Texas Association of Business

The Texas Legislature will be under great pressure once again during this upcoming legislative session to solve a major challenge on the minds of many employers and citizens in the state of Texas: health insurance. Finding a solution to provide affordable health care that is accessible to Texas citizens is a difficult challenge, especially considering the estimated 25 percent of Texans that do not currently have health insurance.

Traditional, employer-sponsored health care is in danger because the increases in health care costs and premiums have outpaced the general rate of inflation, the rate of gross domestic product (GDP), and the rate of increase in median household income ⁷. In 2006, net premiums for the property/casualty insurance sector were up 4.6 percent from 2005. In comparison, life/health insurance premiums and annuity considerations increased 10.5 percent over the same period of time⁸. Competitive forces, along with transparency, must be present in the health care industry to provide consumers the opportunity to make informed decisions about their own health care choices.

Insurance rates and availability are directly impacted by state regulations. In 2008, the Texas Sunset Advisory Commission began its constitutional review of both the Texas Department of Insurance (TDI) and the Office of the Public Insurance Counsel (OPIC). The Sunset Advisory Commission (SAC) was created in 1977, as part of the Texas Sunset Act, as a division within the Texas Legislature to identify and eliminate waste, duplication, and inefficiency in government agencies. The process involves and is guided by a 12-member commission that reviews the policies and programs of more than 150 government agencies on a 12 year cycle. The predominant theme of the TDI and OPIC report was that while the Texas insurance market has improved overall, it is still not as healthy or working as efficiently as it should⁹. The report proposed several recommendations that, if adopted, would significantly impact business.

While the upcoming session will open the door for both positive and negative changes in the realm of health care, TAB’s mandate will remain clear: cost increases for employer-sponsored heath care or cost increases for hard-working Texans will not be acceptable.

81^st Legislature

Committee amendments to the committee substitute to SB 1007
Relating to the continuation and operation of the Texas Department of Insurance and the operation of certain insurance programs; imposing administrative penalties. Adobe Acrobat Document (6.75 MB)

TAB’s Health Care Priorities for 2009

To ensure that the issue of affordable health insurance remains equitable for Texas employers, TAB recommends the following legislative priorities:

Access. Increase access and choice of health care programs by supporting market-driven health 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 education of physician office staff, streamlining 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, also encourage insurance carriers and administrators to accept claims electronically.

Affordability.  Oppose any measure that increases costs for Texas employers and their employees and families. The high cost of health 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 healthcare. Support measures that would increase the efficiency and cost-effectiveness of health services and health insurance.

Balance billing.  Support legislation that prohibits health care providers and physicians from balance billing patients.. Support 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 that a healthy employee and a healthy family create a productive workforce.

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 legislation requiring physicians and providers (hospitals, ambulatory surgical centers and other facilities) to provide the state with data regarding pricing of services and report medical outcomes data. Support giving state agencies adequate funds to analyze and publish data in ways that stimulate improvements in quality of care and consumer comparisons.

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

Corporate practice of medicine. Support legislation to eliminate state prohibitions on the direct employment of physicians by hospitals and other providers of health services.

Exclusive provider organizations.  Support legislation to allow atate-regulated insurers to offer exclusive provider networks for non-emergent care, , like government employee plans and self-insurance employers already can.

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

Fraud and abuse.  Eliminate waste, fraud and abuse in both the commercial employer-sponsored health care market and 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.

Health Professional and Facility 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.

High risk pool.  Support legislation to address the rising cost of providing health insurance through the Texas Health Insurance Risk Pool.

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.

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.

Paid or incurred charges. Oppose any legislation that would calculate punitive damages based on billed charges (paid or incurred charges).

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.

Physician self-referral.Support legislation and other state actions to collect data to disclose physician self-referral for all health 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.

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

State Sponsored Health Care.  Support legislation strengthening and improving Medicaid and CHIP programs with comprehensive reforms that encourage budget certainty and savings while providing high quality care through the utilization of managed care in delivering services to those enrolled in Medicaid and CHIP.

Supply of healthcare professionals.Support legislation and appropriations to expand the educational pipeline for physicians, nurses, physician assistants and other healthcare professionals by public colleges and universities.

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 the waiving or discounting of co-payments, in whole or in part, for insured patients, and encourage enforcement of existing laws.

⁷ “Employer & Health Care Crisis and Solutions” 2006 Report, Texas Association of Business

⁸The I.I.I Insurance Fact Book, pg2, 2008

⁹For the full Sunset report