Free Market Health Insurance: Affordability & Availability

Mandate-Free Health Insurance

Senate Bill 541 (78R) by Williams | Estes | Janek | Nelson | Shapiro

Sponsor - Taylor

 

• Senate Bill 541 allowed insurers to offer mandate-free insurance policies to policyholders. Mandates invariably drive up the cost of an insurance policy and therefore increase the number of uninsured.
• The bill required the insurer to provide notice to policyholders of their option to choose a policy that does not cover the health benefits normally required in the state.
• The insurance company must disclose the list of state-mandated health benefits that are not included.
• Additionally, an insurance company that offers one or more of these non-standard policies must also offer at least one accident or sickness policy with the mandated benefits included.

 

Small Employer Group Health Benefit Plans

Senate Bill 10 (78R) by Averitt et al.

Sponsor - Smithee

• Senate Bill 10 permitted group health cooperatives to help small businesses meet the cost of providing health coverage for their employees.
• Allowing small employers to pool with larger ones in order to obtain affordable health insurance is an important part of the process of reducing the number of uninsured in the state.
• Many reports demonstrate that many uninsured Texans work for a small business

Workers' Compensation Reform

House Bill 7 (79R) by Solomons et al.

Sponsor - Staples

• The reforms enacted by Senate Bill 7 included altering the administration of the workers' compensation system. The Texas Workers' Compensation Commission was abolished, and its functions turned over to the Texas Department of Insurance and the newly created Office of Injured Employee Council.
• In addition to these structural changes, HB 7 moved the state from a failed model of workers' compensation to a model that is more similar to private group health plans. By allowing for the formation of networks for workers' compensation coverage, HB 7 greatly reduced the size of the state's regulatory footprint.
• Before the 79^th Legislature convened, the workers' compensation system was one of the least efficient in the nation. In a 12 state study conducted by the Workers' Compensation Research Institute (WCRI) for 2004-2005, Texas ranked either at the bottom or near the bottom on all analyses. Cost per claim in Texas was the second highest of the states studied.

 

Protecting Investments in Health Savings Accounts:

House Bill 330 (79R) by Berman

Sponsor - Deuell

• House Bill 330 put money invested in Health Savings Accounts (HSAs) on the same protected status as money held in Individual Retirement Accounts plans by exempting HSA funds from seizure for the payment of debts.
• HB 330 provided a further incentive for individuals to invest in HSAs by protecting the asset from seizure, with the goal of encouraging further individual investment in HSAs.

Medicaid & CHIP: Limiting Costs and Improving Services

Health and Human Services Reform

HB 2292 (78R) by Wohlgemuth

Sponsor - Nelson

• HB 2292 limited the period of continuous eligibility in Medicaid by applying a six-month period, rather than rolling to a 12 month continuous eligibility period as passed in the 77^th Legislature.
• The bill allowed for more thorough procedures for verifying assets in determining eligibility for Medicaid, including access to consumer reporting agencies and other similar records.
• The bill expanded the Medicaid fraud investigation and prosecution powers of the Office of the Attorney General.
• HB 2292 initiated agency realignment and consolidation.
• The bill reformed the Temporary Assistance for Needy Families (TANF) program by establishing a marriage program for TANF recipients to provide incentives for clients that promote healthy and stable marriages.
• HB 2292 also implemented a pay-for-performance system for TANF recipients, which requires participants to meet the obligations of the personal responsibility agreement every month in order to receive benefits.

Disease Management in the Medicaid Program

House Bill 727 (78R) by Delisi | Capelo | Wong

Sponsor - Janek

• House Bill 727 required the Health and Human Services Commission (HHSC) to contract for disease management services for Medicaid recipients with chronic health conditions who do not qualify for Medicaid managed care.
• Disease management is an important way in which health care services can be delivered cost-effectively to certain segments of the Medicaid population.
• The bill provided that the Commission could only enter into a contract with a provider of disease management programs with a guarantee of savings to the state.

Prevention of Medicaid Fraud:

House Bill 1743 (80R) by Delisi et al.

