Rx in the City 2012
Klotman Knowledge

How the Affordable Care Act affects the Texas Medical Center: An insider searches for answers

How the Affordable Care Act affects the Texas Medical Center: An insider searches for answers

News_Dr. Paul Klotman_president_Baylor College of Medicine
Dr. Paul Klotman, president of Baylor College of Medicine, believes that the Affordable Care Act will be good for the country.  Courtesy of Baylor College of Medicine
News_Harris County Hospital District_Ben Taub_Emergency Center_entrance
For Houston, in particular, the legislation will be effective. More than 50 percent of visits to Harris County Hospital District facilities, like Ben Taub General Hospital, were made by uninsured patients in FY 2012. 
News_Dr. Paul Klotman_president_Baylor College of Medicine
News_Harris County Hospital District_Ben Taub_Emergency Center_entrance

The United States Supreme Court's recent decision to uphold President Barack Obama's Affordable Care Act has everyone wondering what's next for the health care system, the insurance industry and the wellness of our citizens. 

Those implications are especially relevant in Houston, where the Texas Medical Center forms an integral part of the city's economy and its identity. Dr. Paul Klotman, president and CEO of Baylor College of Medicine (BCM), harbors few doubts about the legislation's effectiveness. 

"I think that it's good for the country," Klotman tells CultureMap. "The bottom line is that a larger percentage of people who are currently uninsured will be insured." 

Texas often ranks last nationally for health care coverage, and Houston, despite all of the services provided, is counted among the worst cities.  

The United States spends more than 18 percent of its GDP on health care costs, significantly more per capita than other developed countries. "That would be OK if we were getting fabulous care," Klotman says, noting that's not the case.

In fact, we're far from it: Texas, in particular, often ranks last nationally for health care coverage, and Houston, despite all of the services available, is counted among the worst cities

"I was certainly hoping that our governor would support expanding the Medicaid program in Texas," Klotman says of Gov. Rick Perry's recent rejection of the Medicaid expansion.

That critical part of the bill, which extends Medicaid to families with incomes less than 133 percent of the federal poverty level, would have granted coverage to as many as 1.7 million Texans

Klotman, who had just come from Ben Taub General Hospital, is in a unique position to recognize the importance of universal access: During the 2012 fiscal year, 62.6 percent of patients treated at Harris County Hospital District facilities were uninsured (charity or self-pay patients). Just over 20 percent of all patients were illegal or undocumented residents of Harris County. 

But he also acknowledges that the Affordable Care Act is not without its flaws, and considers the negligence of coverage for undocumented residents as chief among them. States won't have to deal equally with this issue, one that is so crippling to border states like Texas and California, and Klotman doesn't see an easy, non-political solution.  

Secondly, the Affordable Care Act doesn't actually fix the health care system itself. It just corrects some insurance wrongs by providing a mechanism (more well-payers) to pay for patients with preexisting conditions. 

 But legislation aside, BCM is aiming to improve its own system by producing better care at a lower cost.  

Another problem Klotman foresees is a lack of primary care resources for an influx of newly-insured patients. The industry has undervalued primary care physicians, and disincentivized the profession in favor of more specialized medical fields. 

Plus, if the federal Medicaid reimbursements drop too low, doctors may choose to opt out of the program and not see those patients at all.

"It's going to be very interesting to see what happens," Klotman says.

But legislation aside, BCM is aiming to improve its own system by producing better care at a lower cost. 

"Even before the Affordable Care Act, we started looking at how we can provide better value for our patients," Klotman says. Baylor College of Medicine is measuring outcomes from both doctor and patient perspectives and focusing on outpatient medicine and preventative care. 

"We want to be leaders in helping redefine how care is delivered in this region," Klotman says.

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