Good evening everyone. Thank you so much for being here. I'm Sima the Democratic nominee for District two. two. Thank Thank you you for for joining joining joining us us us as. as as as you you you all all all know. know know. know health health health health care care. care care is is is very personal to me me because because of of my my experience experience experience with with with cancer cancer cancer. cancer and and and and and. I I I I really really really really believe believe in in universal universal universal high high high high quality quality quality quality health health health health care care care care care for. for for for for every. every every. every. every farm farm before before the. the covid- 19 crisis Texas. He had the highest rate of uninsured people of any state in the country, and now it's even worse and you know, in addition, our governor and our Legislature has turned down federal money to expand Medicaid, meaning that more than one and a half million people who could have qualified for coverage on not getting it since the pandemic the crisis. The access to health care has been a lot worse because obviously we've had millions of people lose their job and their health insurance with it. This is really not not a a problem problem just just doing doing doing the the the crisis crisis crisis crisis when when when when it's it's it's it's it's viral viral viral. viral viral vital vital vital vital for for for. for the the the public. public public health health and and that's that's. also the individual. But this is gonna be an important issue of the worst when you figure out how we go about what we do in the next stage of the coro situation, and there are many things that are representatives can do to help and there are ways that are local health system is really trying to bridge the gaps to be ready for what's coming next and I've advocated for I mean access to the ACA Health care Exchange, Exchange, but but really really creating creating creating a a a special special special special enrollment enrollment enrollment enrollment. period period period for for for for people people. people people to to to access access access private. private. private insurance options. don't know. It available premium subsidies. I've also called on Texas to at least temporarily expand the Medicaid access while we're in this sort of global pandemic. This crisis is also really putting lights on how communities of color are being so much more affected by this pendant this week. We're very lucky to have Elena Marz, who's an expert. She is the President and CEO of this health hold on she's the President and CEO. I'm gonna read this quick. She's the President President and and CEO CEO of of of the the the Episcopal Episcopal Episcopal Health Health Health Foundation. Foundation. Foundation, Non-resident fellow. universities public policy and a board member on grandpa in Christian help the largest national organization serving the field of and she is a dear friend thank you so much for being here I am going to handed over to in a minute to provide a bit of the context for conversation we need to see how we talk about this healthcare access in general and in this situation situation thank thank thank you you you everyone everyone everyone for for for listening listening listening for for for all all all of of of you you you watching watching please please putting put your questions in the section of the zoom or you can really dot com it's IIMA F O R T S dot com I will try to get as many of them as possible Thank you so much and please go ahead. Thanks very much Sima for having me and thank you to those who are listening. you did a great job of outlining what the challenges are for us in Texas accessing health care. We have the highest rate of uninsured people in the country and the largest number of uninsured people in the country. We've always been on the high side, but we now outstrip everyone else and the primary reason. That is that almost all other States all but 13 other States have accepted the federal Government's offer to expand Medicaid at a cost that is relatively negligible to the state, But Texas still has refused to do that. And for that reason we have of the five million people who are uninsured. It's estimated that as many as a million and, a half of those people might have been eligible for Medicaid expansion. I wanna make. Few comments about the health system in general and talk about how the Cove experience has just highlighted the weaknesses that preexisted in the system and to hope that when we get out of this and we make changes to the system we do so in light of the facts that have been exacerbated and highlighted during Kobi so first of all something that's not really about health care, but it's about health. and that is that the fact that most of the factors that determine whether a person is healthier or not. Have anything to do with medical care medical care is really important, but whether you're healthy or not to generally 80 percent depends on what people call the social determinants of health and those are factors like where you live, whether you're well educated if you have family and social supports what you're diet and exercise and other health behaviors areli whether you live in a polluted area and all of those factors. Together are actually more influential on your health and medical care. However, the same people who lack access to medical care, which are generally lower income populations and particularly Hispanic populations also happen to be the same people for whom the social determinants of health are very poor. So you find that neighborhoods of color and low-income neighborhoods tend to have poor quality of housing stock for options. For healthy