The headline on this story reads “County mulls big-picture health council”, but a read of the story makes it clear that there’s a big piece of this picture missing from the discussion.
Harris County is discussing a big-picture approach to its complex and overlapping health care costs, proposing the creation of a council to coordinate spending on mental health, public health, the treatment of jail inmates and the county’s hospital district.
The proposed group would mirror the county’s Criminal Justice Coordinating Council, created in 2009 to improve the justice system and reduce jail overcrowding. Though they acknowledge many factors are involved, county leaders note the jail population has fallen since some of the council’s proposals – such as launching a public defender’s office and letting inmates who enroll in vocational or educational programs earn three days’ time for each day served – were implemented.
“We not only have about 30 percent of all the property tax money going to the hospital district, but we have other areas that we support: mental health, incarcerated health and public health,” said Budget Management Director Bill Jackson. “All those together add up to almost $600 million a year, and I think that this council would bring people together, show their different needs. It deserves a lot of attention and a lot of coordination.”
The issues the health council would confront are hard to overstate, Commissioner El Franco Lee said. The same citizens often cycle through the jail and public hospitals, he said, with great overlap among homelessness and mental and physical health troubles. The result, he said, is a huge burden on public resources.
For example, $47 million of the sheriff’s proposed $391 million budget would be allocated to inmate health care. The county jail has been called the largest mental health institution in Texas; a quarter of its inmates take psychotropic medications on a typical day.
“So much of our dollars go into dealing with health,” said County Judge Ed Emmett. “I think every member of the court has said, ‘We’ve got find a way to separate mental health from the criminal justice system,’ and I think if we get everybody sitting together talking about it at the same time, we can make that happen.”
These are good ideas, and if a coordinating council for county health care makes sense to implement some of them then I support its creation. But let’s face it, if we’re not also talking about the need for Medicaid expansion and the huge benefits it would have for health care in Harris County, we’re not seeing the full picture. As Grits reminded us back in September, expanding Medicaid could have a large positive effect on these very citizens that cycle through the jail and public hospitals, not to mention the bottom line for those public hospitals. Medicaid expansion may not be on the table for the state right now, but there’s no reason Harris County can’t join with Dallas and other counties to formally request the right to do its own expansion. I’d conservatively guess that expanding Medicaid would affect over 200,000 people in Harris County, and I’d bet that more than a few of them are well known to the jail and the public hospitals. We can pay for all that ourselves, or we can take advantage of the Affordable Care Act and get the federal government to pay for the vast majority of it. If advocating for that isn’t part of any county health care coordinating council’s mission, then I don’t understand what its mission is.