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CONTENTS FEATURES 1 In A Fervent Heat 2 Indigent Health Care Watch 5 A Tale of Two Hospitals 6 The Low-Tax Myth 12 The Sanctuary Challenge 14 Contras’ Colonel Flaco Tells His Tale A. G. Mojtabai Geoffrey Rips Dave Denison Kim Quaile Hill Jack Elder James Ridgeway DEPARTMENTS 4 Dialogue 16 Political Intelligence 22 Social Cause Calendar Books and the Culture: 17 Places to Hide 18 Yuppie Angst 20 The Sleep of the Ordinary World Gary Pomerantz Michael King Michael King Afterword: 22 Dulce et Decorum Est Pete Hamill poverty population which has no medical insurance rose from 28 percent to 43 percent. On top of that, there are many more wage earners who have become unemployed recently and are losing their health insurance coverage. Add to that the reduced federal assistance to counties and municipalities, and you’ve got a cauldron of expanding needs and diminishing resources. THE INDIGENT health care package, passed during the May 1985 special session, is made up of four bills. SB. 1 defines the responsibility of counties and public hospitals to finance treatment of indigent residents and appropriates money for the entire indigent health care package. The Texas Primary Health Care Services Act, HB 1844, provides for basic state-funded health services for indigents in areas where those services are not otherwise available. The provides for comprehensive maternity and infant health care services. It is designed to prevent or limit the incidence of maternal, fetal, and infant deaths, low’ birth weight, conditions increasing the risk of handicap, and unplanned adolescent pregnancy. The fourth part of the package, HB 1963, provides guidelines for the transfer of emergency patients from private to public hospitals. Under SB 1, $63 million was transferred from general revenue to the indigent health care assistance fund for fiscal years 1986 and 1987. “Before we went into special session,” said Camille Miller, “we had extremely broad, bi-partisan support. . .before Phil Gramm made it a partisan issue.” Helen Farabee told the Human Services advisory council that the health care package was a “very conservative program in terms of the number of people that will be eligible for it. ” So conservative that, according to the Department of Human Services, the eligibility guidelines will restrict the program to those, making up to 25 percent of the federally-defined poverty level income. For monthly countable income is $226. That misses a whole lot of people. , “It doesn’t stand to reason that, if we have so many indigents, the state doesn’t come up with more money,” said Paula Gomez. “We’ve got to really seriously consider parimutuel, a lottery, or a state income tax. Something has to give. The legislative intent was good and very progress&e, but the allocated monies are less than adequate.” Gomez fears that some legislators underfunded the program so that it would fail. “Counties are looking for ways out,” she said. “It’s not being given a chance to work.” In fact, none of the indigent health programs have been implemented. Money for the MEHIA program has not yet been distributed. According to Nancy Epstein of -the Health and Human Services Coordinating Council, MEHIA contracts will be awarded by the end of June. Under the legislation, the county in-patient care responsibility does, not take effect until September 1. It was the intention of all parties concerned with the implementation of the programs that they be initiated in a manner that would provide the best chance for their success. The fact that the county responsibility portion of the program does not begin until a few months before the legislature reconvenes poses a few problems for its evaluation by a legislature bent on cutting expenses. “At this point, it’s pretty much a philosophical situation,” said Camille Miller. “Until you’ve implemented [the program], you can’t tell if you’ve over-estimated or under-estimated.” “The greatest problem we’re going to have,” said Helen Farabee, “is the program goes into effect in September [while the legislature considers it in January]. It will be sort of like the blind leading the blind. That also argues for leaving the program alone and getting a two-year experiential factor or even one year.” While Nancy Epstein is relatively optimistic that the package will not be cut \(“Governor White instructed the health department not to touch indigent health care [in making budget local responses to the program. These may appear in the legislative passage of local definitions of indigent health care services. For instance, “we’re just coming to the debates that say, do you get a liver transplant for your baby if you are without insurance?” she said. “We need to know right up front what we’re doing.” Otherwise there is the danger that hospital districts will have the right to decide what services they’ll include for indigents, and high technology medicine will only be available for those who can pay. So far, there has not been much talk about cutting the indigent health package. “Nobody will argue with you about infant mortality,” said. Camille Miller. There has been some grousing at the Texas Conservative Coalition, which provided the base for opposition to the package in 1985. The Coalition, which has always contended that the indigent health package is a “bottomless pit,” issued a report saying the local requests for funding under the program far out .stripped the money appropriated to pay far them. The requests, however, included such things as a new medical building. When such inappropriate items are pared out of proposed expenses, the program fits its budget. Nevertheless, when budgetary push comes to revenue shove, indigent funding could be vulnerable. Beyond that, what we should be discussing is increasing THE TEXAS OBSERVER