When the election ends, hospitals are ready

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By John Hawkins, president/CEO, Texas Hospital Association
Originally published by the Houston Medical Journal
Oct.18, 2022

Chances are when you’re reading this, the 2022 election will be in its final stretch. Maybe that’s good news for you, particularly if you’re tired of the round-the-clock TV ad saturation and political posturing that always marks an election year.

But for hospitals and the Texas Hospital Association, once Nov. 8 comes and goes, and the winners of state elections have been declared – including for all 181 seats in the Texas Legislature, as well as for governor and lieutenant governor – an important new phase in determining the future of Texas health care begins.

Following the election, THA will assess the makeup and landscape of the Legislature in the runup to its 88th session and will accelerate efforts to impress upon both new and returning faces in Austin what the health care system needs out of the 2023 session in order to thrive. And health care and hospitals need a lot of attention – particularly following the worst of the COVID-19 pandemic and its devastating impact on multiple fronts.

THA’s state policy priorities for 2023 are wide-ranging because the challenges facing hospitals are wide-ranging. You’ve seen me touch on several of those challenges in this space in recent months, such as behavioral health access and the delays and impediments that insurers routinely implement that disrupt provider payments and care delivery. Those concerns drive some of THA’s policy plans and ask for 2023, and other issues also occupy elevated spots on our priority list.

Every THA member hospital we’ve been in touch with has stressed the importance of addressing a depleted workforce. The COVID-19 pandemic has caused attrition in nursing, and other health professional sectors and those shortages have put hospitals on their heels. But there’s a lot we can do with lawmakers’ help. THA is stressing the importance of funding increases for the physician, nurse, behavioral health, and allied health professional training, retention, and loan repayment programs.

In 2021, for example, Texas nursing schools turned away more than 15,700 qualified applicants because of limited clinical education capacity and a shortage of nursing faculty. Additional state support for the Nursing Faculty Loan Repayment Assistance Program – funded at about $3 million in 2021 – could go a long way toward unlocking that new army of nurses – an army Texas desperately needs to put on the healthcare battlefield.

Workforce shortages – which force hospitals to compete for contract employment, driving up their labor costs – also contribute to facilities’ problems staying financially stable. Right now, that’s a problem across the country. A September report by Kaufman Hall and the American Hospital Association found that even under optimistic 2022 projections, margins will be down 37% from pre-pandemic levels. More than half of our nation’s hospitals are projected to have negative margins for the year.

In the wake of that troubling analysis, THA will urge lawmakers to take steps to help Texas hospitals operate in the black. Among other steps, that means hospital payments that come closer to the actual cost of services, maintaining supplemental Medicaid payments to cover unreimbursed costs; and opposing all decreases in hospital reimbursements.

Coming out of the pandemic – which has tested everyone’s emotional resilience in one way or another – behavioral health will take on even greater significance. Most adult inpatient care in Medicaid can’t be covered for more than 15 days because of a federal prohibition on payments to “institutions for mental disease” beyond that time frame. But the state can pursue a waiver for exclusion from that rule. THA will support the pursuit of such a waiver as a key piece of helping Texas expand health care coverage to improve its mental health response.

And as always, the state with the nation’s highest uninsured rate needs more people with comprehensive health coverage. Hospitals will again back efforts to increase the number of Texans with coverage, as well as extend postpartum Medicaid coverage for new moms to 12 months. We’ll also have health equity and access to care in our sights, including the continued push to address health disparities in morbidity and mortality – especially those disparities that disproportionately affect racial and ethnic minorities and Texans of lower socioeconomic status. Those nonmedical health factors were already an evolving area of study before the pandemic, which put a spotlight on the extent of their impact.

Rarely are policy solutions for a healthier Texas realized with ease. Competing priorities come into play, and certain groups without the best interests of health care in mind will be obstacles as well. But as you wait for another election to end and for those tiresome ads to leave your TV screen, know that Texas hospitals will be there after the dust settles, gearing up to strengthen the health of your state.