Health Care

TAB advocates for the highest quality health care at the best cost available for both employers who provide health insurance to their employees and for the state taxpayers who fund Medicaid. TAB’s legislative priorities are wide-ranging, covering issues such as access, transparency, health literacy and quality of service.

TAB will continue to work with the Legislature to improve health care delivery models, help consumers understand their role in their own health care, increase access to primary care and lower health care costs for Texas businesses. Expanding telemedicine in Texas and stopping balance billing practices are just a couple of examples of how we can achieve these goals. TAB’s health care priorities are as follows:

1115 Medicaid Transformation Waiver. Support an extension of the 1115 Medicaid Transformation Waiver and a call for negotiations between the Texas Health and Human Services Commission (HHSC) and Centers for Medicaid & Medicare Services (CMS) to develop an appropriate renewal of the waiver at the end of the extension period.

Access. Increase access to choices of health care programs by supporting market-driven health care policies that maximize consumer and public benefit and allow for the continuation of employer-sponsored voluntary health care coverage. Encourage the establishment of programs that would allow employers selection of the highest quality benefits and the lowest, most competitive prices.

Administration. Support legislation to improve the administration of health care services through the education of physician office staff and streamline the process to enhance outcomes and lower administrative burdens, such as encouraging providers to submit claims electronically. To the extent that they do not do so already, encourage insurance carriers and administrators to accept claims electronically.

Advanced Nurse Practitioners and Physician Assistants. Support legislation that would expand the ability of advanced nurse practitioners and physician assistants to provide primary care and would reduce physician oversight requirements and other restrictions on their practice. Increase the supply of advanced nurse practitioners and physician assistants by expanding educational opportunities and by improving the practice environment.

Affordability. Oppose any measure that increases health care costs for Texas employers and their employees and families. The high cost of health care services and health insurance is a primary contributor to the number of uninsured and to the rising percentage of budgets that households, businesses and government spend on health care. Support measures that would increase the efficiency and cost-effectiveness of health care services and health insurance.

Balance Billing. Support legislation that prohibits health care providers and physicians from balance billing patients. Support placing limits on what out-of-network health care providers can charge, and support other legislation that will help eliminate the conditions in which balance billing occurs.

Consumer-Directed Health Care. Support legislation to promote consumer-directed health care models. Encourage employees to be more involved in their health, and encourage education of employers and employees on actual health care costs and fees. Promote understanding of the maxim that a healthy employee and a healthy family create a productive workforce.

Consumer Credit Protection. Support legislation that protects consumers from the submission of adverse credit reporting from medical bills when the provider did not give the allowable price that would be accepted as payment-in-full in advance of services rendered.

Consumer Information. Empower employees and consumers with information regarding the cost and quality of health care services to allow consumers to make informed purchasing decisions. Support giving state agencies adequate funds to analyze and publish data in ways that stimulate improvements in quality of care and consumer comparisons. Support efforts to facilitate health plans providing members with information on the allowable amount and patient responsibility in advance of receiving services.

Contracting. Oppose legislation that restricts the ability of health insurers to negotiate contracts with physicians and providers.

Corporate Practice of Medicine. Support the repeal of the state prohibitions on the corporate practice of medicine, and support necessary safeguards in law to ensure physicians are not restricted from exercising independent medical judgment in diagnosing and treating patients.

Employee Retirement Income Security Act (ERISA). Preserve employer, employee and health care system benefits of ERISA by opposing any attempt to erode the federal preemption of state law relating to health benefit plans. Support legislation to vigorously protect the ability of ERISA employers to operate uniformly across state lines.

Fraud and Abuse. Eliminate waste, fraud and abuse in Medicaid, the commercial employer-sponsored health care market and in the private sector health programs. Support legislation to ensure that prompt payment statutes do not result in the reimbursement of fraudulent claims. Support legislation to require health care providers to submit information to the state on financial relationships and utilization of services that will deter and detect improper activities.

Freestanding Emergency Rooms. Support legislation that would prohibit a freestanding emergency room or hospital outpatient department from charging a facility fee unless it can show that the treatment rendered was beyond a doctor’s office visit. Support greater transparency related to services provided at freestanding emergency rooms to ensure consumers understand the scope of services provided, potential costs and network participation. Require prominent signs to distinguish freestanding emergency rooms from urgent care clinics and to disclose hospital affiliation, if any. Support legislation to add freestanding emergency rooms, or any facility that charges a facility fee, to the balance billing mediation statute.

Health Care Professionals. Support legislation and appropriations to expand the educational pipeline for physicians, nurses, physician assistants and other health care professionals by public colleges and universities. Specifically, TAB endorses policies that would:

  • Support funding Texas Higher Education Coordinating Board studies to increase productivity and to reduce the cost of training health care professionals.
  • Support legislation to prevent discrimination against nurse training programs based on clinical hours.
  • Support six-year BS/MD programs to accelerate the production of physicians at a lower cost to the state.
  • Support standardized pre-licensure training for RNs.
  • Support state funding of additional residencies. In regards to the allocation of appropriations, TAB supports giving priority to providing state funding for medical residencies over additional state funding for medical schools.
  • Support funding to increase the number of advanced practice registered nurses.

