Healthcare forum to examine cost, access

Health care has emerged as one of the top issues of the 2020 presidential elections with several minutes of the Democratic presidential debates dedicated to questions on the topic.

The conversation among the candidates usually focuses on access to health insurance, specifically, on the concept of Medicare for All. However, during a Wednesday public forum, titled “The Future of Health Care,” legislators, educators and leaders in the industry will engage in other aspects of the conversation, such as the costs of care, legislation and innovation.

Lisa Kirsch, senior policy director at Dell Medical School and formerly the Medicaid/CHIP director for Texas Health and Human Services Commission, will be among the panelists for the discussion titled “Getting a Handle on Costs.”

“(In) the Texas legislature, and really nationally, there’s a continued interest in how do we get a handle on growing health care costs,” Kirsch said, noting that costs continue to be on the rise. “And so there’s that question of what can we do to try to get a handle on this and I think there will probably be really good discussion on our panel.”

Kirsch said the conversation might touch on price transparency — how to have consumers and also other payers better understand drug prices and hospital prices so that they can make informed decisions about purchasing.

But also, she said, it’s about how to get people good access to primary and preventive care, chronic care management and identifying the factors that make people unhealthy.

“So I think you’ll see discussion about things like housing insecurity, food insecurity, transportation,” Kirsch said. “If there are things that are preventing people from being healthy, there’s a lot of discussion now about what should be the role of the healthcare sector in that or partnering with community partners.”

Also on that panel will be David Balat, director of the Right on Healthcare initiative and the Texas Public Policy Foundation.

Balat said cost was “the most critical thing” they could talk about right now.

“That’s the key thing that Americans care about right now. Every poll demonstrates that people are concerned about the affordability of health care,” Balat said.

“Access is a big issue, but access is a function of affordability,” he said, adding that many people restrict themselves from seeking care because they might not have the means or they’re unsure what bills they might receive for going to the emergency room or to the doctor.

“So there’s a lot of fear because of our current system,” Balat said. “Affordability has restricted access in a significant way.”

The discussion on innovation, dubbed “Innovation, Transformation & Disruption” will feature John Krouse, dean of the University of Texas Rio Grande Valley School of Medicine. He addressed the large need in South Texas.

“Given the need for good primary care, given the need for specialty care, for patients with significant diseases — even for preventive care, is a large need — that we need to think about innovative ways that we can approach that,” Krouse said.

UTRGV is addressing those issues through the school of medicine’s unimovil, a mobile van, which goes out into rural areas to directly serve patients near their homes in order to increase access, he said.

Krouse also pointed to their health education centers and federally funded projects that are administered through the medical school in rural areas across the Rio Grande Valley by which they’re bringing clinicians and services closer to where people reside.

“So we need to think about how we do that,” Krouse said, “How do we use teams, how do we use other health providers like nurse practitioners and physician assistants, how do we assure that we’re providing good prevention services, good vaccinations, how do we make sure people are getting good information on nutrition?”

Krouse stressed they had to take different approaches here compared to a large urban area with a more developed health care system.

“Where we sort of sit back and people are very literate about what to do with their health and then they just kind of come in and seek care as they need it,” Krouse said. “That’s not going to work for us, hasn’t worked, so we need to find ways in order to improve the health of the population through us being more proactive in some innovative approaches to health care.”

In addition to those topics, the event will also address Medicare for All, or “Medicare for Y’all” as the segment on the topic is titled.

Anne Dunkelberg, associate director for the Center for Public Policy Priorities, will take part in that discussion. She thinks people might be getting a clearer picture about Medicare for All.

“I think one of the things, if we’d talked nine months ago, I would’ve commented on is that it probably means something different to every person you talk to,” Dunkelberg said.

“They each have their own position on it,” Dunkelberg said of the Democratic presidential candidates who have made Medicare for All a part of their platform, “and for some of them, they’re talking about really replacing the private insurance industry completely with an insurance program that everybody in the United States would have access to regardless of what their income is.”

She added that what those candidates are advocating for would not be today’s Medicare but would, instead, be more expansive.

“One of the things a lot of folks who are under 65 don’t understand is that Medicare doesn’t cover eyeglasses, hearing aids, doesn’t cover long-term care, doesn’t cover dental care, and it has a lot of co-payments, deductibles, co-insurance,” she said. “When you’re talking about, for example, the Bernie Sanders version of it, you’re talking about fixing that too so that no matter what income level you’re at, while you have to pay something through your taxes, you’re not going to be priced out.”

“If you look across all of the candidates, you have others that are just saying, ‘No, that is too big a step to take all at once,'” Dunkelberg added, saying those candidates would rather focus on who is still uninsured today because of gaps under the Affordable Care Act and try to fill those.

“And so you find people across that whole spectrum,” she said.

A wide spectrum of perspectives on health care will also be on display Wednesday during the forum. The event, which is free and open to the public, will be held at the Edinburg Conference Center at Renaissance from 8 a.m. to 3 p.m.