Experts discuss strategies to close Texas health care gap

As one of the largest states in the U.S. in both landmass and population, filling the health care gaps in Texas can be a battle on multiple fronts.

Legislators and lobbyists discussed the issue on Thursday during the Closing the Health Care Access Gap panel at the 2021 State of Reform Texas conference.

Before the pandemic began more than 7 million Texans lived in a primary care shortage area and 15 million lived in a behavioral health shortage area, Jamie Dudensing, the Chief Executive Officer of the Texas Association of Health Plans, explained.


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Texas has the highest uninsured rate in the country, with nearly a third of the state’s residents not having access to health insurance. The state also has the largest volume of uninsured residents of any U.S. state. Twenty-six counties do not have a maternity ward.

The pandemic created even more issues for Texans. The pandemic-induced economic contraction caused many to lose their health care. The reaction to the virus also moved much of health care to telehealth. Many Texans, and specifically those in rural areas, do not have access to broadband internet.

Dudensing believes telemedicine has the potential to be a valuable tool in the future of healthcare, but internet infrastructure must be improved upon first:

“Telemedicine [is] one of the fastest easy ways to get access to care across the state, but you still have the same disparities that we have right now. When you face having more providers in an urban area compared to a rural area, you have the same problem with telemedicine. You don’t have the same access to broadband [in rural areas] as you do in an urban area.

There are underserved areas. There are individuals that have a harder time getting access to those providers. Even though I think we’ve all realized telemedicine is a huge asset to get access to care …a huge investment needs to occur to help ensure that we’re both expanding access to broadband and at the same time, ensuring people have access to the high speed internet.”

Representative Donna Howard, a Democrat from Austin, believes expanding Medicaid is a key to granting Texans health care access.

Texas is one of 12 states that has not adopted Medicaid expansion that was passed as a part of the Affordable Care Act in 2010. Howard believes that passing expansion in the state would be cost effective, as it would pass many cost burdens currently shouldered by the state on to the federal government and expand health care coverage.

Another issue leading to gaps in health care is a lack of staffing. Health care staffing issues have been a problem for providers nationwide for a long time and the pandemic has exacerbated the situation.

Drew Darby, a Republican representing San Angelo, points out health care gaps in Texas are partially due to staffing problems.. While Texas has 14 medical schools, meaning the state is producing a large pool of doctors every year, it has trouble keeping its talent at home. Unlike states like New York and California, Texas does not fully fund medical residencies. This incentivizes some younger medical talent to leave the state. The state’s poor health care infrastructure also diverts talent out of the state.

There are also some additional regulations Advanced Practice Registered Nurses (APRN) face in Texas that they do not face in other states.  Bill Hammond, the chief executive officer of Texas Employers of Insurance Reform, pointed out that many nurses often leave the state, and neighboring New Mexico even once ran an advertising campaign to draw Texas APRNs out of the state.

Hammond believes lifting some regulations could attract nurses into Texas the same way lighter regulations benefitted New Mexico.

Entering into an interstate medical licensing compact can be a crucial step to solving these staffing issues, especially in the age of telemedicine, according to Dudensing, but it may have its limits:

“It’s the only way you’re ever going to get across the state line providers. I think you know we’ve waited and pushed it off for years and years and years, but this becomes a really big deal with telemedicine, because it is so easy to do across state lines. [It’s] the best way to increase the number of providers that are available to do telemedicine is an interstate compact, but I don’t usually think it’s going to solve what we call the ‘rural problem, the underserved Medicaid populations.”

Interstate medical compacts allow for physicians licensed to practice in one state to practice in other states within the same compact. If Texas were to join a compact, physicians in nearby states could practice across state lines. Physicians could also meet with patients virtually across state lines.