Texas health leaders weigh in on rising health care costs, mental health, health equity and more

Texans can expect to see telehealth expansion, health care cost reduction and changes to the public health infrastructure at the forefront of  health care leaders’ priorities this year. Elena Marks, CEO of the Episcopal Health Foundation, Andy Keller, president and CEO of the Meadows Mental Health Policy Institute, Sen. Charles Perry and Rep. Tom Oliverson spoke on a panel discussing the future of Texas health policy at State of Reform’s 2021 Texas Health Policy Conference on Thursday.


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Oliverson, an anesthesiologist, is optimistic about state health policy. He praised the state’s accomplishments last year on halting surprise medical billing — something that was subsequently used by the federal government, according to Oliverson.

However, he believes the rising costs of health care are a continual problem for Texans:

“I don’t think the issue is coverage, I think the issue is affordability. That’s something that absolutely has to be addressed in the 2021 session. We’ve got to bend this cost curve down and make health care more affordable across the board.”

Marks offered a different perspective, saying health care coverage is “the means to affordable access.” She believes covering more Texans will allow for more affordability, and said she wants to see Texas expand Medicaid. She pointed out this is what many other states with conservative leadership have done.

Oliverson also pointed to the state’s “disorganized” response to COVID-19, saying it needs to be reconstructed to more adequately respond to public health crises. 

“I think we should take this opportunity to carefully examine the existing public health infrastructure and look for ways to make it a much more seamless, much more efficient mechanism that would allow us to respond in a cohesive fashion to a future pandemic.”

Marks agreed, saying the allegedly incompetent public health infrastructure “isn’t unique to Texas; it’s an American phenomenon.”

“I look forward to seeing a bigger investment in the public health infrastructure because the way you stop or prevent things like pandemics is through public health, not health care. So our underinvestment in data systems, personnel and training has come home to roost.”

She said there is data to support the benefits of expanding Medicaid in the state, pointing specifically to models from Texas 2036.

“Why would we not allow people to have health insurance coverage if we can do so affordably? Because that’s the mechanism that we’re all using. None of us are giving up our health insurance saying we just want to pay for more affordable prices. So I really hope legislators will take a pragmatic look and look at the costs and benefits [of Medicaid expansion].”

Perry said he spoke with Sen. Lois Kolkhorst, Chair of the Texas Senate Health and Human Services Committee, about the state’s response to COVID-19. He anticipates that she will put forth a “best practices’ bill in the near future, which will detail the lessons the state learned from COVID-19 that can be utilized going forward.

He added that the Legislature will introduce a bill to extend rural broadband services this session.

“Rural broadband is going to absolutely happen this session. The majority of the reason why is because the federal [government] has committed up to $9 billion of federal money [for rural broadband services].”

As a result of his bill, SB 170, rural access care hospitals will continue to be reimbursed by Medicaid, he said. 

Keller offered a mental health-centric perspective on Texas’ current health policy, citing the mental illness epidemic exacerbated by the pandemic.

“Four times as many Americans today — and that includes Texans — are reporting symptoms of depression and symptoms of anxiety than they were a year ago, before COVID.”

Oliverson said he has been working with Perry for the past several sessions on telehealth expansion, which is key to addressing mental health issues, according to the representative. He noted that patient satisfaction levels have risen with the increased use of telehealth as opposed to in-person visits.

Keller also pointed to the need to address the country’s high suicide rates. He says health providers need to treat depression like they do other illnesses and identify it early so patients can seek treatment.

“The terrible thing is that we know what to do about it. It’s the same thing we do for every other disease. We don’t wait eight to ten years, like we currently do, to provide treatment, and wait until people are in state hospitals and homeless and dying from suicide — we identify the illness early.”

He stressed how much mental illness affects people physically, saying people with mental illness are more susceptible to COVID-19. According to Keller, the state needs to add collaborative care to its Medicaid program. He said the 1115 Waiver is a step in the right direction for improving mental health care.

Marks highlighted the racial inequities of COVID-19, noting that Texas’ large non-white population has been hit hardest by the pandemic. According to her, this can be addressed through Medicaid and legislative efforts.

“If we can improve the overall health and life trajectory of the populations who have the worst outcomes right now, while it’s long-term work — in the future, it benefits not just them, but all of us, because we’ll have more productive, self-sufficient citizens, family members and communities.”