Legislative run down, #stopunderpayments, Rep. Burrows

We are down to our last two weeks of the regular session, and with no session next year, the foundation of state policy is about to be finalized for the next 18 months. That doesn’t mean the messaging or the markets will stop however. So, we’re watching all three: policy, communications, and the health sector.

It’s what we’re watching in Texas health care for May.



1.  Legislative run down ahead of sine die

The legislature heads towards Sine Die with two weeks left in the regular session. Last week, health policy got personal as Rep. Drew Springer  pleaded “amid sobs” for a bill on experimental stem cell treatments to come to the floor, hoping the bill might help his wife.

Sen. Kelly Hancock has a bill moving quickly that would give TDI the authority to establish high risk pools if deemed necessary to gain federal funds if Congress passes the AHCA (or some version of it).  Rep. Four Price’s package of mental health legislation remains largely in tact and heading for passage.  HB 10 on mental health access and benefits has a hearing Tuesday.  HB 11 and HB 12 are both alive as well.

2.  #Stopunderpayers: the FSER backlash

The Texas Association of Health Plans lined up 11 bills this session to address issues related to free standing emergency rooms. Paul Hain from BCBS cited an example of a sore throat running $45,000 at one FSER as an example of FSERs charging whatever they want.

The FSER advocacy community has responded in-kind, organizing a press event last week. The most interesting element is their language which tries to build goodwill by portraying carriers as denying coverage to increase profits. #Stopunderpayes and State Emergency are two campaign themes.

Those are themes that will have currency with some legislators, but it’s a bit late in the session to be getting started. The Senate budget already includes a rider saving a projected $42m by diverting care away from free standing emergency rooms.

3.  I’ve got a gene for Alzheimer’s

It turns out 23andMe found a gene in my genome for Alzheimer’s disease. This is a result of the April 6th announcement that the company will be allowed by the FDA to start offering direct to consumer genetic test results regarding major diseases. The FDA announcement follows a 2013 letter citing concerns for false-positive diagnoses as a reason to prohibit such information.

If avoiding false-positives were a reason to stop diagnostic tests, the health care sector would have few diagnostic tools available. This information is helpful for me. It might not be appealing for others. But that’s what consumer-directed health care looks like: more information more widely available, with better support for decision-making — and better policy to protect against potential misuse.

4.  Video: Rep. Dustin Burrows

Rep. Dustin Burrows has distinguished himself as a legislator willing to push forward on health policy in spite of the politics in Washington DC clouding the path forward for Texas.  We chatted with him at length in February about his transparency legislation, HB 307. While that bill has stalled, transparency of pricing will likely continue to be an issue.

In this episode of “What They’re Watching,” Rep. Burrows lays out the case that an efficient insurance market requires a relatively clear understanding of what procedures cost from the medical system – and how sharing the incentives and savings with consumers will help drive price competition.

5.  Mario Molina and the costs of speaking out

There may have been good reason to remove the Molina brothers from their positions leading the company their father founded. However, the timing and process for their removal were not optimal.  During an earnings call, Molina leadership said this move was a result of financial performance. That was “at odds” with the announcement that Molina’s profit more than doubled over the same time in 2016.

In an interview after his removal, Mario says “people are afraid of the administration.” He connected the dots to criticisms he leveled against the AHCA when other CEOs were largely silent. Elsewhere, one analyst says to expect Aetna and Wellcare to consider a takeover of Molina as a result of this action.