By Jonathan Nelson
Speaker Dade Phelan led a bipartisan group of representatives in announcing support for a number of bills to address access to health care during a press conference at the State Capitol on April 7, 2021. The Healthy Families, Healthy Texas plan marks a serious commitment to tackle some longstanding barriers to care facing Texas patients.
“The goal of this legislative package is to make health care more affordable, more accessible, and to save lives through better health outcomes,” Phelan said.
The bills in the package are:
- HB 4, which would expand telehealth by making permanent the waivers put in place during the pandemic that allow programs administered by the Health and Human Services Commission to pay for telemedicine services at the same rate as in-office services and by allowing audio-only telemedicine visits.
- HB 5, which increases access to high-speed internet across the state, thereby removing one of the chief obstacles to telehealth in rural areas.
- HB 290, which would provide two six-month periods of continuous coverage for children in the Medicaid program. Families currently have to complete several income eligibility assessments throughout the year to remain in the program. This legislation would reduce the required number of eligibility tests to one every six months.
- HB 797, which allows home care and hospice agencies to administer vaccines.
- HB 15, which creates the infrastructure needed to invest in research on brain health, including the prevention and treatment of traumatic brain injuries and of substance use disorders.
- HB 18, which would establish a statewide discount drug program to allow uninsured Texans access to medications like insulin and epinephrine at significantly reduced prices.
- HB 133, which addresses maternal mortality by providing 12 months of continuous postpartum coverage for new mothers in HHSC programs.
- HB 4139, which would create an office within HHSC dedicated to eliminating health disparities and increasing health equity.
- HB 2487, which would require hospitals to disclose prices before the provision of services.
- HB 3923, HB 3924, and HB 3752, which expand health care coverage options for small employers and individuals who are not eligible for Medicaid and do not have access to employer-sponsored plans.
TAFP CEO Tom Banning says this package of legislation would go a long way toward helping Texas families get the care they need. “The fact that Speaker Phelan pulled this coalition together from both sides of the aisle and from all regions of the state is a strong signal that health care access is a priority for the Texas House,” Banning says.
Conspicuously absent from the package is HB 3871, which would draw down billions of federal dollars by expanding Medicaid to cover an estimated 1.5 million uninsured working age adults. The bill has garnered some Republican support since it contains key compromises like health incentives, an employment initiative, and a provision that terminates the program if and when federal funding under the Affordable Care Act ends. It even includes a provision requiring that physicians and other health care providers must be paid at least the Medicare rate for Medicaid services. Still, the bipartisan bill entitled the Live Well Texas program was not included in the Healthy Families, Healthy Texas package.
“Obviously we are disappointed coverage expansion was left out of the House plan,” Banning says, “but that doesn’t mean the Live Well Texas program is off the table for the session.”
TAFP also has concerns with some components of the House package, most notably the inclusion of House Bills 3923, 3924, and 3752. If signed into law, these measures would introduce unregulated insurance products in the Texas market. “These kinds of plans would completely circumvent the patient protection laws we passed back in the 90s and could leave many people dangerously underinsured,” Banning says. “We will continue to work to ensure that health care coverage options offered in Texas provide some measure of patient protections that are currently required by state law.”
In other legislative news …
The Budget Beat — The Senate unanimously passed its version of the state budget, SB 1, this week and while it does not contain any payment increases for physicians in the Medicaid program, it does continue to adequately fund the graduate medical education grant program. SB 1 includes almost $200 million for the biennium to maintain the Legislature’s stated target of funding 10% more residency slots than the number of Texas medical school graduates.
The Family Practice Residency Program, a dedicated stream of funding that goes directly to most family medicine residency programs in the state, took another hit in the Senate budget. In the current biennium, the program receives $5 million per year but in the Senate proposal for 2022-23, it would get only $4.75 million per year. For perspective, the program received well over $10 million a year a decade ago. And while the number of family medicine residents in training has increased over that period, the amount of funding per resident has withered, dropping from $14,300 per resident each year in 2011 to $5,400 in 2021.
For more information on the FPRP and why lawmakers should increase its funding, check out this issue brief.
The Price Transparency Take — On April 6, the House Committee on Insurance took up a major plank of TAFP’s Primary Care Marshall Plan, the creation of a statewide all-payer claims database. HB 1907 seeks to address runaway health care costs by injecting price transparency into the market. It would use the existing Center for Healthcare Data at the University of Texas Health Science Center at Houston to collect, aggregate, and analyze health care claims and encounters for state regulated commercial health insurers and self-insured employee benefit plans that choose to opt in to the program.
The bill’s sponsor, Rep. Armando Walle, of Houston, told the committee that creating such a database would allow patients and employers who purchase insurance coverage and medical services to compare prices and quality of care, and it would give lawmakers an invaluable tool to help craft effective health care policy. “While there are many potential applications for this initiative, the overarching goal of establishing an all-payer claims database for Texas is to facilitate state efforts in controlling these rising costs of health care by helping increase competition and transparency in our health markets. So members, we would like to obtain Texas data to make Texas-based decisions,” he said.
TAFP’s Banning testified in support of the bill, saying that at least 21 states have passed similar legislation, many of which are already experiencing the benefits of having access to such information. “When you think about health care and health care costs in particular, this has the opportunity to democratize data, to drop the silos that exist within Medicaid, Medicare, and the commercial market, and to provide a whole picture of what’s going on in the health care system,” he said. “It can empower employers; it can empower physicians; it can empower patients. And I think importantly for you, it can provide good independent data for you to make good health policy decisions.”
The bill was left pending.
The Scope Scoop — No news is good news on the scope of practice front. The House Public Health Committee took up HB 2029 — this session’s nurse practitioner independent practice bill — on March 24, (read about the hearing) and since then, the committee has not taken any action on the measure.
The bill would allow APRNs to prescribe medications, order and evaluate diagnostic testing, and prescribe durable medical equipment, all without any physician collaboration. These actions are clearly defined as the practice of medicine under Texas law, yet the text of the bill states that should HB 2029 become law, an APRN performing one of these acts “is not considered to be practicing medicine without a license.”
TAFP has many objections to HB 2029, including the following.
- The training APRNs complete is not adequate to prepare them to practice medicine. Physicians undergo rigorous training to provide complex differential diagnoses, order and evaluate diagnostic tests, and develop treatment plans. That training includes seven or more years of postgraduate education and between 10,000 and 16,000 hours of clinical patient care. APRNs complete two to four years of postgraduate education and 500 to 720 hours of clinical patient care.
- While all members of the health care team — especially APRNs — are important to the provision of high-quality care, members of the health care team are not interchangeable. There is no equivalency between a physician and a nurse practitioner, and allowing APRNs to practice independently will only serve to further fragment a health care delivery system sorely in need of more collaboration.
- Allowing APRNs to practice medicine without a delegated authority agreement with a physician will not increase access to care or reduce health care costs in Texas, despite what nurse practitioner organizations claim. There has been no significant increase in access to care in states that have expanded APRN’s scope of practice nor have costs gone down.
Many bills die in committee without ever receiving a vote but there is still plenty of time for the Public Health Committee to move HB 2029. Stay tuned.
For more information on TAFP’s legislative priorities, read this article from Texas Family Physician.