HARLINGEN, RGV – Appearing before a House panel recently, former UT-Pan American student Aaron Barriero testified that far too many Rio Grande Valley residents are afraid to see a doctor or go to the hospital.

Barriero works at Edinburg Regional Hospital in the emergency department. He is hoping to be admitted into the inaugural class of the UT-Rio Grande Valley School of Medicine.

At a Rio Grande Valley Leadership class at TSTC in Harlingen, Manny Vela, CEO of Valley Baptist Health System was asked if Barriero’s comments were accurate, that too many Valley residents are afraid to see a health specialist.

Vela said Barriero’s testimony was, sadly, true. Vela said there are probably three explanations. One is that some Valley residents are simply afraid to find out what their ailment is. Another is that they do not have the means to purchase healthcare insurance. Another one again is that they are undocumented and therefore afraid to come out of the shadows.

Valley Baptist Health System CEO Manny Vela (second from left) spoke in favor of Medicaid expansion, or something similar, at Edinburg Conference Center at Renaissance in January.
Valley Baptist Health System CEO Manny Vela (second from left) spoke in favor of Medicaid expansion, or something similar, at Edinburg Conference Center at Renaissance in January.

“All too often you get people visiting emergency department who are well down the road from an acute perspective with regard to their illness. They have not had access to care previously and by the time they get to the emergency room, the cost is exponentially higher than it would be otherwise,” Vela explained.

Vela pointed out that the cost of a visit to the emergency room is, approximately, ten times greater than a visit to a primary care physician.

“You might say, so what, right? This is the so what and this is what I hope resonates with you guys,” Vela told the RGV Leadership class. “When someone who is uninsured comes into one of our facilities, there is a federal law that obligates us to care for them. We take these people at will. Some of us do more uncompensated care work than others. In fact, Valley Baptist does the most in the Valley, but the other hospitals do their fair share as well.”

Vela then explained the ramifications of uncompensated care. “We take these folks but don’t kid yourself. The cost of care escalates for the rest of us who have access to insurance through an increase in our premiums. Any time there is a cost in the provision of healthcare the insurance companies have to raise their rates. The relevance is this, if we don’t address the uninsured problem in this state the cost for the rest of us will continue to rise. So, it behooves all of us to work together to try to find a solution.”

In his Q&A in front of the RGV Leadership class, Vela said he was probably going to get asked about Medicaid expansion. So, he segued into this subject himself.

“I just read something from one of my governmental folks at Tenet this morning that said that Medicaid expansion in Texas this session is basically dead. The point I tried to make when the legislators were down here through the Partnership event a couple of months ago was this. Don’t call it Medicaid expansion. Call it increased accessibility.”

Tenet owns Valley Baptist Health System.

Vela was referring to a visit to the Valley by state lawmakers organized by the Rio Grande Valley Partnership, the Valley’s regional chamber of commerce. Vela and other hospital leaders spoke to them at a function at the Edinburg Conference Center at Renaissance. It was held in late January and Gov. Greg Abbott spoke at the event.

Speaking to the RGV Leadership class, Vela said if legislators do not address access to healthcare Texas will “run into the problems” he was articulating.

“Sicker people in our communities that have no coverage either because they are afraid to present themselves either because of their immigration status, or because they have no funds, or because they are scared to see what is wrong with them, are going to be sicker and sicker by the time they come to us (Valley Baptist) to anyone of us (hospitals in the Valley) and the costs are just going to escalate out of control,” Vela said.

If Medicaid expansion is “dead” for this session, are there any alternatives, Vela was asked.

“That is the sad thing. They (state leaders) are not talking about any other options. If you remember, when the Governor and the Lieutenant Governor had their State of the State addresses or their inauguration speeches, which I happened to be at, not one of them mentioned health care as a priority in the state of Texas. And, yet, healthcare is either the first or second highest cost component, and soon to be first, in the state budget,” Vela responded.

“For the Governor and the Lieutenant Governor to basically disregard the basic fact that it (healthcare costs) is out of control and escalating further out of control and leave it off their priority list is, for me, completely irresponsible. That is my opinion. We can certainly talk about it in greater detail if someone has a question or someone wants to proffer a different opinion. But, from my perspective, from a healthcare provision perspective, you have got to at least try to address it. Right now they (state leaders) are not even willing to talk about alternatives.”

Vela said one suggestion he has heard and likes is to take incremental steps towards improving access to care.

“There are 80,000 veterans and/or their families who are falling through the cracks in Texas, veterans and their families who do not have coverage in the state of Texas. Let’s start with that group. Who is going to fight or argue about that?” Vela asked. “Let us get an incremental movement going so that we can make a difference in their lives and at least make some movement in the right direction in the state in regards to addressing the accessibility issue. Let us think about that. A veteran and their family who has no access to healthcare with the sacrifices they have made in their lives, to not have access that is immoral in my mind.”

Vela was then asked if “block grants” might be an alternative to Medicaid expansion. He responded:

“Block grants would basically give the state the authority to direct the traffic in regards to those (Medicaid) funds. It sounds really good. The problem is, Texas in the last five or six years does not have a history of creating a good relationship with the federal government in Washington. Quite the opposite. Texas has sued the federal government on numerous occasions and as a result there is major friction between CMS (the Centers for Medicare and Medicaid Services) and the State of Texas right now. CMS would have to approve that kind of a model.

“It is at a standstill. You have the state saying we want block grants and you have CMS saying we are not going to give you a block grant. But, there are some models out there in other states that have proven effective. They are almost a hybrid of sorts. So, that is another thing we are urging. Let’s look at some of these other models that maybe make sense. Right now, there is not a lot of traction as it relates to Medicaid expansion.”

Vela then recapped his thoughts on access to healthcare so that the RGV Leadership class was clear.

“Let me also make sure our folks also understand this. The Valley has the highest medically uninsured rate in the entire state of Texas. Texas has the highest medically uninsured rate in the entire country. That means we have the highest medically uninsured rate, at just less than 40 percent. So, when we talk about the relevancy from a healthcare provision perspective it hits home hard here in the Valley – much more so than in areas such as Dallas or Houston or San Antonio or Austin, where they don’t have those high levels of uninsured,” Vela said.

“It is upwards of five million people that are uninsured in the state of Texas and we have the majority. Texas is right under 25 percent right now and that actually came down a little bit when the exchanges created by the Affordable Care Act came into effect a few years ago. It came down from 26 or 27 percent to 24 percent.”

Editor’s Note:The main picture accompanying this story is of Manny Vela in his office at Valley Baptist Hospital in Harlingen, Texas.

This is the first of a three-part series on Manny Vela’s analysis of the state of healthcare in the Rio Grande Valley. The second part, focusing on the push for a healthcare district, will be posted later this week.