This column was originally published in the Houston Medical Journal on April 20, 2021.
For the first time in years, Republican and Democratic state lawmakers are united in supporting legislation to expand health care coverage in Texas. Senate Bill 117/House Bill 3871, known as the Live Well Texas Plan, is the first promising package to expand health care coverage in Texas that the legislature has seen in nearly a decade.
The plan boasts strong bipartisan support and provides a path to coverage that is straightforward and fiscally responsible. Importantly, the Live Well Texas Plan would bring billions of our federal tax dollars back to Texas. Specifically, the plan would trigger a federal offer to pay the lion’s share of the cost to provide health insurance for about 1.5 million low-income adults in Texas. With a 90-10 federal-state match rate, the state only would need to invest $10 for every $90 that the federal government invests in the program. This is an incredible deal that about 38 other states have already taken.
While support for the Live Well Texas Plan gained momentum, House lawmakers unveiled their own plan to address health care issues in Texas. At a press conference earlier this month, a group of bipartisan House lawmakers joined House Speaker Dade Phelan (R-Beaumont) in announcing the House Health Care Plan. The plan includes a number of policy priorities that hospitals have advocated for and supported over the past several years. The plan would provide 12 months continuous Medicaid coverage for children, up from six months, and would extend health care coverage for postpartum moms from 60 days to 12 months after delivery. It would also provide prescription drug coverage for about 3 million uninsured Texans, expand telehealth and broadband services across the state, invest in brain health, and increase health equity.
These policies would increase access to care, make health care services more affordable and improve health outcomes. Clearly, the House Health Care Plan makes major strides to increase access to and affordability of health care services. But it does not address the elephant in the room—comprehensive health care coverage for low-wage working Texans.
While the proposal is missing this key element, Texas hospitals still view it as a win.
Lawmakers have heard our asks to prioritize health care issues and responded with a plan that addresses many of them. Further, they held a press conference to shine a spotlight on them. Press conferences on bipartisan initiatives to address health care are not commonplace at the Texas Capitol, and this movement is a signal that our advocacy work is effective. The announcement of the House plan creates an important opening to discuss what is missing—comprehensive coverage expansion.
Since the House plan was announced, Texas hospitals expanded an outreach campaign to encourage the legislature to support a number of priorities in the House Health Care Plan and double down on the importance of comprehensive health care coverage for the uninsured.
In addition to the federal financial incentives to expand health care coverage, Texas hospitals are promoting some key provisions in the Live Well Texas Plan. One is that beneficiaries would have some skin in the game too. Adults who make more than 138% of the federal poverty level (more than about $26,500 a year for a family of four) would be required to invest some of their income into health savings account to help pay for certain medical expenses. Individuals below the poverty line would be responsible for small copays.
Coverage expansion under the Live Well Texas Plan also would work to bolster the state’s health care system. It would increase physician reimbursement rates, with the goal of incentivizing more doctors to join the program and give more Texans access to care in their communities. Lastly, another popular provision is the escape hatch, which would end the coverage program if the program cost exceeded the benefits or if the federal government stops paying for the majority of it.
There are many good reasons for lawmakers to support expanding health care coverage for the uninsured. And the announcement of the House Health Care Plan is a clear indication that state lawmakers are listening. With the COVID-19 pandemic and recent winter storm, Texas needs comprehensive health care coverage now more than ever. Health care providers, advocates and patients alike are encouraged to join Texas hospitals in advocating for health care coverage expansion. There is still time to educate and move our state lawmakers on this important issue.