Battling Uncompensated Care in Dallas County, Texas

Dallas, Texas, provides a microcosm of a problem affecting most major metropolitan areas in the United States: uncompensated care.  Dallas County Judge Clay Jenkins, who holds an administrative position over the fourth most uninsured county in America, speaks almost daily with HHS Director Kathleen Sebelius and White House staff about the problems posed by the uninsured in metropolitan areas.

In November 2013, President Obama visited Dallas County to observe first hand, Judge Jenkins' Affordable Care Act Coalition, a grassroots effort supported by hospitals, concerned citizens and interdenominational religious groups to enroll Americans under the reform law.

I recently sat down with Jenkins to explore how what's happening in Dallas County has larger implications for medical practices across the nation.

Martin Merritt: How big is the problem of uninsured in Dallas County?

Clay Jenkins: It is a huge problem. If the Dallas-Fort Worth metroplex were one combined county, we wouldn't be the fourth largest, but the most uninsured county in America. A staggering 672,000 individuals are uninsured in Dallas County, which represents more than 28 percent of our citizens. Of that number, 506,000 qualify for a subsidy, which brings affordable, quality insurance into their grasp.

Texas hospitals provide over $5 billion a year in uncompensated care. Texans pay for this care through local property taxes, increased premium costs, and higher medical costs. Dallas County citizens pay more taxes to cover uncompensated care than for all other county services combined. Our county hospital, Parkland Hospital, provided $685 million in unreimbursed care in FY 2012.

MM: So you developed the ACA Coalition, tell us about it.

CJ: The Dallas County ACA Coalition has been in existence since August 2013, and is successful because of the many different Dallas-area organizations participating. My office’s role in chairing the coalition is to empower our government and private partners in the healthcare, faith, business, and grassroots communities to synergize efforts to comprehensively approach enrolling citizens and their children in the health insurance marketplace.

MM: You say there is no downside for physicians or individuals who need health plans?

CJ: As you know, studies are steadily finding that lack of access to care leads to shorter and less healthy lives. So, anything that increases access to care is a good thing. For physicians, there is a long-term benefit in decreasing the amount of uncompensated care and building a healthier patient population. As to differences in these policies and others, in Texas, the biggest difference to consumers is the network of care, which tends to be narrower for subsidized policies. For providers, the reimbursement rates can be lower with subsidized policies.

MM: How has the White House responded to the coalition's work?

CJ: The White House is a tremendous partner providing us with extensive resources and information. While we have been a focal point of the White House’s efforts to export our work in Dallas County to other metro areas, we have also been able to pick up best practices and ways to improve our efforts while working with the White House and HHS.