food or active living in the community and so you have people who are already disadvantaged and put in a position where they are at greater risk to be unhealthy in the first place and they don't have as easy access to health care services when they do get sick because they are more likely to be uninsured and so focusing on the social determinants of health trying help people be healthy in the first place would counteract. The fact that they don't have the greatest access to health care once they are sick and another thing that this pandemic is pointing out is how poorly funded our public health system is nobody knows about public health and public health is working well. It's actually invisible. The reason we don't have rampant TV tuberculosis in the Houston area is because we have a health Department that is constantly checking on it testing people. Contacts and over the years at the National level, the state level and the local level we have gradually defunded public health and so now when we're in a position where we've got a pandemic spreading widely, we don't have the infrastructure in place to administer tasks and to trace contacts. That's how you get your hands around and contain an outbreak like and finally regarding the health care. System it is based on a financing model that is more and more service delivery without regard to the quality of the care or whether it actually impacts health or not, and because we pay by the piece we are incented providers, hospitals and doctors. Everyone does what they're paid to do it. It's not that they're bad when they get paid by the piece to one more test or to see more patients they will do those things. and that's what that are. To whether or not, it's actually what the person needed if we can reform our system in a way we're paying for value and where the value is the health of a person. then we would let the dollars follow the health needs of. for example, we might pay for someone who is diabetic to have access to healthy foods rather than relying on medications that can only go so far and recognizing that people who don't have access to healthy food or weight. Any kind of exercise are going to have bad health outcomes and if we can reform our system so that it pays for value it'll pay for more upstream measures like healthy food it'll pay for more preventive care and it won't in the escalating costs where we pay by the piece because we won't be delivering pieces will be delivering health outcomes. Thank you so go on forever and ever on a million related topics but let me stop for a minute and see if anyone's got questions and if not, I'll go on and talk about a few of the actual positive things that have happened in the health care system because of Kota that I would like to think that maybe we hang on to afterwards. One thing that's happened during covet is that we have accelerated the use of telehealth because so many providers are closed or partially closed. They are seeing a lot of patients where it's appropriate through telemedicine, so you can do it to your laptop or your phone through your tablet and it's not appropriate for all this, but it's appropriate for a lot of kinds of care and it's actually easier on the patient. you don't have to get in your car. You don't have to go to the Texas Medical Center, find parking and pay a fortune for it and wait for the doctor to be ready to see you if you use it. Telehealth portal then you can actually accelerate the visit and say you're safe your own top five where that's appropriate. It's very successful and you find that patients like it and providers are getting used to it. I hope we can keep some of that in our system that goes back to how we pay for services, though if we continue to pay by the piece and providers able to see more patients because they are able to do it in this compressed and different sort of way of doing it if we pay for. In the old way, we're just gonna continue to escalate health care costs and so as we use these new technologies, we need to be looking for ways to make them financially sustainable and that needs to bring the total cost down. another thing that is happening during this pandemic is that we've relaxed the rules about which providers can practice where we're now allowing providers to cross state lines because we want providers to be able to. Where there's a need normally you have to be licensed in a particular state and some States make it hard than others for someone who is coming into the state to actually get licensed to provide services. Texas is one that has been as protective as many and more protective than some about outsiders coming in and we have a lower a position to person ratio than most States and we could relieve some of that pressure by allowing qualified out-of-state. Providers to practice here like we're doing during the pandemic lastly, in the case of Medicaid and chip, the federal government has mandated that some of the administrative burdens be reduced during this period of time they are not requiring people who are on Medicaid to do the income checks that they do as often as they normally do they are streamlining some of the ways that people get on to Medicaid and reduce. The likelihood that they will get dropped inappropriately and those are things that we could be doing all the time and so I hope that some of the improvements we've seen that have been caused by urgency. We recognize our really good elements for a health care delivery system and why don't we keep them when we go forward. Thank you Ellen and this is really helpful for what you just said I had a question on the Telehealth If there are people who don't have primary doctors or are not insured for that. What. To them like that, I guess the hard time right now about