BCBS of TX Releases Legislative Update: Addressing Obesity and Cancer

This article is a copy of the Texas 81th Legislative Session: Health Care Topics on the Agenda

Two issues likely to drive much of the health care discussion during the 81st Session are access to health care and the high rate of uninsured Texans. Although the state currently is seeking a federal Medicaid waiver intended, in part, to leverage federal and state dollars to increase health coverage among low-income Texans, approval by the Centers for Medicare and Medicaid Services (CMS) have been slow in coming. As a result, legislative initiatives addressing the uninsured are likely to be proposed with the same aim of maximizing federal funds, but in a manner utilizing federal stimulus funds to state programs, expanding health care programs such as Medicaid and CHIP (Child Health Insurance Program) and/or small employer-based purchasing pool initiatives. The original Medicaid waiver proposal established a Health Opportunity Pool (HOP) wherein the state would combine federal and state funding to offer a variety of coverage (i.e., catastrophic care) and allow families to blend funds from various programs (i.e., State Child Health Insurance Program and Medicaid Health Insurance premium) to enable families to buy into employer-sponsored coverage. However, approval of the Medicaid waiver has been slow in coming about. It is expected that legislation may be forthcoming to address the same aim as the waiver in maximizing those federal funds, but using federal stimulus funds instead. Bills promoted by key health care advocates addressing increased eligibility for Medicaid and CHIP have already been filed, including proposals that would extend Medicaid continuous eligibility from six months to twelve months, mirroring a significant legislative gain in the CHIP program from last session. Additionally, a renewed effort to enroll all CHIP-eligible kids has emerged as a priority, at least in the Senate. Increased CHIP eligibility levels driven by the federal SHIP reauthorization bill may trigger a serious discussion of program eligibility expansion beyond the current 200 percent Federal Poverty Level limit.
Wellness initiatives continue to be popular legislative proposals. It is anticipated that discussions will range from disease-specific approaches, such as reducing obesity and diabetes incidence, to provider payment structures rewarding wellness care. In fact, during a recent press conference, Lt. Governor David Dewhurst noted, “America is the only country in the world that pays doctors on the basis of the number of procedures they perform…not on wellness.” Health care advocates should anticipate additional pilot programs. Representative Myra Crownover (R-Denton) has introduced legislation, HB 5, relating to the elimination of smoking in all workplaces and public places. “The benefits of a statewide smoke-free law are undeniable,” Crownover said. “It’s good for health, good for business and saves money now spent on healthcare…No one should be forced to choose between their health and a paycheck.” Across the nation, 24 states have strong smoke-free laws that include restaurants and bars – a significant increase from the 16 states that had smoking bans when the Texas Legislature convened in 2007, the first session during which lawmakers debated a smoke-free bill. According to Smoke-Free Texas, 28communities around the state already have smoke-free ordinances, including Austin. Funding related to Frew v. Hawkins, in which Texas parents filed a class action lawsuit against state healthcare officials claiming deficiencies in the state's Medicaid program, continues to be a health care priority. Targeted provider rate increases for physicians and dentists accounted for $1.3 billion of the total $1.8 billion settlement. Several interim studies have recommended increased Medicaid reimbursement rates, especially for physicians. The Senate, at least, will take a “return on investment” approach, as evidenced by the Senate Finance Joint Interim Report with Health and Human Services on Medicaid Rates. This report recommends an evaluation of whether appropriate and measurable outcomes were produced by the most recent provider rate investment before any additional provider rate discussions occur. One significant result, easily attributed to enhanced provider rate levels, has been the documented increase in Medicaid providers. Legislation may also emerge to develop Health Enterprise Zones, which would offer tax incentives to medical providers who locate within identified areas. In addition, franchise tax proposals are expected to change the current franchise tax deduction for health care benefits to a more lucrative deduction. The intent is to provide a tool for increasing the number of insured employees.