Sponsor - Nelson

• The bill allowed the Health and Human Services Commission (HHSC) to perform a pre-payment review of a claim for reimbursement under the Medicaid program to determine whether the claim involves fraud or abuse, and to withhold payment for up to five working days in order to complete the review.
• The bill also allowed HHSC to impose a post-payment hold on payment of future claims submitted by a provider if the department has reliable evidence of fraud committed by the provider.
• The bill granted authority to the HHSC Office of Investigation and Enforcement (OIE) to issue a subpoena to compel the attendance and testimony of a witness or the production of records. In addition, the (OIE) was given authority to seize assets if there is a likelihood that the owner engaged in fraud or abuse of the Medicaid program, and that the seizure is necessary to protect HHSC's ability to recover any amount that was wrongfully obtained.

Medicaid Reform:

Senate Bill 10 (80R) by Nelson

Sponsor - Delisi

• The bill requires the Health and Human Services Commission (HHSC) to initiate a pilot program to encourage Medicaid recipients to engage in health-conscious behaviors, such as participating in weight-loss or anti-smoking programs, to help lower costs and reduce reliance on expensive emergency care.
• SB 10 also requires HHSC to study the feasibility of increasing the use of technology to detect and deter fraud in the Medicaid program, including using technology to verify a person's citizenship and eligibility. In fiscal year 2005 it recovered $441,551,341 as a result of fraud investigations.
• SB 10 directs HHSC to determine a standardized definition of "uncompensated care," and to establish a methodology for calculating the cost of the uncompensated care. HHSC estimated that hospitals over-reported uncompensated care in Texas in 2005. While $9.2 billion was reported, HHSC calculated that actual uncompensated costs were between $443 million and $2.3
  billion.

Investigating Medicaid Fraud:

Senate Bill 1694 (80R) by Nelson

Sponsor - Jackson, J.

• The bill facilitates better communication between agencies during the investigation of Medicaid fraud, and allows the Attorney General to more effectively prosecute those who defraud the Texas Medicaid program.
• In fiscal year 2005, the Inspector General at HHSC successfully recovered more than $800 million as a result of investigations into Medicaid fraud. This money was diverted back into the program, which ensures that the program can continue to provide assistance to those who need it.

Reforming Governments' Role in Health Care

Regulation by the Texas State Board of Medical Examiners:

Senate Bill 104 (78R) by Nelson et al.

Sponsor - Allen | Capelo | Pitts | Lewis | Nixon

• Senate Bill 104 is intended to help reduce medical errors and ensuring that patients are guaranteed an acceptable level of care.
• The bill provided for more strict penalties for renewal of expired licenses and devoted a portion of a new registration surcharge to be used to strengthen the Board's ability to enforce licensing rules.
• The bill required the Board to place priority on complaints of sexual misconduct, quality of care, or impaired physicians.
• The bill established guidelines for the investigation of complaints, and the suspension or revocation of a license. Specifically, the bill required the Board to immediately investigate a license holder that violates a disciplinary order or has additional complaints filed while under disciplinary order.

Federally Qualified Health Centers

Senate Bill 610 (78R) by Nelson

Sponsors - Capelo | Truitt | Naishtat | Zedler | Coleman

• Senate Bill 610 permitted the Texas Department of Health (TDH) to issue grants to establish federally qualified health centers. [Federally qualified health centers (FQHCs) are non-profit corporations that operate in a consumer-directed manner and provide high-quality, low-cost health care to underserved populations and the uninsured.]
• The grants made available through this Senate Bill 610 allowed for the accelerated development of FQHCs in an effort to provide care to the areas of Texas that need it most. Federally qualified
  health centers are an important way to alleviate the stress that is already placed on the current system.

Disease Management in State-Funded Managed Care Programs:

House Bill 1735 (78R) by Delisi | Capelo et al.

Sponsor - Janek

• The bill required the managed care plans that are offered by the Health and Human Services Commission, the Teacher Retirement System, the Employee Retirement System, the University of Texas and Texas A&M Systems, and the Correctional Managed Health Committee to provide disease management services or coverage.

Increasing the Number of Registered Nurses:

House Bill 3126 (78R) by Truitt | Capelo | Zedler | Christian et al.

Sponsor - Janek

• House Bill 3126 required that all money appropriated by the Legislature specifically to fund enrollment growth in a professional nursing program is expended for that purpose to help abate the state's shortage of qualified nurses.

