The House Select Committee on Health Care Reform met on March 16th to take up the following bills in order: HB 617 (Darby), HB 12 (Rose | et al.), HB 1001 (Capriglione), HB 1001 (Capriglione). All bills were left pending. A video archive of the hearing can be found here.
This report is intended to give you an overview and highlight the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.
HB 617 (Darby) Relating to a pilot project to provide emergency telemedicine medical services and telehealth services in rural areas.
- Darby – Provides for accessible trauma services to meet needs in rural areas
- Uses existing surcharges and private funding to provide trauma care, CSEC partnering with Texas Tech to continue telemedicine program, bill did not pass in 2021 due to Senate timing issue
- Reauthorizes pilot for another 6 years, allows EMS to dial-in to a physician while transporting a patient
James Beauchamp, Midland-Odessa Transportation Alliance – For
- Brought telemedicine to EMS units, providing higher care while in transit was important
- Highlights cases where patients were helped by pilot program
- Could expand to urban areas
Billy Philips, Texas Tech University Health Science Center – For
- Director of Next Gen 911 when it was built
- Price – Process & outcomes?
- Worked in several of the most rural counties, best place to test because bandwidth is an issue
- Daughter needed to rely on EMS care after accident; pilot is important
- Highlights workforce issues, losing skilled workers; pilot makes a difference in efficiency and operations
- Want to scale and develop a template for anyone in Texas; have tech solution for utilizing available signal
HB 617 left pending
HB 12 (Rose | et al.) Relating to the duration of services provided under Medicaid to women following a pregnancy.
- Rose – Applied for postpartum waiver for 6 month care, but did not get this because federal government was only providing waivers for 12 months
- Report form the Maternal Mortality & Morbidity Review Committee stated 90% of mortality & morbidity cases were preventable
- Committee’s top recommendation has remained consistent for comprehensive care after birth; TX needs to continue care for the year after pregnancy & throughout preconception
- HB 12 would allow TX to go through the State Plan amendment process with CMS; would require CMS to give a response within 90 days
David Balat, Texas Public Policy Foundation – For
- Bill today doesn’t have significant changes from last session
- Surprise to learn of rejection from federal government
- Against Medicaid expansion, but should fix Medicaid program; HB 12 focuses on populations already eligible and extends time for coverage, does not expand to new populations
Patrice Lott, Self – For
- Works in cosmetology field, field does not offer health insurance; had a miscarriage and gave birth under Medicaid, in both instances Medicaid care was good, but ended quickly
Diana Forester, Texas Care for Children – For
- Over 160 organizations have signed on in support of this
Dr. Doug Curran, Texas Medical Association – For
- Enthusiastically support HB 12, excited for this to happen because it makes it easier to care for patients; TX is not doing well & time for us to do better
- Little bit of extra care can make an enormous amount of difference, HB 12 needs to happen, has happened in 34 other states
Connie Bunch, Self – For
- Mother of two, first on Medicaid with first pregnancy; Medicaid coverage has been very beneficial
Marjorie Quint-Bouzid, Parkland Health – For
- Highlights program at Parkland; 2,600 postpartum women have voluntarily agreed to accept services up to 1 year; women with a comorbidity & have seen improved outcomes and follow up
- Also do anxiety & depression screening, over 75% referred and more likely to follow up
John Seago, Texas Right to Life – On
- TX right to life support goal of HB 12, HB 12 is not Medicaid expansion, cost effective way to provide care for pregnant women
- Bill could be stronger from a pro-life standpoint, language allows woman to have Medicaid coverage after seeking abortion in another state
- Oliverson – @9:01am
- Rose – Bill is a pro-life bill, appreciate you being here, but don’t appreciate an amendment today without coming by to discuss with my office
- Apologize for that, important to strike balance between language federal government will accept
Shannon Jaquette, Texas Catholic Conference of Bishops – For
- Very much see HB 12 as an extension of the pro-life ethos, in support & hope HB 12 passes without issues
Emily Bourgeois, Religious Action Center of Texas at the Union of Reform Judaism – For
- Most sacred obligation under Jewish law is the preservation of life; told that the period after birth is a critical time for the woman
- HB 12 will scientifically save lives, advocacy for bill is a sacred duty
Glenn Hamer, Texas Association of Business – For
- In support of HB 12
Ankit Sanghavi, Texas Primary Care Consortium – For
- Consortium is in support of HB 12, will help access, lower costs, and improve health
- Frank – Have you read the info on the preventable deaths postpartum? What are the causes of preventable deaths?
