2010 was a big year in the realm of health care. The federal government passed the Patient Protection and Affordable Care Act (PPACA) and the President signed the bill on March 30, 2010 .The law includes, among other items, a large number of health care provisions to take effect over the next four years. Such provisions include: expanding Medicaid eligibility, mandating medical loss ratios (MLRs) for carriers, prohibiting denial of coverage based on pre-existing conditions, and establishing health insurance exchanges.
The quality, cost and accessibility of health care services provided to Texans continues to be one of the most important public policy issues for the Texas Association of Business.While federal reform will change many dynamics of health care, currently most Texans under the age of 65 obtain health care services through employer-sponsored health insurance plans. Also, businesses pay 62 percent of the combined state and local taxes. Thus, employers have a major stake in how efficiently and effectively the coordination, management and supply of health care services is being rendered in Texas , and how the demand for these services is being met.
TAB’s health care priorities cover a wide-range of public policies that seek to enhance the quality, lower the costs and increase the accessibility of health care services in our State.In considering health care legislation, TAB looks to answer the question as to how the laws would benefit or harm the consumer of health services and what effect changes in the law would have on health care consumers.
To ensure that Texans and their families have access to quality and affordable health care services, TAB recommends the following legislative priorities:
Access. Increase access and choice 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, 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
Advanced nurse practitioners and physicians assistants. Support legislation that would expand the ability of advanced nurse practitioners and physicians 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 physicians assistants by expanding educational opportunities and by improving the practice environment.
Affordability. Oppose any measure that increases 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 legislation requiring physicians and providers (hospitals, ambulatory surgical centers and other facilities) to provide the state with data regarding the price of services and medical outcomes. 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 legislation to completely eliminate state prohibitions on the direct employment of physicians by hospitals and other providers of health care services.
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.
Free Standing Emergency Rooms. Support legislation that would prohibit a free standing emergency room or hospital outpatient department from charging a facility fee unless it can show that the treatment rendered was beyond a doctor
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 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 on-going basis. Support the development of a
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.
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.
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 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.
Prompt pay. Support legislation requiring that notification of any late, inaccurate or non-payment of a health claim by a healthcare 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.
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.
Telemedicine. Support the expansion of telemedicine and oppose any increased restrictions on current, telemedicine laws. Support legislation that allows the commercial market the same, or greater, freedoms in this area that are found in the Medicaid program. Support the Federation of State Medical Board
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.
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.