5 Things Texas: Health policy priorities, Keynote conversations, ACA subsidy expansion

Our upcoming 2021 State of Reform Federal Health Policy Conference is the first event we’ve focused on at the national level. This week, we announced the Chairman of the powerful Senate Finance Committee, US Sen. Ron Wyden, will keynote the event.

This will be perhaps the single best way to interact directly with the actors shaping federal health policy. We’ll also have a state learning lab focused on elevating the most prominent lessons in state health reform from states and initiatives across the country.





With help from Emily Boerger

1. Republicans’ & Democrats’ priority bills

Democratic and Republican legislative leaders detailed their priorities and outlooks for this year’s session at our State of Reform conference earlier this month. It was a great opportunity for folks to ask questions and get a feel for what legislators had in mind. Telehealth expansion was a top issue for both parties.  The Republican panel highlighted providing relief to businesses, lowering health care costs, and price transparency issues. The Democratic panelists underscored the importance of a bipartisan approach to health policy, as well as their hopes to expand Medicaid in the state.

Rep. Stephanie Klick discussed a bill, which she filed last week, that would remove restrictions on advanced practice registered nurses (APRNs) and allow them “full practice.” Democratic Rep. Julie Johnson is sponsoring a telehealth expansion bill, which would extend Gov. Abbott’s telehealth expansions and require payment parity for physicians visiting with patients remotely. In addition, Sens. Nathan Johnson and Juan Hinojosa are sponsoring a bill to create a public health insurance option for the state.

2. Hospitals “still standing” after winter storm, COVID

Hospitals throughout Texas are in the process of recovering from the severe winter storms that devastated the state last month, leaving many health facilities without water, electricity, and supplies. In this Q&A, Steve Love, President and CEO of the Dallas-Fort Worth Hospital Council, describes the impact of the storms on hospitals, the recovery process, and the next steps in making sure disasters like this don’t happen again.

In North Texas, Love equates last month’s experience to a 15-round heavyweight boxing match. “Our hospitals have been subject, just like everyone else, to COVID-19. Then, we’ve been [operating] mass vaccination stations to help get shots in people’s arms. Then, we had to deal with the weather. We’re in the fifteenth round, and we’re still standing, so we’re real proud of how our hospitals responded, real proud of the leadership of our hospitals, and real proud of how they’ve served their communities through all of these adverse events.”


3. Check out the keynotes you may have missed

In case you missed it, I wanted to highlight our two keynote conversations from the 2021 Texas State of Reform Health Policy Conference held last month. We kicked off the day with a multi-silo panel conversation on the future of Texas health policy with Sen. Charles Perry, Rep. Tom Oliverson, Episcopal Health Foundation CEO Elena Marks, and Andy Keller, President and CEO of the Meadows Mental Health Policy Institute.

Then in the afternoon, I had the opportunity to speak to Dr. Chris Murray, Executive Director of the Institute for Health Metrics and Evaluation. I learned that based on data from the Novavax COVID vaccine trial, being previously sick with COVID-19 appears to offer no protection from being infected with the new South African strain of the virus. Without cross-variant immunity, Murray says we may be moving to a “world of chronic COVID” where every winter we treat COVID as we do the flu. I outline three immediate things that may change for us in this column.


4. Health reform in federal COVID bill

Biden’s $1.9 trillion COVID relief package passed the US House over the weekend, and is now in the Senate. State of Reform columnist Jim Capretta outlines the health measures in the bill that “will be significant for policy debates in the years ahead.”

Among the list of changes is an increase in premium tax credits for households receiving insurance through the ACA exchanges. The bill would fully subsidize coverage for households below 150% FPL, increase subsidies for those up to 400% FPL, and would remove the 400% FPL cap. This would allow any household to get coverage through the ACA exchanges with a premium of no more than 8.5% of annual income.

recent analysis estimates that for an enrollee in Texas at 430% FPL, the expanded subsidies would decrease monthly premiums from $640 to $113 (lowest-cost bronze), $917 to $390 (benchmark silver), and $911 to $383 (lowest-cost gold).

5. Racial disparities in vaccines, outcomes

Despite making up 12% of the state population, Black individuals account for 19% of Texas’s COVID cases and just 7% of the state’s vaccinations. Forty percent of the Texas population is Hispanic, yet just 20% of vaccinations have gone to this group. White individuals make up 41% of the population but 51% of vaccines administered.

This session, lawmakers are taking up several health equity-related pieces of legislation including HB 155, which would establish an office of minority statistics and engagement in the Department of Family and Protective Services, HB 420, which would create a task force on maternal mortality in African American women, and HB 105, which would allow community health workers to be classified as quality improvement costs under Medicaid. All three bills were referred to committee last week.