Health Care Professional Licensing Agencies. Support appropriations that allow the professional licensing agencies to keep a larger percentage of the licensing fees they collect to improve processing of applications by providers and to conduct data collection, analysis, public information and oversight activities to improve the quality of health care for Texans.

Health Literacy. Support legislation that ensures health literacy in Texas, including the taxpayer-funded health care enterprise system. Support the provision of plain language usage and disclosure of basic health information, including financial and quality information, whenever possible to expand the capacity of individuals to make appropriate health decisions on an ongoing basis. Support the development of a “Health Literacy” curriculum that is a required course study for all health care professionals so they may help educate Texans on proper self-care, appropriate services and unwarranted spending on unnecessary or duplicative services.

HMO Contracting Abilities. Support legislation that seeks to expand the definition of contracting entities in the HMO statute. Texas’ outdated and narrow statutory language needs to be updated to reflect current market practices and innovations.

Interstate Insurance. Support legislation to allow Texans to purchase insurance policies, which have been approved by the insurance boards of any state and contain adequate consumer disclosure, across state lines, therefore increasing options for Texas citizens in purchasing health care policies.   

Liability. Prevent needless increases in cost and litigation through the expansion of any kind of medical liability. Support legislation to curb existing abuses and the filing of frivolous lawsuits.

Mandated Benefits. Oppose any additional mandates on employers providing health care.

Medicaid. Continue to support Medicaid managed care as a service delivery model. Support legislative policies that seek to create significant savings to the state and allow for flexibility, such as allowing managed care organizations (MCOs) to use their own formularies and their own prior authorization for prescription drug coverage. Encourage the transition of Medicaid managed care from the fee-for-service payment model.

Medicaid Expansion. Support a private insurance model that includes copays and a sliding scale in order to reduce the number of uninsured Texans.

Patient Safety. Support legislation to ensure patient safety and control costs by reducing the number of medical errors. Promote affordable, quality and safe health care. Encourage better monitoring and reporting of health professions by supporting legislation that provides for the release of information regarding medical errors while balancing the need for health provider liability protections. Support legislation to provide immunity to providers for sharing information regarding physician performance.

Personal Responsibility for Health. Support legislation and other state actions to encourage and equip each Texan to accept personal responsibility for his or her health throughout their lifetime, including health literacy.

Physician Self-Referral. Support legislation and other state actions to collect data to disclose physician self-referral for all health care services, to enforce disclosure of self-referral to patients and health plans and to prohibit self-referral for those services where it has been shown that self-referral unnecessarily increases health care costs.

Price Controls. Oppose government mandated price controls for medical products, health care provider services and health insurance.

Prompt Pay. Support legislation requiring that notification of any late, inaccurate or non-payment of a health claim by a health care provider be made to the paying entity within 180 days of receipt of claim payment or written explanation of payment as long as claims were processed timely.

Regulatory Relief. Support the mitigation of regulation on health care related issues impacting employers.

Quality. Enhance quality in our health care system. Support legislation to provide a safe harbor for state-sponsored and private health plans to deny payment to health care providers for events for which the Medicare program denies payment to hospitals.

Specialty Prescription Trend. Study the impact of specialty medicines on health care outcomes and costs over time. Examine recommendations to lower overall health care costs that balance the value of cures, quality of life, health outcomes and medical innovation with the necessity to manage costs.

Stop Loss Insurance. Support legislation that would preclude harmful regulatory action that could limit access to stop loss coverage, ensuring that groups seeking to self-insure are able to access the necessary tools to do so.

Telemedicine. Support the expansion of telemedicine as an affordable and accessible component of coordinated, efficient high-quality care. Support legislation that allows the commercial market the same, or greater, freedoms in this area than are found in the Medicaid program. Support the Federation of State Medical Board’s interstate compact for medical licensure.

Transparency. TAB favors relying on market forces to correct the major cost and quality deficiencies in the U.S. health care system. To allow the market to work, TAB favors requiring health care providers to publish on the Internet their prices in order to permit consumers to compare prices in advance of receiving scheduled services. “Price” is the amounts the provider accepts as payment in full for each service. TAB also favors legislation that increases the ability of health benefit administrators to assist consumers in using health benefits in a cost-effective manner.

Uninsured. Support legislation that will reduce the number of uninsured Texans by increasing the affordability of health insurance and will allow the most efficient use of public, group and individual insurance arrangements within state budget constraints.

Waiver of Co-Payments. Support legislation to stop providers from waiving or discounting co-payments for insured patients, in whole or in part, and encourage enforcement of existing laws.