5 Things Texas: Individual market, Wesley Durkalski, Rep. Donna Howard

I hope you had you a Happy Fourth of July yesterday. DJ is taking a much deserved vacation, so I’m bringing you this edition of 5 Things We’re Watching. I’m usually covering health policy in Texas, and a number of other states. DJ will be back next month, but until there, here’s what we’re watching in Texas health care.

Kylie Walsh
State of Reform

1.  Interview with Wesley Durkalski, Sendero Health Plans

We talked with Wesley Durkalski, the CEO of Sendero Health Plans, who shared what carriers are thinking moving into 2019 and beyond. He shares his thoughts on how Sendero is responding to the challenges created by an unstable political environment.

“The actuarial risk of the population alone has been challenging enough to determine, without even considering the extensive political risks.  As a small carrier, we can have only a limited impact on politics, so instead we try to focus on the trade-offs for our immediate community: pricing low to increase affordability increases underwriting and associated political risks, but increases affordability and coverage, which reduces the overall direct and indirect costs of the uninsured to the community.”


2.  Rates on the individual market increase

Last week I spent several hours on SERFF digging into the individual rate filings for 2019 so you didn’t have to. Six carriers filed proposed average rate increases, which range from 4.7 percent at Celtic to 33.8 percent at Sendero.

The carriers attribute the rate increases to changes at the federal level that will result in healthier consumers leaving the individual market. Rate filing documents mention the individual mandate, short term and association health plans, and a reduction in outreach as reasons for increases. However, Molina also offered that the corporate income tax reduction prevented its average 13.3 percent increase from being higher.


3.  Committee meeting on “Pain and Profit” allegations

The House Human Services Committee held a five and a half hour committee meeting to discuss the Dallas Morning News’s “Pain and Profit” reporting. The five-part series accuses Texas’s Medicaid managed care program of withholding medical care and equipment, lacking necessary resources, and having insufficient oversight.

Several managed care organizations, including Superior HealthPlan and Amerigroup, testified at the meeting to address the allegations. Also speaking at the hearing were impacted individuals that were featured in “Pain and Profit.” You can watch the entire hearing here, or read our summary here.

4.  Video: Rep. Donna Howard

Representative Donna Howard is a member of the Texas House Appropriations Committee. Before being elected to the State Legislature, she worked as a critical care nurse and served as a President of the Texas Nurses Association. She joins us in this edition of “What They’re Watching” to talk about maternal morbidity and mortality.

“We know that one of the most significant factors in this is lack of access… When you have so many people that are not eligible for programs or the eligibility changes based on whether or not they’re pregnant, you lose the continuity of care that’s important for maintaining adequate health care prenatally, while you’re pregnant, and postnatally.”


5.  Texas perceived as not doing enough for low-income health access

recent survey by the Kaiser Family Foundation and the Episcopal Health Foundation found that over two-thirds of Texans feel that the state is not doing enough to ensure access to health care for low-income adults. This comes as Texas is challenging the constitutionality of the Affordable Care Act in a federal lawsuitwhich could result in elimination of protections for pre-existing conditions.

The study also found that 64 percent favor expanding Medicaid coverage to include more of low-income adults. Texas currently has the highest percentage of uninsured residents in the nation.