The Texas Medical Association appealed to the Texas Legislature last week to guard patients from inadequate health insurance coverage and physicians from unfair ranking and tiering practices, while supporting increased oversight and streamlining of certain health plan processes.
In the House Committee on Insurance, TMA Council on Legislation Chair Zeke Silva, MD, spoke against House Bill 139, which would compromise health plan benefits and consumer protections for the sake of lower premiums.
“We believe this legislation will take Texas in the wrong direction by undermining long-standing patient and provider protections, removing oversight and accountability from the health insurance market, and exposing working Texans to hidden costs and harmful coverage gaps,” Dr. Silva said in written testimony.
The so-called “employer choice plan” created by HB 139 would be exempt from some key provisions of Texas insurance law, including:
- Surprise billing protections;
- Network adequacy standards;
- Utilization review timelines and appeals processes;
- Continuity of care provisions; and
- Prior authorization guardrails.
Dr. Silva also raised concerns about House Bill 1959, which TMA argues would undo physician protections the association helped secure in 2009 against health plan ranking and tiering practices.
Dr. Silva welcomed the goal of modernizing ranking processes but raised the specter of the potential for insurers “to steer patients and steer services to facilities in which [insurers] have an ownership or financial interest.”
“If there are going to be criteria applied to the ranking and tiering of physicians, we'd like to know what those criteria are beforehand,” he told the committee. Physicians “would appreciate a due process to be able to comment, oppose potentially, or at least inform those types of determinations.”
On the other hand, TMA voiced support for House Bill 1818, which would give the Texas Department of Insurance more oversight of health plans’ compliance with utilization review and preauthorization processes.
“We know that the reviews are revealing more potential shortcomings, and those numbers suggest a more frequent review would be appropriate,” Dr. Silva told committee members. “Therefore, we support an annual review of the quality of care of the important protections which are described.”
Within Medicaid and the Children’s Health Insurance Program (CHIP), TMA encouraged legislators to pass House Bill 321, which would implement an express lane option to speed up enrollment in the two programs by allowing the Health and Human Services Commission to use existing eligibility data from other federal programs.
Other Medicaid bills TMA supports include:
- House Bill 1782, which would enhance Medicaid eligibility for breast and cervical cancer, providing assistance for those at or below 250 percent of the federal poverty level; and
- House Bill 136, which would enact Medicaid coverage and reimbursement for lactation consultation.
Budget update
With the Senate budget bill headed to the house, TMA is closely watching and working to preserve a $15 million allocation for a 5% Medicaid payment rate increase for physicians in health professional shortage areas (similar to Medicare), so physicians caring for the complex needs of a diverse Medicaid population in rural and underserved areas can stay viable.
On the education front, TMA is supporting:
- A budget rider by Rep. Suleman Lalani, MD, that funds primary care physician preceptors who dedicate their time to mentor and train the medical students who will become Texas’ future physician workforce.
- The creation of a pathway for a residency program to help Texas keep unmatched medical school graduates in-state to train and care for Texas patients.
Debuting bills
Among other quickly moving bills, TMA is monitoring recently introduced scope-of-practice and workforce-related legislation including:
- House Bill 1503, which as written would allow physicians and nonphysician practitioners to refer patients to licensed genetic counselors;
- House Bill 1731, which would enact a physician assistant licensure compact that, as of this writing, is substantially different from the physician licensure compact Texas participates in;
- Senate Bill 397, which relates to rules regarding the provision of telemedicine among other telehealth services; and
- House Bill 18, which would create a new State Office of Rural Hospital Finance to support hospitals serving rural communities, including telehealth programs providing pediatric mental health care at rural hospitals.
Among a variety of public health bills that also went before house and senate committees, TMA showed support for:
- House Bill 2735, which calls for a prohibition on e-cigarette advertising within 1,000 feet of a church or school.
- Senate Bill 2024, which would place restrictions on certain e-cigarette advertising.
- House Bill 1816, which would prohibit the operation of e-cigarette retailers near public primary or secondary schools.
- House Bill 1644, which would decriminalize the production or use, fentanyl testing strips.
Keep up with all TMA testimony delivered on behalf of medicine this session, and register for the last remaining First Tuesdays at the Capitol event in 2025.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.