this Telehealth is that how do you talk to somebody when you don't have the insurance well Harris health, which is our public health care system in Harris County, sees people who are uninsured sees people who are undocumented anyone who lives in Harris County is an eligible patient for Harrisburg, depending on income levels that determines how much you will pay, but Harris' health has done 20000 Telehealth visits. In the last month and so you can get telehealth services for primary care through harris' health and there are a lot of federally qualified health centers and nonprofit community-based health centers that work in our area and they too are increasingly doing telehealth and they serve uninsured and undocumented people so there is access at affordable rates to primary care in the Greater Houston area. That's pretty good to know. Thank you so much Elena. I just wanted to remind everybody. if you have any questions, please put it in the Q and A box or email it to us at at youma for Texas dot com and then I will ask you have we flatten the curve in Houston and how we're doing in terms of health care capacity here in the community. so it's flattened, but it's not declined in the way that experts say it needs to for us to let up our guard. And so while things aren't getting worse, they haven't been getting better or better. Sufficiently for a long enough time for us to relax our guard, we know that within the Texas Medical Center hospitals, we do have capacity right now and as you know, the governor has loosen restrictions on what kinds of medical services can be provided. and that's a good thing in the sense that there were a lot of people who had they were calling them elective procedures, but if you need a hip replaced or cancer surgery, it's not exactly elective, but as though. Procedures come back online. We need to be really careful that we watch hospital capacity levels because we are skating so close to the edge that we could drop back to where we need to be more vigilant. and so I hope that the hospitals will bring up their elective procedures in a careful way so that they're mindful of capacity issues. Well, that makes a lot of sense. They have to be very careful on the next next steps. steps. As As you you you know, know know, we we we open open open up up up more more more people people people going going going in in in. these these hospitals. hospitals. What do you what? To think, is needed in terms of getting people, the care they need here in Houston now Well specific testing. contact tracing contact tracing contact tracing that is public health 101. That is the best defense against any kind of communicable disease. It's not new. It's not sexy. This is how we have contained other communicable diseases. We forgot about that. and when this hit we. Spent more time talking about ventilators which are really important, but we spent less time saying let's do testing widespread testing and let's do contact tracing because that's how you get your arms around something that's spreading quickly. How are we doing as far as having enough testing like I know we had a problem? We don't we haven't had enough and also the result you know they've taken from two days to five days like how are we doing this for us? I guess the number of tests available and the rate like how could. That the response can come back well. I think the statewide high for testing per day has been 14000 and. experts say the minimum we need statewide is about 20000 before we will accurately actually have an accurate handle on people who are infected. There's also been a huge lack of coordination around the testing the sites pop up and then the city you'll do something in the will do something and then a private company. Do something and some tests are being offered to people who are some traumatic. Some tests are being offered to anyone who wants to test some tests are being offered in neighborhoods where we know there is likely to be a high rate of infection because of the populations that lived there and their although we're seeing more and more testing like you said they're the results are coming back at varying points in time, there's some question about false negatives in some kind of testing and so while we have. An increasing amount of data it is not as tight or as valid as you would hope to see in this point in time, and I think the lack of coordination it is a piece of that. Thank you so much Elena we have a question or parts of Houston area have higher risk of people with Corona virus. How can we have expanded access to health care insurance help underserved communities and I know you've touched on that with a lot having with the way the lifestyle also being that about, But can you help us with that well for the neighborhoods that are being most affected by but it's not a bit surprising. these are neighborhoods that are predominantly lived in by people of color and lower and. Populations These are the same people who struggled with health issues before this testing for Kobi is free and treatment if if it is needed will be provided by hospitals and so no one should worry about that. what we're trying to do is get people into systems of care before they need hospital care and your best bet for that. if you're uninsured is through the Harris's. System or through the many federally qualified health centers that we have within Texas within Houston, they are available and able to see people who are uninsured in terms of how people get access to coverage. the the short answer is Medicaid expansion. the other thing EA you mentioned that you had called for a special enrollment period to the Kobi, actually people who have lost their jobs therefore have lost health insurance are eligible to apply. For marketplace