Hospitals Survived a Siege This Session, and Look Now to Prevent Another One

Defense wins championships, the age-old expression goes in sports. Politics is sport in and of itself, and THA had to play some serious defense during the just-concluded session of the Texas Legislature.

John Hawkins, President/CEO, Texas Hospital Association

The “championship” we won – if you want to call it that – was vital and hard-earned: a crisis was averted. Many hospitals and clinics that would’ve faced a new threat of hardship, reduced access for patients and even closure don’t face that enhanced threat – for the time being. Now, the work begins to ensure that it doesn’t happen again.

Legislation that would be detrimental to hospitals and their patients is nothing new; we identify it and work overtime to stop extremely bad bills every session. But the degree to which hospitals came under siege this winter and spring – with bills threatening to gut hospital reimbursements, and hamper or destroy access to care in many areas across Texas – was unlike anything seen in recent memory. And I’ve been doing this a long time.

A few lawmakers led the charge, the health insurance lobby provided the wind beneath their wings, and their efforts gained troubling momentum across both the House and Senate. But THA and its members engaged at every turn. Our advocacy – through boots-on-the-ground work at the Capitol, Advocacy Alerts and thousands of member letters to lawmakers illustrating the gravity of what these bills would do – was nonstop. And it resulted in already-struggling hospitals ending the siege with no major new wounds.

I’d like to not have to think about the worst of these measures again for quite some time, as I’m sure you understand – they’ve consumed our advocacy work here at THA for months. But we all need to remain aware of these bills, as their central aims may be the basis for rhetoric during the upcoming legislative interim, and for renewed attacks on hospitals during the 2025 session. So, here are the big three initiatives that we at THA mobilized to successfully defeat in this session:

Banning hospital outpatient payments – Companion bills House Bill 1692 and Senate Bill 1275, as filed, attempted to ban all hospital outpatient payments under the guise of prohibiting “facility fees.” THA research showed that move would have been catastrophic – nearly 70% of Texas hospitals would have had to close outpatient clinics, 85% would have reduced staff and 80% would have reduced services. These bills took on other iterations as they made their way through the legislative process – none of which were remotely acceptable.
Rate-setting for care outside insurance – Government rate-setting is always a nonstarter for THA, but House Bill 633 was just one dangerous attempt to institute it. It would have capped payment for services provided outside of insurance at lowest contracted commercial rate a hospital had with any health plan. That would have incentivized patients to be uninsured and involved the government picking winners and losers in the health care system – with hospitals singled out as a loser.
Rate-setting on state employee health plans – House Bill 5186 would have turned over decision-making on payment rates for four state health plan systems to a committee of 10 legislators. Running counter to Texas’ usual commitment to letting market forces dictate payments, that committee would have unilaterally decided the rates for the Employees Retirement System and Teacher Retirement System of Texas, the University of Texas System and the Texas A&M University System.

Heading into the session – and during it – THA undertook extensive efforts to educate lawmakers about the struggles hospitals were facing coming out of the COVID-19 pandemic, and to dispel the curious myth that hospitals had experienced financial windfalls in the pandemic era. So for us, defeating these bills was gratifying, but their very appearance – and palatability to enough lawmakers to become a real threat – was discouraging.

THA accomplished a great deal in this session, much of it going well beyond merely stopping bad legislation. And we’re celebrating those wins in the areas of workforce, behavioral health and more. But what this temporarily arrested rush of anti-hospital sentiment tells us is that there’s still work to do. We need to keep telling our story to avoid having to expend our legislative capital (no pun intended) on defeating initiatives that will cause hospital closures and negatively impact patients’ access to care.

These particular fights aren’t the ones we should be undertaking every two years. Hospitals still need help, not targeting. This is a triumphant time for THA, but it’s also the time to keep spreading that message.

Originally published by the Houston Medical Journal.
June 23, 2023