The University of Texas Medical School at Houston
The University of Texas Medical School at HoustonThe University of Texas Medical School at Houston
The University of Texas Medical School at Houston
Nov. 13, 2009 | from the Office of Dean Giuseppe Colasurdo

Distributed every other Friday via e-mail to all Medical School employees, students, residents, and postdoctoral fellows, UT 2 Me is Dean Giuseppe Colasurdo's regular update of news and items of interest. He also welcomes feedback through this two-way communication.

This week I want to address the very timely issue of health care reform. With the recent passage of the U.S. House legislation on this topic, and the Senate finalizing its bill, many of you have been asking what the Medical School’s stance is on this important issue.

Although everyone claims to have knowledge in this field, I have asked our resident expert on the topic, Dr. Guy Clifton, former chair and founder of our Department of Neurosurgery, former Robert Wood Johnson Foundation Health Policy Fellow, and author of Flatlined Resuscitating American Medicine, to bring us up to speed on what the bill means to us as members of this Medical School community.

Highlights of U.S. House of Representatives’ HR3692 include:

  • Creating a public health insurance option, allowing the federal government to sell insurance.
  • Requiring citizens and legal residents to obtain health insurance by 2013, or pay a penalty of 2.5 percent of their adjusted gross income.
  • Requiring employers to offer insurance to employees, or pay a penalty up to 8 percent of payroll (excluding some small businesses).
  • Providing for the purchase of health insurance through a health insurance exchange.
  • Offering federal subsidies for families with incomes up to 400 percent of the federal poverty level ($88,200 for a family of four).
  • Capping annual out-of-pocket health care expenses for families at $10,000 and $5,000 for individuals.
  • Expanding Medicaid and CHIP eligibility from 133 percent to 150 percent of federal poverty level ($33,075 for a family of four).

Q: Dr. Clifton, what does this bill mean for our faculty?
A: For faculty, it will mean a whole lot less uninsured patients, as it will result in 2.5 million newly insured Medicaid patients in Texas. And, an undetermined number of Texans would be eligible for federal subsidies to help offset the costs of health care.  This massive expansion of Medicaid patients will increase the demands upon primary care physicians and exacerbate the shortage we are already experiencing in this area.

Q: What does this bill mean to our students – our physicians of the future?
A: The existing problem of unsustainable public spending on health care will be worsened. Future physicians will practice in an environment with far more controls on cost, which will become a feature of medical practice forever. I predict future physicians will be dealing with another round of health care reform between 2017 and 2020 as the Medicare trust fund becomes bankrupt.

Q: And what will this mean for patients?
A: For those who work for small employers, those who are self-employed, and those who are uninsured, it will guarantee that they have insurance coverage without having to be cleared for pre-existing conditions, and their premiums will be regulated.

Q: How will this health care reform affect academic medicine?
A: I don’t think there is anyone better organized to be accountable for health care quality than academic medicine. It is a natural for institutions like ours to be organized to practice to manage health care costs, and we have an obligation to teach students to be a part of the health care team with an eye on cost and quality. We also will need to turn out more primary care physicians to meet the growing need.

Q: Finally, what can we do as an academic health center to be prepared for these changes?
A: We must develop systems of care that help us manage cost and quality in a coordinated manner for the full range of services we provide.  This is really managed care. It will take us about eight years to do this right, so if we start today, we’ll be in good shape.

I want to thank Dr. Clifton for his expertise and clearly articulating this very complex topic. We are fortunate to have such leaders on our faculty.

Have a great weekend,


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