Q&A: Jamie Dudensing, CEO of TAHP shares her thoughts on health reforms this session and the end of PHE
Jamie Dudensing, CEO of the Texas Association of Health Plans (TAHP), spoke to State of Reform and shared her insights about the current session and the work ahead in the coming year. TAHP is a statewide trade association that represents the health insurance industry, which includes employer-based coverage, insurers on the individual market, Medicaid managed care, Medicare Advantage, and more, altogether covering more than 20 million Texans.
Dudensing says the association is tracking hundreds of healthcare-related bills this session that directly or indirectly impact the health insurance industry and consumers, especially changes to Medicaid, insurance regulations, and managed care in Texas.
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State of Reform: How are healthcare affordability efforts playing out in Texas? What are your plans to help reduce costs?
Jamie Dudensing: “If you go look at studies, prices contribute to 75% of what’s driving health insurance premium increases, whether it’s physician prices, prescription drug prices, hospital prices. And the number one thing driving those prices is really consolidation—anti-competitive actions in the market, private equity, mass consolidation—where you don’t have that competition and you’re seeing huge price increases happening.
Every time private equity buys up a physician group, you see dramatic increases in prices in the market. And consumers really have fewer and fewer choices. Kaiser has done a number of articles talking about how bad that is, particularly in Texas, and how it not only results in higher prices, but [how] it was contributing to surprise-billing.
[Consolidation] was one of the reasons [surprise billing] was happening and now too, we have a new kind of surprise bill, which [are] facility fees. You’re seeing consumers have out-of-hospital care, outpatient care at a physician’s office, and suddenly seeing thousands of dollars of facility fees showing up, which is a big surprise on their bills. Just one other thing that’s really adding to the cost of healthcare.
The second piece that we really worry about, that we really see in Texas versus the United States, is the threat of mandates and overregulation. Texas has more mandates over the Affordable Care Act than almost any other state, which is a really interesting thing when you think about how much Texas has opposed the adoption of the Affordable Care Act. It’s almost as if we’re embracing it and going 100 miles past it.
As far as the regulations and mandates, we’re seeing high-cost ones that drive the cost of healthcare. I’m not talking about benefit mandates, I’m really talking about [the] contract type of mandates or payment mandates that providers are up here advocating for that force us to pay higher prices or bill charges for services, which means higher out-of-pocket costs for patients and higher premiums for families and employers.
So a big thing that we have to watch for is just how many mandates are being passed [this session].”
SOR: Heading into the new session, there has been considerable focus on the state of child and youth mental and physical health. What was your engagement with lawmakers over the interim on developing policies to assist in those areas?
JD: “About 50% of children in Texas are covered by Medicaid. So one thing that we’ve really tried to make a point of is that if you’re really going to make a difference in providing concrete, comprehensive behavioral health or mental health coverage for children, you need to make sure that Medicaid is providing those services.
In the commercial market because of mental health parity laws—Mental Health Parity and the Affordable Care Act—everything’s covered when it comes to mental health services because it must be treated in the same way as you would have treated any other acute care services. So a lot of those old traditional limitations were gone.
However, in Medicaid, that’s not the case. So with Medicaid, what we tried to explain is that Texas provides, as a traditional Medicaid benefit, coverage for things like psychiatric visits—going to see your doctor or a counselor or a therapist one or two times a week—or full-blown hospitalization in an acute care hospital.
But there is an entire continuum of mental health services that exist in between those kinds of coverages [such as] stepped-down units, residential treatment services, [and] intensive outpatient services that can be done at home or at a facility during the day and it’s still good to go home.
There are all types of crisis services, and these benefits are not covered as a traditional benefit in the Texas Medicaid program. We do sometimes cover them through many of the mental health GR programs that exist over at the Department of Health Services, but those programs are aimed at adults and they receive no federal matching dollars.
So by looking at these other services [and] adding them to Medicaid, you’re talking about getting that typical match, [those] federal matching dollars—[which] gets close to 60 cents on every dollar—and you’re really building that stronger infrastructure of coverage for children so that those services are not only available in the private market but also available in Medicaid.”
SOR: Senate Bill 76 proposes the establishment of a health literacy advisory committee that aims to improve health literacy in the state over the long term. Why is health literacy important and how can it be improved through this measure?
JD: “I think health literacy is extremely important. Healthcare is very confusing, whether it’s understanding your insurance or how someone’s billing or why they added on a facility fee to your bill or understanding when you leave your doctor’s office, how you’re supposed to follow up with taking the right medications and having that medication adherence and changing your daily activities around improving your outcomes. I think it’s always important for the state to have a focus on literacy and these pieces.
[Some] 42% of the uninsured in Texas are eligible for very low-cost premiums or no-cost premiums because of the subsidies in the individual market. But [Texas 2036] recently did a survey and found that most of them have no idea. They think they’re gonna have to pay for that completely out-of-pocket. They have no idea that they could even get access to coverage. So I think there’s a whole lot of things out there around educating and providing outreach to consumers that really needs to happen, because healthcare literacy will only go so far if you don’t have any access or coverage in the first place.”
SOR: There were concerns over the public health emergency (PHE) ending due to workforce shortages at the Texas Health and Human Services Commission (HHSC) and the large number of people who are likely to lose their continuous Medicaid coverage. Are you concerned about the redetermination process? How are you working with the state to minimize the gaps in coverage?
JD: “No, I think HHSC has a really good plan. I know that we’re still waiting for the go-live date, but one of the benefits of the PHE being extended so many times is that we had so many opportunities to get ready for it that HHSC had had an opportunity to fine-tune what populations will go first and go through the process. I think they have a very thoughtful process.
One nice thing about it is they have extended the enhanced match and are ramping [the end of coverage] down very slowly. So the state has the ability to slow down or stop the process if issues do come about. [Previous processing] backlogs had to do with people waiting on hold times to change their passwords. HHSC is making that easier on multiple fronts, including allowing us to just do that for consumers. No matter what, I think it’s really hard to process 2.7 million Texans’ eligibilities in a few months. That is a challenge no matter what.
It’s highly likely that more than a million Texans will no longer be eligible for Medicaid. That’s not because of technical problems, that’s just [because] they’re financially—or because of their age—no longer eligible for the Medicaid program. The number one thing that’s going to help with that was just recently the omnibus budget bill that got passed in December created 12 months [of] continuous eligibility for children as a requirement for all 50 states. That was a discussion that was probably going to come up in this session that would probably be the most helpful thing for making it easier for kids who are eligible to stay on Medicaid. Now that’s a permanent requirement.
HHSC has created a new program that allows the Medicaid managed care plans to partner with the state for the first time to help our families get through the eligibility process. We will be able to use telehealth to get on and help them fill out their application, change their passwords, help them get into the system, get all of their paperwork done, [and] hold their hands through that process where we’ve never been able to do that before.
Quite a few people who will no longer be eligible for Medicaid are very likely eligible for subsidies in the individual market that substantially lowers the cost of coverage. The average cost for individuals [who] get subsidies is less than $40 a month and quite a few people can almost get zero-cost coverage.
There’s still going to be an increase in the number of uninsured in Texas and Texas still needs to be working to find more affordable options to expand or increase access to coverage in Texas. But there’s a lot of opportunity to either help someone stay on Medicaid that’s still eligible or help them enroll in the private marketplace.”
This interview was edited for clarity and length.