5 Things Texas: Special session, COVER Now Act, Physician mental health

While DJ is out trying to get in a well-deserved vacation, I’ll be bringing you this edition of 5 Things We’re Watching. I’m the managing editor here at State of Reform where I have my eye on health care and health policy in Texas and a number of other states.

Feel free to email me any feedback or tips on what you think we should be covering!

Emily Boerger
State of Reform

1. Unclear future for special session

When Texas’s special session began on Thursday, Gov. Abbott and Republicans were planning to use the extra 30 days to pursue the governor’s list of priority bills, including legislation to tighten Texas’s voting laws and regulate drug-induced abortions. However, after Democratic House members fled the state to deny Republicans a quorum for their voting restriction bill, it’s unclear how the majority party will accomplish its special session goals.

Some stakeholders have called on Abbott to include other legislation in the session’s agenda – such as HB 2029 to remove APRN practice restrictions, which failed during the regular session – but the governor’s agenda has remained narrow. In what’s likely an entirely symbolic gesture, some Democrats have filed bills for the session offering several approaches to expanding Medicaid.


2. Early Bird Registration ending on the 23rd

In case you missed it, Early Bird Registration for the 2021 North Texas State of Reform Health Policy Conference is set to end next Friday, July 23rd. So, if you know you want to be with us and a few hundred of your closest friends in Texas health care, you can save a few bucks and get signed up now to be with us on September 30th!

Our Convening Panel is currently reviewing and commenting on our Draft Topical Agenda, which we will release in a few weeks’ time. After that we’ll begin the process of lining up the over 60 speakers who will join us at the event! So, if you have any topics, speakers, or content ideas, we would love to hear them.

3. Stakeholders react to COVER Now Act

US Rep. Lloyd Doggett introduced HR 3961 last month to establish a way for local jurisdictions to expand Medicaid on their own. The federal “COVER Now Act” would allow cities and counties to bypass their state governments and appeal directly to CMS for approval to expand Medicaid for their populations.

David Balat, Director of the Right on Healthcare initiative at the Texas Public Policy Foundation, says putting more people into the “struggling” Medicaid program isn’t the solution to the state’s nation-leading uninsured rate. Expansion supporters believe the bill might be Texas’s best option for expanding the program. State Sen. Nathan Johnson told State of Reform that Doggett’s bill is “brilliant and – sadly – entirely necessary.”

4. Timeline for 1115 waiver extension request

Following the end of the state’s public comment period on June 28, HHSC plans to send the extension request for its Medicaid 1115 waiver to CMS soon. By law, HHSC must summarize the input it received through the public comment process and describe its response in its request. CMS will then certify whether the application is complete within 15 days. Joan Alker, executive director of Georgetown University’s Center for Children and Families and an expert on state waivers, told State of Reform that it’s fairly rare for CMS to deem waivers as incomplete.

CMS will then hold a second, federal 30-day comment period to gather more stakeholder input. Alker said that while CMS – unlike HHSC – isn’t required to incorporate or publicly respond to the comments they receive, they often do. “The Biden administration is clearly going to be taking another look at this, and where they end up is an open question. The state and the feds have to come to an agreement on this,” Alker said. View details of HHSC’s waiver extension application here.


5. Three lessons from Vox’s story on physician mental health

In a 4,700-word piece titled “The doctors are not all right,” Vox explores the structural barriers in place that make it difficult for doctors to access mental health care. The article highlights stories of physicians who have died by suicide, COVID-19’s impacts on physician mental health, and efforts to make it easier for doctors to access care. Here are our three lessons learned from the piece.

Vox Correspondent Julia Belluz describes suicide as an “occupational hazard” in the medical field. “The problems emerge in the high-stress years of medical school, and by the start of residency – when doctors’ DNA was found to age six times faster than that of their non-physician peers – rates of depression increase fourfold in the first four months. Across all residency programs, an average of one-third of doctors meet the diagnostic criteria for major depression.”