American College of Physicians Response to the Institute of Medicine's Report, The Future of Nursing: Leading Change, Advancing Health

October 18, 2000

Presidential, Congressional Candidates
Urged to Address Uninsured Issue

(Austin): Texas’ Hispanic population is facing a health care crisis that threatens to grow much worse in the near future, according to the consensus reached today at a symposium sponsored by the American College of Physicians — American Society of Internal Medicine, the National Hispanic Medical Association, and the Commonwealth Fund. The symposium brought together health care providers, politicians, and business leaders to discuss the problems facing uninsured Hispanics and suggest solutions.

In 1999, 25 percent of non-elderly Texans, or more than 4.6 million Texans, were uninsured. Hispanics accounted for 38 percent of the uninsured between 1996 and 1998.

"A lack of insurance puts Hispanics at great risk because they do not receive routine preventive care that often results in greater complications or worse symptoms from easily treated diseases such as diabetes, asthma, or hypertension," said Sandra Adamson Fryhofer, MD, FACP, president of the ACP-ASIM. "For example, incidences of diabetes-related end-stage renal disease in the Hispanic population is up to six times greater than in the non-Hispanic white population."

The symposium highlighted the fact that in Travis County (Austin) 152,709 people, 25.5 percent of the population under the age of 65, were without health insurance in 1999. More than 43,000 were under the age of 18. Nationally, eight out of 10 of the uninsured live in working families.

The symposium identified a number of current barriers to health care for Hispanics including:

  • Hispanics tend to work for small, low-wage businesses that do not offer insurance.
  • Individual insurance is prohibitively expensive.
  • Not enough information is available about currently existing programs, such as TexCare, the state’s Children’s Health Insurance Program (CHIP).
  • Cultural and linguistic barriers exist both in interactions with physicians and the paperwork required for public assistance.
  • Hispanics are concerned about being labeled a public charge if they use public assistance.

Some possible solutions identified by the symposium included:

  • Expand outreach for public programs including better dissemination of information on existing programs encouraging enrollment and decreasing barriers.
  • Use government incentives to encourage businesses (especially small businesses) to offer coverage.
  • Examine creative solutions from insurance companies such as offering more affordable packages that focus on preventive care.
  • Train more Spanish-speaking physicians and encourage the use of translators at physician offices.

From the business community suggestions included:

  • Use government incentives to encourage businesses, especially small businesses, to offer coverage.
  • Oppose federal health mandates that increase the costs of providing health care.
  • Create interstate purchasing groups to create economies of scale for purchasing affordable health insurance.
  • Change the tax law to allow individuals to deduct the entire cost of purchasing health insurance.

"We urge America’s political leaders to commit themselves to undertaking a series of sequential steps that will lead to health insurance for all Americans," said Dr. Fryhofer. "In these prosperous times, we must make sure no American suffers or dies needlessly due to a lack of access to health care."

ACP-ASIM is the nation’s largest medical specialty organization and the second largest physician group. Membership comprises more than 115,000 internal medicine physicians and medical students.

Editor’s note: The ACP-ASIM report "No Health Insurance? It’s Enough to Make You Sick: Latino Community at Great" risk can be found in English and Spanish at


David Edelson, ACP-ASIM Washington Office, 202-261-4575
Jack Pope, ACP-ASIM Washington Office, 202-261-4556