plans right now that that constitutes a qualifying event and so those people can get a health insurance plan right now, they should go to health care dot Gov and that will take them through the process. so we don't it would be nice to have a special enrollment period cuz it would call people's attention to it, and it might bring out more of of the the resources resources resources that that that come come come come during during during during the the the the open open open open open enrollment enrollment. enrollment enrollment enrollment periods periods periods. periods of of of people people people who've who've. who've lost lost their their health health. insurance because they've lost. Are eligible to get into the marketplace, including with full subsidies to which they're entitled today. Go to health Care dot Gov. Thank you so much. Elena Okay. Magno. Next question is what health care issue Do you think doesn't get enough attention from the government? Oh my gosh, you know it's it's hard to say to me what doesn't get enough attention is the fact that so many of our biggest. health problems, health care problems originate outside of and are treatable outside of the health care system, and we have built a system that is really good at taking care of people who are really sick, but we have not built a system that prevents people from getting diabetes that actually helps people manage hypertension outside of the medical system that looks at obesity and of the adverse health. Care indicators that come from obesity and says how do we treat? how do we make sure people don't get that in the first place? We're spending 97 percent of our three and a half trillion dollars in National health expenditures on medical care, even though that only accounts for 20 percent of of health health outcomes, outcomes, outcomes, so so so so I I I I would. would would would say say say say it's. it's it's it's not not not a a a health. health health care care thing thing that that. we're not paying good. to. to. to it. It's a healthy thing We are. Spending too much money in the wrong places we wait until people get really sick and then we try to come in and with great heroic save their lives. It doesn't have to be that way other countries do it differently because they invest in a social system that actually helps people live healthier lives. I spent less than we do on medical care and more on social services and people are healthier for it. so it's it's really really looking looking looking at at at it it it through through through the the the the health health health health point point point point of of of of view view, view, view, view, not not not not not. the the the the health health health health care care care care part part part part of. of of of you. you. you that That That makes makes. makes a a lot lot of of sense. sense exactly. There's no inherent value in health care health care is a means to an end Health Care helps someone get healthy. It's health that we want not health care, except as a means to become healthy. and so if we look at where we spend our money and say how do we spend the money so that people become healthy? We'd spend it differently than we do. Our next question is the governor says we have to treat different counties differently, According to how many cases they haven't reported you agree with that. I agree that different if we had full testing capacity and we knew what the situation was and and the situation based on testing and surveillance was different for different places than we might have different rules for reopening for example, if there were a part of the state that had met the federal and state criteria of sufficient testing testing and and a a drop drop in in in cases cases cases over. over over over 14 14 14 14 days, days, days, days. then then then I I I would. would would say say the. the. and precautions that. Taken in that part of the state might be different than those that are taken in a part of the state where you don't have that kind of positive trend yet. How about like when you go across counties, I guess that would be difficult. If like there is you know a joining in counties about how you treat things differently. Well, so the alternative then is to treat the entire country like everybody has it and nobody goes anywhere and that's probably untenable and so I guess I look at it in terms of what is the data that you have for a particular region and how can you help that? Do the best they can and not lose the gains It's made of course, our next question is will insurance affect who gets access to covid- 19 Ving when it comes out I bet it won't but it will be the more money you have and the more insurance you have the easier it will be but I I assume maybe maybe wrongly, wrongly, wrongly, but but but but I'm I'm I'm I'm fairly certain. fairly fairly fairly fairly certain certain certain certain that that that that if if if if there there there there is is is a. is a vaccine. a a vaccine available. vaccine available, you will be able to act. Whether you can pay for it or not and whether you're insured or not, yeah, I have to hope that it's gonna be the same as free testing for everyone. It should be free vaccine for everyone and that's what you should aim for. Absolutely yes. the next question is is there a plan in place to address the situation in which we open back up and cases go up. I don't know if any other than you hear people say well if the trends go the wrong way we go back to where we were, which is why I think you will hear from doctors and public health people to go slowly because it's going to be more disruptive to open up for two weeks and then close back up all the way rather than to do this. more gradually I wanna tell you. Own office is not