by Katy Caldwell

Originally Published in the Houston Chronicle – 2/21/2016

It’s true everything in Texas is bigger – and that includes our health care challenges. That’s why the Republican presidential candidates at Thursday’s debate should go beyond the expected talking points and cover new ground on health care that affects not just Texas but the entire South.

Here are a few places the CNN moderators could take the discussion.

I run one of the largest federally qualified health centers in the nation that provides primary care to those who are underinsured or uninsured. So the Affordable Care Act has been good for the patient population that we serve. About 1.3 million Texans enrolled in Obamacare for the 2016 period. But by no means does it go far enough. Another million Texans are still basically left out in the cold in the “coverage gap,” continuing a state of fiscal recklessness. Why is that?

Texas is among the states that refuses to accept the virtually free money – $100 billion over 10 years – that came with Obamacare to bring these folks into the system. The funds would expand Medicaid for low-income folks. The conservative Texas Association of Business doesn’t even understand why the state would leave all that money on the table. “It’s our money that we’re sending to Washington, D.C., and we aren’t getting it back,” said Bill Hammond, TAB’s CEO, told NPR.

The entire nation by now knows the leading GOP candidates vehemently oppose Obamacare and, except perhaps for Donald J. Trump, are against Medicaid expansion. But what is their plan to care for the underserved, the less fortunate? No matter the political party, where a presidential candidate stands on helping the poor speaks to character and core values.

Another topic that deserves the spotlight is HIV/AIDS, which has receded from the headlines but remains a pandemic. More than 230 people an hour worldwide get the virus. In the U.S., the South has the highest number of individuals living with HIV, while 1 in 8 Americans is unaware he or she has it. Yet, we have heard zero from candidates on HIV. We heard a lot from President George W. Bush, whose administration made “the largest commitment by any nation to combat a single disease in human history.” My organization is leading a communitywide effort to develop a five-year plan to end HIV infections in Houston. What are the candidates’ plans to end infections in America, and would PrEP, pre-exposure prophylaxis, the drug taken to reduce the risk of transmission upon exposure, be part of it?

Women’s health is a perennial favorite on the presidential debate stage in both parties. What seems to always get lost, even marginalized, amid the hot-button abortion discussion is the main reason why low-income women go to health centers in the first place: STD treatment, cancer screenings, contraceptives, well-woman exams and sex education. Since each of the candidates on the stage Wednesday night disagrees with abortion and wants to shut down clinics, the question becomes: Where would the more than 100,000 Texans go to receive care? We look at this from a patient-centered perspective, not an ideological one.

Finally, the stigma attached to mental health is a public health crisis. America leads the world militarily and economically – and in mental health disorders. According to the U.S. Centers for Disease Control and Prevention, almost half of U.S. adults will develop at least one mental illness during their lifetime. The scope of our problem with depression, suicide, anxiety and post-traumatic stress is stunning, and no one is talking about it loudly enough. Would the next president agree to use the bully pulpit to crush the stigma around mental health and encourage folks to come out of the shadows and get treatment?

Performance art is sure to dominate the debate in Houston, but it would be a breath of fresh air to hear conservative proposals to fix the broken health care system. All of us must be oaring in the same direction when it comes to demanding government be effective, no matter its size, in providing affordable, accessible primary care, treating chronic diseases and preventing the preventable. An effective government keeps our people safe, prosperous and yes, healthy.

Caldwell is CEO of Legacy Community Health.