The Texas Health Insurance Risk Pool:

Senate Bill 809 (79R) by Averitt

Sponsor - Taylor

• Senate Bill 809 made several structural and operational changes to the Health Insurance Risk Pool to help ensure its long-term sustainability and improve its delivery of health care coverage.
• The Texas Health Insurance Risk Pool exists to provide health care coverage to certain residents of the state who cannot obtain health care coverage in the private market, usually as a result of a pre-existing medical condition. The Risk Pool includes provisions that can extend coverage to individuals who lose coverage under an employer, group, or church-based insurance plan.
• Senate Bill 809 improved the financial operation of the Risk Pool by requiring the implementation of cost-containment measures including individual case management and disease management. The bill also defined the subrogation rights of the Risk Pool, determining when the Pool is required to be reimbursed and the type of benefits payable. These reforms helped ensure the long-term sustainability of the Risk Pool and laid the foundation for subsequent reforms initiated through House Bill 1977 in the 80^th Legislature.

The Texas Health Insurance Risk Pool:

House Bill 1977 (80R) by Taylor

Sponsor - Averitt

• House Bill 1977 reforms the funding mechanism of the Texas Health Insurance Risk Pool to ensure equitable treatment for all health benefit plan issuers.
• The reforms enacted by HB 1977 address Risk Pool funding inequities by allowing certain health benefit plan issuers' contributions to be based on their gross premiums received rather than total lives covered. This will help guarantee the continued fiscal solvency of the Risk Pool while ensuring that health benefit plan issuers that offer low-premium, high-deductible policies are not penalized by the Pool's funding mechanism, which has grown to an annual tax of $95.1 million.

Wholesale Drug Distributor Licensing:

SB 943 (80R) by Janek

Sponsor - Truitt

• The bill reduces unnecessary regulations by exempting from licensing any wholesale drug distributor who is engaged in the distribution of drugs or devices that have been approved by the FDA.
• The bill also exempts third-party distributors from the licensing and pedigree requirements and provides that retail pharmacies or chain pharmacy warehouses are only required to comply with pedigree requirements if they are engaged in the wholesale distribution of prescription drugs.
• SB 943 tightens several of the licensing and pedigree requirements so that the Department of State Health Services may only issue a wholesale distributor license if it has completed a physical inspection of the proposed place of business.

Improving Health Care by utilizing Technology

Health Care Technology Advisory Committee:

Senate Bill 45 (79R) by Nelson

Sponsor - Delisi

• The Health Care Technology Advisory Committee established by Senate Bill 45 issued recommendations in September 2006, many of which were realized through bills filed during the 80^th Legislature. Most notably, the Committee's primary recommendation was that a statewide coordinating body be established to oversee the adoption of electronic health care records "across Texas that meet patients' expectations for privacy and control of access to their records."
• The THSA is expected to improve the delivery of health care services by significantly improving Texas' health care infrastructure and allowing medical information to be shared effectively and accurately, which will result in a reduction in medical and clerical errors. Senate Bill 45 in the 79^th Legislature was the first step in this process.

Health Care Technology:

House Bill 1066 (80R) by Delisi

Sponsor - Nelson

• HB 1066 establishes the Texas Health Service Authority to facilitate the voluntary and secure electronic exchange of health information which will improve the delivery of health care services by cutting down on errors while protecting patient privacy.
• Electronic storage and sharing of health information, particularly medical records, is an important reform that will improve the delivery of health care services to all Texans. According to the Institute of Medicine, "preventable medical errors [such as] unplanned drug interactions, kill between 44,000 and 98,000 people each year in America alone."

Health Plan Identification Cards:

House Bill 522 (80R) by Woolley

Sponsor - Duncan

The bill requires that health plans operating within the pilot areas issue enrollees a health care information card which contains:

• the name of the issuer of the health benefit plan;
• the name of the administrator of the health benefit plan;
• the name of the policyholder or group contract holder;
• the number of the policy, contract, or evidence of insurance;
• a telephone number or electronic address for authorizations; and,
• the name of the payer under the health benefit plan.





• The card is also required to hold "accurate and current information" regarding the holder's health benefit plan, such as relevant deductibles and the availability of physicians operating within the provider's network.
• One of the most important aspects of the bill is that it requires the Texas Department of Insurance (TDI) to establish the technological requirements of the health plan identification card. The standardized approach required by HB 522 will ensure that all health plan identification cards use the same technology and thus maximize the effectiveness of the health benefit plan identification card program.
• Using technology to store information on health plan identification cards is an important reform
  because it will reduce errors and improve communication between the different health care providers, plan issuers, and consumers.