, enrolls and monitors children in their first
year of life, and provides transportation and other services. Telemedicine can
expand access to chronically ill and disabled children in remote, rural areas of
Texas. Technology and disease state management (DSM) - tailor-made, customized
health services for people with chronic diseases, can reduce the cost of
frequent trips to the emergency room made by children suffering from asthma and
improve the quality of their care. The state should provide more comprehensive
health care services by refinancing the cost of health care for children with
serious medical problems.
Reduce Costs and Improve Services by Customizing Services
A fundamental assumption behind modern government is that all
persons—all “clients”—should be treated the same. Once
groups are characterized—as disabled, single mothers, mentally retarded,
poor, or elderly—they receive treatment deemed appropriate for that group,
with little or no consideration for their unique circumstances. This
cookie-cutter approach results in waste and, worse, ineffectiveness in programs
that have a major impact on many people’s lives. Yet the personalization
trend now sweeping across the consumer market is precisely about being able to
treat people differently, according to their own needs and preferences.
Many people needing state services are confused by the structure of state
government and unable to determine which agency could provide the particular
assistance they need. Texas should expand TexasOnline to provide a single point
of entry for citizens seeking health and human services. Texas should provide
options other than nursing home care to the frail elderly seeking long-term care
so that they can remain in their own homes.
Texas should take full advantage of the flexibility that it has with the new
federal welfare reform law to provide employment-related services to all welfare
recipients before they exhaust their five-year lifetime limit for receiving
federal assistance. Texas should restructure its Temporary Assistance for Needy
Families (TANF) program by providing additional alternatives to the monthly cash
grant that eligible families currently receive and by customizing financial
assistance and services according to their individual needs.
Make Better Use of the State’s Bargaining Power as a Major Purchaser
of Health and Human Services
As the payer of last resort for the Medicaid population and low-income
Texans with major high-cost illnesses, the state should make every effort to be
a prudent purchaser of health and human services. Texas should examine the
practices of other states and the private sector to find more efficient and
cost-effective ways of purchasing medical goods and services.
Health services and prescription drugs are purchased separately by more than
a dozen different Texas agencies. Texas may be able to negotiate better prices
by combining agency purchases instead of allowing each agency to strike its own
Other ways the state could reduce drug costs would be to allow seniors to
purchase drugs at Medicaid prices, reduce costs of the Medicaid Vendor Drug
program and change the way the state purchases prescription drugs in the prison