The 2009 legislative session is unlikely to lift the state out of its rock-bottom national ranking in healthcare.
Texas has the highest rate of uninsured residents and spends the least per resident on healthcare — $2,141 compared with the national average of $3,508. The state is not impoverished, ranking 21st in per-capita income, and consistently has a lower unemployment rate than the nation.
Healthcare spending is simply not a priority.
But legislators can improve accessibility and affordability by exerting leadership.
Here are 10 suggestions.
Aggressively enroll eligible children in the Medicaid and Children’s Health Insurance Program (CHIP).
According to the Austin-based Center for Public Policy Priorities (CPPP), about half of uninsured children are eligible for these programs.
Extend children’s Medicaid eligibility from six to 12 months.
The 2007 Legislature extended CHIP enrollment to annual eligibility. Medicaid children deserve the same. When California extended Medicaid eligibility re-enrollment to 12 months in 2001, it saved an estimated $17 million when 3,000 fewer children were hospitalized for asthma, pneumonia and gastroenteritis, says a recent study in Medical Care.
Allow Texans to buy their way into the CHIP program.
According to CPPP, there are families who request pay cuts to enable their children to qualify for the program. Parents making up to $63,000 (more than current eligibility, 200 percent of the federal poverty level, or $42,400 for a family of four) should be able to sign up their children and pay a premium for coverage.
Make insurance companies accountable for their rates.
Texas premiums for family coverage increased 40 percent between 2001 and 2005 while income was up only 3.5 percent. But according to the Journal of Insurance Regulation, Texas is only one of 10 states that do not actively review health insurance rates. The Texas Department of Insurance is up for a sunset review, and lawmakers should use the opportunity to strengthen the department’s oversight.
Assist in forming risk pools to protect individuals and small businesses from unaffordable rates.
Other states have implemented reforms for reinsurance — or insurance for insurance companies — to lower rates, made high-risk pools more affordable for those with chronic conditions, and formed health insurance exchanges to assist in creating a larger risk pool and foster competition among insurance companies.
Improve the Texas Advance Directives Act.
A 2007 compromise bill that would have improved the 1999 version for disputes over end-of-life care failed primarily because the session ran out of time. The measure built more time and a swift legal appeal into the process and dictated better communication between the care providers and patient families. It deserved passage.
Keep the funds for trauma care where they belong.
Money designated for hospital trauma centers from the Driver Responsibility Program fines continues to be diverted for other uses. Trauma centers are only getting about half of the fines’ proceeds.
Implement a statewide smoking ban.
Cigarette smoking and obesity are the two most preventable causes of chronic disease and death. Smoking restrictions and excise taxes are the most effective means of decreasing smoking rates. The House passed an exception-laden ban in 2007 that deserved its legislative death.
Build on protections against "balance billing."
This hoary practice bills patients treated by physicians outside their insurer’s network for the portion the insurance company won’t pay. This is especially outrageous in emergency situations where the patient is in no condition to make informed choices. California and Illinois have taken measures to protect residents, and Texas should do the same. Lawmakers in 2007 passed requirements for disclosure of non-network practitioners, but they need to go further.
Increase healthcare access by increasing providers and broadening scope of practice.
The the state demographer reports Texas will need at least 40,000 new doctors by 2025 because of physician retirements and population growth. The Task Force on Access to Health Care in Texas recommends increasing the number of medical school graduates by 25 percent and dentists by 20 percent over the next decade. Physician assistants and nurse practitioners are increasingly important in rural areas, and staff most retail health clinics. Onerous physician oversight requirements handcuff too many opportunities to give basic care.