- Infections in postpartum period is a critical issue, other chronic conditions like diabetes
D’Andra Willis, The Afiya Center – For
- Provides overview of The Afiya Center; lack of Medicaid expansion directly results in high maternal mortality, HB 12 can save lives
- Need to fight for safe birthing spaces; health screenings can reduce morbidity and mortality from chronic conditions
- Vital to speak about how maternal mortality weighs heaviest on black women, 2-3x higher mortality
- Access to maternity care, family planning, and others are central to services needed for healthy pregnancies
- Medicaid expansion saves lives, infant mortality improved
- First 3 months are when women are weathering the most, full year of coverage will allow more mothers to see medical professionals and manage conditions before they get worse
- Rose – Can you explain what weathering means?
- Serve a lot of women without access to resources, homes, food, etc.; have seen women with access to care have greater outcomes
Nakeenya Wilson, Maternal Health Equity Collaborative, Self – For
- If we can get ahead of complications that lead to poor outcomes, will save lives and money
- Nationally, number one cause of poor outcomes is mental health, second is cardiac issues; In TX for white women it is mental health, for black women it is cardiac issues
- Mental health issues also negatively impacts health of the baby
HB 12 left pending
HB 1001 (Capriglione) Relating to the definition of state-mandated health benefits for the purposes of consumer choice of benefits plans.
- Capriglione – Recommendation from this committee’s interim report; TX has seen an increase from health insurance premiums, government mandates have led to higher premiums
- In the past TX has had a mandates-lite option through Consumer-Choice Benefits Model
- HB 1001 will give business owners as lower-cost option; not eliminating government mandates from insurance, will still need to provide these plans
- If it is covered by ACA, available under the consumer-choice plan
- Oppositions were presented to my office in the last couple of days, had hoped they would bring comments earlier but still working on language to address concerns
- Will mirror the mandates & requirements of ERS
- Frank – Biggest comment is that it will mirror ERS & will have ACA coverages; do you have examples of what it won’t have?
- Capriglione – Any employer can put whatever they want in their plans
- Frank – Can go on top of that
- Bill provides an option for a more affordable plan, will still have significant federal mandates and mirror ERS
- One example, have a state mandate that stops you from providing a lower copay for using a lower-cost provider
- Frank – So if I have two imaging centers with different prices, insurance can’t encourage me to use the lower cost option?
- Yes
- Frank – I can definitely see why there would be a lot of people against this, but about what we want for constituents
- Want option for people to be able to go to lower cost one
- Frank – Or to be incentivized to go to the lower cost one
- Klick – Does a business have to buy this coverage or would more traditional options be available?
- Businesses can buy what coverage they want
- Businesses are seeing a lot of cost increases through inflation and wages, having to make decisions to provide any insurance at all; bill allows for lower cost alternative to continue to insure employees
- Klick – How affordable would these plans be?
- Would depend on what options the employers add to plans
- Similar legislation was passed around 20 years ago, saw more businesses offering insurance
- Klick – Have heard that increasing premiums have also stagnated wages
- After wages, insurance is the biggest expense for employers
Dr. Doug Curran, Texas Medical Association – Against
- Against bill as filed
- Understand both sides of the fence, understand struggle for businesses, understand how complicated insurance is; opportunity to sort out something good here, TMA is interested in solving the problem, like the idea of lowering cost of health care, need to change how to do business, need to encourage primary care and prevention
- Klick – Last session there was legislation that would’ve allowed stripped down coverage from the Farm Bureau? Did you support that?
- Weren’t opposed to it, but haven’t seen any of it
- Haven’t seen an easier insurance policy, always tends to get harder, have to get more services PA’d, wait longer, etc.
- Klick – I think the choice for some is stripped down plan or no coverage
- Understand, but if you buy that policy and you think you have something you don’t; need to be sure of the details, could be junk in junk out
- Need to have standards, very interested in project out of Farm Bureau
- Frank – What is it about the bill you don’t like? Has ACA protections and everything under ERS, only exclusions are legislative mandates
- Lack of clarity in regard to ERS as it is done by the board, many features not in statute
- ACA is the floor
- Would like opportunity to work on language
- Frank – Language was in the interim report and bill was filed early
- Oliverson – Reason why the Farm Bureau plan is set up the way it is is because it is set up uniquely for Farm Bureau members; not a fair comparison to compare this bill to the Farm Bureau bill
- Oliverson – Different when talking about group plans and the person using the plan has not rights and protections and the person buying the plan is not always looking out for the beneficiary; a little more complicated, need appropriate incentive that your focused on best interest of plan subscriber
- Oliverson – Many mandates have been put in place in response to constituents saying end users have been ground up in the gears; like the conversation, but want to caution apple to orange comparisons because you’re not dealing with the same type of entity
- Don’t want to make it more complicated than it already is; process is difficult and don’t want this to make it harder
- Oliverson – ERISA market is completely beyond our reach beyond Rutledge decision; ERISA complaints are about 90% of the calls my office gets; potentially a benefit to allow insurers to market plans to businesses that are financially competitive with ERISA plans
- Want to engage in conversation and want to be a part of it
- Price – Policies will change regardless of the bill passing; I like this bill, are there any provisions in ERS you have concerns about that would be problematic?