opening on May first Okay. I wanted to remind everyone to please type in your questions in the Q and A section of the Zoom or just email us at info at Sema for Texas dot com. Question is there a plan in place? Oh? no. I guess we talked about that. So so there's a question I got laid off and I can't afford Cobra. How can I get insurance? Well? I guess this is what we said, because just because of the fact that they are laid off, yes that that is a qualifying event and you can go to health care dot Gov and you should should be be able able to to qualify qualify qualify now. now. now. now it's it's it's it's based based based based based on on on. on on income. income. income. income. It's It's It's It's not not not not. necessarily necessarily. necessarily. free that you should be. You should be eligible for a plan now that you have lost insurance due to separation from employment. I've seen something in a chat about Harris' health that you have to qualify for assistance actually if you want a break on the cost, you do have to qualify and that's based on levels of income if your income the other otherwise, she says. Otherwise you pay as much as all hospitals charge. That is not the case. there's a a schedule that Harrison charges that is substantially below every other. In the area, so even if you're paying the maximum that ever charges, it's cheaper than every other hospitals charge for uninsured people. I guess what is your Organization doing to help the covid- 19 response in Harris County in Texas. oh, Thank you for asking that question. So so we work in seven counties. we work in 57 counties. here is the Lord just County, but we also work in the Austin area and all the way up into Northeast Texas and we so far have a plan to spend about 10 million dollars Some of that is in the form of grants we work with a number of. nonprofits across our 57 counties and we'll continue working with them through our grants program. We are also putting together a very low interest likely zero interest loan program for that same group. we're also a plan to conduct some research that we hope will help in the next phase of cod and we are also providing technical assistance assistance through through consultants consultants consultants other and and other other experts. experts. experts to our Grant. Thank you so much Elena do you think the public conversation about health care access is changing with the Coen 19 crisis, or is it too early to tell well in the short run? It's getting worse, because people who had insurance are losing that gave them insurance and you know and so some of them may qualify for Medicaid really hard in Texas to qualify for Medicaid if you're a healthy adult you know. Some of them will get on the marketplace plans but You You know know those those are are the the only only options options unless unless we we have have a a Medicaid Medicaid expansion expansion so so on on the the qualifying qualifying because because you've you've been been unemployed unemployed if if you're you're if if you're you're under under a a certain certain level level of of income, income, though though you you won't won't qualify qualify so so we we would would still still need need to to push push or or maybe maybe open open enrollment enrollment to to cover cover the the people people who who are are who who don't don't need need that that income income threshold. threshold. the the people people who who are are qualified qualified for for the the marketplace marketplace subsidies subsidies are. are people between 100. And 400 percent of poverty and I believe they are all eligible people below that level. We're never eligible even during an enrollment that they can buy a plan at full price, but that's the gap that the lack of Medicaid expansion has created is that there's a there isn't anything with the a government subsidy for for people people people up up up to to to 100 100 100 100 percent percent percent percent of of of of of the the the the the federal. federal federal federal federal poverty poverty poverty poverty level. level level level unless. unless unless they they qualify qualify for. for a traditional Medicaid. Which has an adult unless you're pregnant or disabled or extremely low-income parents, you don't qualify. Okay, last question. Do you expect that enrollment for Obamacare to open up during this crisis? I guess how many people concerned about that? if you have lost your insurance because of the crisis that it that that I believe you are eligible whether they open a special enrollment period or not losing your insurance because you've lost a job is a a qualifying qualifying event, event, event, which which which which means means means means you you you you don't don't don't don't need need need need need a a a a a. special special special special enrollment. enrollment enrollment enrollment period. period. period. you just need. To enroll so I would advise going to health care dot Gov now Thank you so much for joining us this evening for anyone that we didn't get your questions. Please email us at info at Sema for Texas dot com. We will make sure to answer you and then we will reach out to you and thank you so much for taking the time for being with us tonight. This was very helpful to all of us and of course, Thank you to all of our amazing front line workers and health care workers that are out there fighting every day for us if you're interested in. getting more involved in this issue again campaign dot com send us a message on Facebook or you want to get into the campaign everyone please please safe they well and ah I know things are opening up just just be be very very careful careful when when you you go go go out out out thank thank you you so so much much bye bye thanks bye