With the new year comes new opportunities and a renewed focus on our goals for the future. COVID-19 vaccination is underway, and Texas hospitals hope for a healthy future. But herd immunity is just one part of ensuring a healthy future for Texas residents. Texas hospitals have several public policy priorities for the 87th Texas Legislature, which recently convened in Austin for its 140-day legislative session.
Reducing the number of uninsured Texans is a top priority for Texas hospitals and it is critical for a healthy, strong population. Before the pandemic, Texas had the largest population (5 million) and the highest rate (18%) of uninsured residents in the county. Pandemic-induced job loss has only exacerbated the problem. In addition to the health and wellness benefits that health insurance brings, increasing health care coverage also is a wise financial choice. The legislature could save billions for the state by expanding coverage for the working poor.
A recent study by Texas A&M University and the Episcopal Health Foundation estimated that roughly 1.2 million Texans would qualify if the Texas Legislature widened Medicaid eligibility to include low-income individuals who make 138% or less of the federal poverty level. What’s more, expanding Medicaid under the Affordable Care Act could bring $5.4 billion in federal funds to the state. With the 90-10 federal-state match rate provided under ACA expansion, the study estimates the total cost to the state to be at least $540 million. An amount that the state could cover with existing general revenue or an alternate approach. In either case, it would yield a positive impact to the state budget and achieve a coverage solution for many Texans in need. But expansion under the ACA is not the only path to achieve a coverage solution or to ensure access to care.
Ensuring adequate Medicaid reimbursement for hospitals, increasing availability of emergency inpatient and community-based outpatient behavioral health care and continuing telehealth and telemedicine flexibilities all will improve access to care for Texans.
Hospital Medicaid reimbursement rates continue to fall below the actual cost of providing care. At the same time, the state is facing the most significant budget deficit in its history. Lawmakers will have $4.58 billion less to spend for 2021-2022 than originally anticipated. The biennial budget is the one bill lawmakers must pass each session. Crafting that bill will be more challenging than ever, and budget cuts likely are imminent. Protecting hospitals’ payment rates and hospitals’ ability to finance the non-federal share of Medicaid supplemental payments is essential to keep their doors open to care for Texans in need.
In addition, Texas hospitals will advocate for funding to support a strong behavioral health system. Before the pandemic, one in five Texans experienced a mental health condition each year, and more than two-thirds of those with a behavioral health condition did not seek treatment for their condition. Workforce shortages, underfunding and treatment barriers create obstacles to access appropriate behavioral health care. The result is that adults and children with behavioral health needs increasingly rely on clinically inappropriate settings, such as hospital emergency departments, to get the behavioral health treatment they need.
With the increased need to stay home, telemedicine visits have exploded during the pandemic. Texans who would otherwise struggle to find transportation or childcare for a doctor’s visit can easily speak with a health care professional from virtually anywhere. Telemedicine payment parity for in-person visits for commercial payors and the ability to establish a physician-patient relationship by phone only are flexibilities from the pandemic that Texas hospitals want to make permanent.
2021 is sure to be a pivotal year for Texas hospitals. Hospitals statewide will continue treating COVID-19 patients and embark upon a coordinated vaccination effort of epic proportions. And they remain ever committed to educating lawmakers about the policy and funding items that are needed for a healthier, stronger Texas.