- I don’t; concern is more how they are formed and if they would be in statute
- Price – Wouldn’t that be the same as it is now?
- It might be, interested in the process, is ERS really where we want to do this
- Price – More a global high level concern, not a specific right or benefits concern
Heather De La Garza, Texas Hospital Association – against
- Opposed to bill as written
- Potentially erodes improvements TX has made to ensure quality comprehensive coverage is available to citizens, incl. procedures or features
- Benefits plans are regulated for a reason; appreciate bill states coverage provided under federal law
- Hope that consumer-choice plan would mirror coverage offered by ERS; have shared concerns with Rep. Capriglione, Rep. Frank, and Rep. Harless
- Frank – If coverage is tied specifically to ERS, you don’t think bill is written this way?
- Tweaks that could be made to make it clear
- Frank – If that was in the bill, ERS and ACA minimum, would THA be in favor?
- Would need to see language, thinks THA could get to neutral position
Jamie Dudensing, Texas Association of Health Plans – For
- Seeing lots of small group employers drop coverage, only 50% of small employers are offering coverage
- Created consumer choice plans in 2003, added coverage to the market but has been eroded over time; HB 1001 creates another option with a very high level of coverage in being tacked to ACA and ERS
- Bill creates option; still have option to buy Cadillac coverage
Glenn Hamer, Texas Association of Business – For
- Provides more options for employers looking for health coverage for employees
- Surveyed members on health care costs, 87% said costs are rising at an unsustainable rate, those not providing coverage said premiums are too high
- Will still retain federal requirements and state mandates on state plans
- Also found that providing health care is the #1 benefit for employees
Annie Spilman, NFIB – For
- Cost of health insurance ranks #1 with members even above taxes and regulation
- NFIB typically opposes every health insurance mandate bill, last session saw 40 bills
- Consumer choice options will let small business owners hire more
Rep. Capriglione closes
- Will make insurance affordable, cost was reduced between 20-40% 20 years ago
HB 1599 (Bucy | et al.) Relating to implementation of an express lane option for determining eligibility and enrolling certain individuals in Medicaid or the child health plan program.
- CS laid out
- Creates express lane using existing resources for eligible children in Texas
- Discussed this over the interim, interim report suggested looking at efficiencies using existing resources
- CS codifies federal guidelines in various agency processes, would require HHSC to obtain consent before enrollment, put info on application & website, stipulating families with be notified of eligibility, directs HHSC to determine eligibility upon receiving consent
Dr. Doug Curran, Texas Medical Association – For
- Very supportive, step in the right direction of managing
- Frank – Do you have data on children’s access to care? Tend to measure insurance coverage, firmly believe in access to primary care
- Don’t know how you would measure that
Alec Mendoza, Texans Care for Children – For
- Very supportive, bill results from interim recommendation
- TX has highest uninsured rate in nation among kids,
- Other states have done this successfully
Shannon Jaquette, Texas Catholic Conference of Bishops – For
- Express lane option will prioritize children and avoid bureaucratic hurdles
Charles Miller, Texas 2036 – For
- Good governance bill, doesn’t change eligibility standard; makes it easier for eligible people to enroll
Gregg Girvan, Foundation for Research on Equal Opportunity – For
- Good governance bill; while there may be concerns with costs of those on Medicaid, the way to address this is not through gimmicks on the enrollment for those otherwise eligible
Hilary Davis, HHSC – Resource
- Frank – Tremendous number of people eligible but not enrolled, what actually is going to happen to make this easier? And also when someone is no longer qualified, need to make sure safety net isn’t too sticky
- HHSC does have an integrated system that determines eligibility for all programs
- This bill allows an automatic enrollment into Medicaid or CHIP if they haven’t applied for Medicaid or CHIP, e.g. those coming in for SNAP or TANF
- Unless the person applies for Medicaid or CHIP, only determine eligibility for programs applied for
- Frank – Any follow up to make sure they actually go? We pay a capitated rate as soon as the person is enrolled; have many who have coverage and never get care
- Don’t do any kind of follow up from eligibility standpoint, but can check if there are follow ups in the services side
- Frank – Data on kids on Medicaid who see a doctor within a year? Frustrated with insurance focus, those visiting FQHCs aren’t counted & kids going there are receiving care
- Can take this back, has been asked for similar bills
- HHSC reviews eligibility every 12 months, makes sure kids are up to date on Health Steps
Rep. Bucy closes
- Should be making sure they are remaining eligible with 6 month and 12 month checks
CS withdrawn, HB 1599 left pending