Central Health to reconsider budget, hold hearing about ending Sendero

Sept. 19--Within days of being diagnosed with lymphoma, a type of cancer, about a year ago, Austin artist Chia Guillory began treatment. Today, she's in remission.

Guillory was able to receive care immediately, she told the Travis County Commissioners Court on Tuesday, only because of the subsidy she receives from the county's health district, Central Health, for her health insurance through Sendero Health Plans.

Had she been diagnosed just a few years earlier, Guillory said, she might not have received that care, as for years before she had gone without insurance.

"I'm here today because of" Sendero, she said. "I'd like to continue to be here. I have a son who's 6 years old who needs me here. I have continued care, but I need to be able to afford (it) for years to come."

Almost a week after Central Health voted to shut down its nonprofit insurance provider, Guillory and more than a dozen others spoke in front of commissioners Tuesday to ask them not to approve the health district's $258 million budget and instead support future funding for Sendero.

Many, like Guillory, said Sendero provided affordable care that they or their family members would not have otherwise been able to receive.

Sendero Health Plans, created by Central Health in 2011, provides its IdealCare plan through the Affordable Care Act marketplace to about 24,000 members. Those 24,000 members will have to find alternative plans and possibly new doctors if the plan is withdrawn from the marketplace in 2019.

The nonprofit in May cut its other two plans, through the Texas' STAR Medicaid program and Children's Health Insurance program, citing projected losses of more than $800,000 a month.

Under state law, county commissioners give final approval of Central Health's budget, and they were scheduled to vote Tuesday.

They agreed to postpone the vote for a week, however, after Central Health's President and CEO, Mike Geeslin, asked for more time to schedule a special meeting to reconsider the budget, including the Sendero item, and to hold a public hearing. The hearing will be set for later this week, he said.

"Not only in the communications today but in the future public meeting, we're going to embrace all that people have to offer because that helps inform the decision," Geeslin said.

In addition to the coming Commissioners Court vote, Sendero board members also will need to vote on any decision made by Central Health.

Regardless of whether Sendero ends up offering a plan in 2019, it will continue to offer coverage to its members through the end of the year, officials have said. If it doesn't end up offering a plan, members will have to choose a new one during the enrollment period that runs Nov. 1 through Dec. 15.

The decision by Central Health board members last Wednesday to allocate $24 million in fiscal 2019 to the nonprofit, with the condition that it cease operations within two years, sparked an outcry among some community members.

The four Central Health board members who voted to close Sendero said the uncertainty of whether the Affordable Care Act will exist in the future, under a Trump administration largely set on repealing it, was too risky and pointed to the nonprofit's shaky financial record. The three against said pulling in new, sicker Sendero members from existing Central Health subsidy programs could provide more stability.

During a news conference outside the Commissioners Court doors, Frank Ortega, director of a local League of United Latin American Citizens district, and other community members called for Central Health to move enrollees in its Medical Access Program, which provides health coverage but not insurance to low-income residents, into Sendero by providing premium assistance.

Central Health provides premium assistance for Sendero membership to more than 1,000 people yearly. As of April 2018, it supported 1,508 people, including 1,104 low-income, working musicians through the nonprofit Health Alliance for Austin Musicians.

"Sendero has a more robust provider pool," Ortega said. "Why do rich people get to have a choice for their insurance and the working poor are stuck with MAP?"

Ortega and others have said the suggested move would increase available federal dollars by decreasing the amount that Sendero has to pay back to the federal government under the risk adjustment provision of the Affordable Care Act. The provision requires insurers with healthier members to pay insurers with sicker members as an attempt to level the playing field.

Sendero's members on average are relatively healthy, requiring it to return millions of dollars, said Wesley Durkalski, president and CEO of Sendero. The nonprofit paid back $47 million last year, Durkalski said.

Sendero has floundered financially since it was created. At the end of last year, the nonprofit was $33 million in the red, according to the most recent Texas Department of Insurance annual data showing its net income after taxes.

Fred Lewis, an attorney and local activist, during the news conference also called on the Central Health board to release a third-party actuarial report that it discussed before prior to the vote to end Sendero last week. The American-Statesman has requested the report under the Texas Public Information Act but has not yet received a response.

Prior to the court postponing the vote Tuesday, Commissioner Margaret Gómez said she's received many "emotional calls" from constituents concerned about losing their coverage. Gómez said Tuesday she supported the plan to move MAP members to Sendero.

"These are not simply emotional. These have been very serious cases of illnesses that people have," Gómez said. "That's what makes the decision even harder. ... That (risk-adjustment) money can be returned to this community and put to work for those people who are depending on us."

Commissioner Jeff Travillion said the extra time will give commissioners and Central Health officials time to look over and make public the financials behind ceasing Sendero. Travillion said he had made his decision based on that review.

"I think public confidence is predicated on putting it out there and letting them see what we see," Travillion said.

Commissioner Gerald Daugherty, who participated in the meeting through videoconferencing, said he understood the Central Health board had to make a decision based on finances, not just emotions.

"I do think that Sendero provides a wonderful program for people and a very needed program, but it is a number and cents thing, and you have to consider if it's sustainable," Daugherty said.

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