Originally published in The Texas Tribune
(4/28/23)
Hospitals agree: The cost of health care is too high for patients. Texas hospitals are striving to help the Texas Legislature find solutions.
The same, however, can’t be said for the health insurance industry, which is riding a pandemic-era windfall and just wants the wind to keep blowing – even if those gusts damage access to care across Texas.
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For years, Texas hospitals have worked to provide lower-cost access points for health care, and are working to make sure prices are clear. But hospitals are in a challenging place coming out of the pandemic. Half of the state’s hospitals finished 2022 in the red, driven by record-level staffing costs. Right now, Texas lawmakers have an opportunity to help with the No. 1 driver of high health care costs, labor.
Unfortunately this legislative session, an effort involving legislation that chips away at hospital access and creates more barriers to boost health insurance company profits is moving speedily through the Legislature. This unfortunate movement could dismantle the state’s hospital infrastructure, drive up costs and reduce patient access to convenient, low-cost care.
Solution No. 1: Texas needs more nurses
Health care workers are linchpins of the state’s overall health, but Texas doesn’t have enough of them. Hospitals are scrambling to recruit and pay for thousands of nurses with premium price tags. Coming out of the pandemic, Texas hospitals have 20% nurse vacancy rates and record-setting labor expenses – billions of dollars more than in 2019.
This legislative session, it’s a top priority for Texas hospitals to substantially increase the health care workforce and fill available jobs. Through nursing school pipeline expansion, loan repayment programs, scholarships, worker protections and other efforts, Texas can address the No. 1 cost driver in health care today. Fixing the state’s workforce shortage will have the single biggest impact on costs.
Solution No. 2: Moms need access to care
One in five Texans lacks insurance coverage. Addressing postpartum coverage for moms will ensure better outcomes and create healthier moms and babies. Medicaid provides pregnancy coverage for about half of the births in Texas, but moms in Medicaid lose this coverage shortly after giving birth – a time when maternal complications and deaths are at an elevated risk. And, Texas has one of the highest maternal mortality rates in the country.
Texas hospitals support increased coverage and are strong supporters of House Bill 12 that extends maternal Medicaid coverage from the current two months to 12 months postpartum. Lawmakers should support its passage.
Solution No. 3: Help people in crisis
The consequences of untreated mental health conditions are significant, ranging from drug overdoses, violence, lost jobs and poor physical health. Untreated behavioral health issues put pressure on the health care system by forcing patients to seek mental health care in emergency departments – driving up costs for everyone. That’s why Texas hospitals are pushing for additional beds across the mental health continuum, longer Medicaid coverage for adult inpatient behavioral health stays and coverage for intensive outpatient therapies – through House Bill 2337 and Senate Bill 905 – that will prevent hospitalizations.
Solution No. 4: Protect emergency room care
Emergency rooms are available to Texans around the clock and are often the only access point in times of crisis. However, despite clear state guidance, some health insurance companies are denying reimbursement for emergency room visits based on a final diagnosis, and not the patient’s presenting symptoms. A patient who believes they are having a heart attack can be denied coverage if it is determined to be a panic attack. House Bill 1236 and Senate Bill 1139 prevent such denials and help ensure a patient is covered for emergency care.
A web of bad bills, many backed by insurance companies
Across the spectrum of legislation filed this session, it’s clear the powerful insurance industry seeks to profit from – not protect – patients. Post-pandemic, health insurance company profits are setting records, and they want more. It behooves them to support adding red tape to delay or deny health care, strip away access, and keep more money in their pockets.
Texas hospitals have been urging lawmakers to pay close attention to bills that are detrimental to health care. House Bill 1692 and Senate Bill 1275, as filed, would prohibit hospitals from collecting payment for outpatient services, which would force those outpatient facilities to close. House Bill 633 would force hospitals to accept the lowest rates for services – rates set by the government. House Bill 5186 and Senate Bill 2502 would underfund and unravel the network of providers that care for state retirees and teachers, and allow government interference in private negotiations between hospitals and insurance companies.
Finally, House Bill 1973 would require hospitals to provide unrequested line-item statements with every single request for payment, causing confusion for insured patients, and leaving providers and patients to foot the bill for these costly and cumbersome documents.
Lifesaving infrastructure
For nearly three years, Texas hospitals provided care on the frontlines of a pandemic, while insurance companies collected record profits and concocted legislative roadmaps to forge a path for more money.
Hospitals are vital to the state’s economy, are the bedrock of their communities, and are critical infrastructure necessary to protect all Texans. This level of care and safety for a community is priceless – and should not be dismantled for profit at the expense of patients.