Texas legislators discuss health policy priorities ahead of the next legislative session
Four state lawmakers gathered this week to discuss the health care and fiscal policy teed up for Texas’s 2021 legislative session. The conversations took place between two separate panels – one featuring Democrats and the other featuring Republicans – during the 2020 North Texas State of Reform Virtual Health Policy Conference.
The Democrats panel featured Reps. Lina Ortega and Chris Turner. Reps. Tom Oliverson and James Frank offered their perspective on the Republicans panel.
Below are highlights from the wide-ranging discussions that took place in both panels.
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Policy Leadership: Republicans
- Rep. Tom Oliverson, Vice Chair of the House Insurance Committee, says the most important health care issue that needs to be addressed in the coming legislative session is affordability. In particular, he highlights the importance of making health insurance more affordable for Texans.
“We have a robust insurance market, but unfortunately it locks too many people out because it’s just simply not affordable,” says Oliverson. “We need to find a way to get those costs down so that folks will find value in having insurance coverage.”
- A key to affordability, says Oliverson, is price transparency. He says we can expect to see a big push on this topic from Republican leaders in 2021.
“Because the patient is kept in the dark until after the service is provided, we do not have a cost-effective health care delivery system. It just doesn’t exist.”
- He says they need to encourage a cash-based system for more health care services so that individuals have the ability to shop around. Oliverson brought up the examples of cosmetic surgeries and LASIK as areas where there is a known cash price and as a result, they say quality has improved and prices have gone down.
- Rep. James Frank, who Chairs the House Human Services Committee, says Republicans will also prioritize access to care. This, he says, is intertwined with affordability.
- Supporting telemedicine is also key to improving access to care, he adds. Oliverson says next session he would like to see a further expansion of telemedicine and a recognition that if services are provided at the same level of care via telemedicine, then the service should be reimbursed the same as in-person. This will help with the shortage of providers in the state, particularly in the areas of mental health, specialty care, children’s health services, and in rural areas.
“Being able to leverage the providers that we have to the maximum extent possible by giving them the flexibility to see patients in person or over the internet…I think that’s pivotal,” says Oliverson.
- Another potential area to be addressed during the session is licensure compacts, which Oliverson says can help expand the workforce and make it easier for health care providers to practice in different regions of the country.
- Frank says it will be important to address the impacts of COVID-19. During the pandemic, emergency waivers and flexibilities were enacted to remove certain restrictions and make it easier to access care. Frank says he expects the legislature to take a look at these changes to evaluate which ones might be made permanent.
“I think the legislature, when we go back into session, is going to have to look at each one of these things that have been waived in the interim and determine which ones of those things do we want to become permanent and actually decrease costs and add to access, and which ones are actually needed for the health, well-being, and safety of our citizens,” says Frank.
- He adds that he thinks the state needs to make a change to allow legislative input in emergency situations, even if the emergency takes place when the legislature is not in session.
Policy Leadership: Democrats
- Rep. Lina Ortega, member of the House Public Health Committee said she wants to pass legislation this coming session to strengthen existing infrastructures and policies that relate to the binational spread of COVID-19. This could look something Senate Bill 1680 from two sessions ago, which created a binational task force of border health officials to make recommendations on how to improve public health in Texas border regions.
- Standardizing data collection on both sides of the border, as well as improving access to preventive and specialty care in border communities are priorities for Ortega.
- Rep. Chris Turner, Chair of the House Democratic Caucus, said the pandemic has laid bare health disparities in Texas, made worse by the high rate of Texans with underlying health conditions. In 2016, more than 11% of Texans had diabetes.
- In May of this year, 4.9 million Texans were uninsured – giving Texas the highest uninsured rate in the nation. Nearly 30% of non-elderly adults had a preexisting condition before COVID-19. As a result of these metrics, Turner says increasing health access through Medicaid expansion should be the foremost policy concern for legislators.
“I think as we look ahead to the next session, the priority for Democrats has been for a long time, and as much now as ever, to expand Medicaid in Texas under the ACA. We know that we could probably insure as much as 2 million Texans overnight with Medicaid expansion. Additionally we can draw down our federal tax dollars which we have been forfeiting as a state now for several years, for no reason. The only reason we’ve forfeited these billions of dollars has been politics,” said Turner.
- Through Medicaid expansion, Turner says over a ten year period, Texas would invest roughly $6 billion and draw down $66 billion in federal funds.
- Ortega said nearly a third of her constituents are living on a fixed income, making unexpected medical costs, such as a COVID-19 test, unaffordable. Expanding Medicaid, she said, would help ameliorate the health care affordability crisis, as well as keep hospitals financially sound in periods of high demand.
“This places a heavy financial burden on people, forcing people to choose between things like vital medicine, food, on paying utilities; without the ability to seek medicare when necessary, we continue to see spikes in COVID. This has to be remedied by access to health care.”
- Turner said the session would look different due to the pandemic and that he hopes everyone will be wearing masks inside the capitol, though some of his colleagues have rejected the idea of mandating masks inside the capitol.
- Texas’s budget shortfall will be at the top of the agenda when session begins. Ortega said budgetary cutbacks to women’s and children’s services should be avoided. Preserving essential services like these will take a bipartisan effort, she continued.
- Turner said a proposed 5% cut – compressed into one year making it more like 10% – to programs that aren’t well-funded to begin could have a dramatic impact on health outcomes. For this reason, Turner says the Legislature should take a closer look at tax loopholes in the state.
- Improving the census response rate, as the deadline is not for another four weeks, should be a top priority in the short-term since Texas can draw down more federal funds for health care as a result, said Turner.