Earlier this month, the Texas Legislature gaveled in its 88th session, and what’s going on at our state Capitol will occupy a great deal of hospitals’ attention for the next four-plus months. If you’re a conscientious health care provider who wants the best possible care environment for your facility, city and state, I’m sure you’ll be following along, too.
But also this month, in Washington, D.C., a new U.S. Congress began its work as well. And while the Texas Hospital Association will be closely watching developments in Austin and working with lawmakers there, acts of Congress also make an outsized impact on all facets of how health care operates back here in the Texas.
That’s why THA is pursuing an ambitious list of federal policy priorities and working with Texas’ congressional delegation to help us realize those needs – including help for rural hospitals at risk of closure, Medicare Advantage reform and protecting and improving access to care for vulnerable populations.
It’s worth noting that many of these same congressional lawmakers recently demonstrated a commitment to hospital health. At the end of 2022, Congress earned high marks from THA and others in the hospital sphere, passing a $1.7 trillion omnibus package to fund the government through this September (the end of fiscal year 2023). The omnibus bill contained several critical provisions that benefit health care and hospitals. Among them: Delaying the 4% Medicare PAYGO funding cut that would have slashed Medicare provider payments by $38 billion; extending two important rural hospital funding programs that were set to expire; and extending for two years COVID-19-era telehealth flexibilities that would have otherwise gone away with the eventual end of the COVID-19 public health emergency.
These and other pieces of the federal package made for great news for a new year. But there’s so much more that Texas hospitals still need from Congress.
At the federal (as well as the state) level, insurer-generated administrative barriers to patient care are a needed point of emphasis. Congress should continue scrutinizing health plans and care-impeding practices, such as prior authorization requirements that require hospitals and providers to spend staff time and money proving the necessity of their planned care. We support federal efforts to ensure simplified, streamlined commercial health plan practices, as well as congressional scrutiny of insurer delays and denials of coverage. The ultimate victims of the notorious trifecta – “slow payment, low payment, no payment” – are patients. They deserve better.
Medicare Advantage (MA) plans – which are Medicare plans administered by commercial insurers – generate some of the most persistent difficulties in that regard. Their benefits and cost-sharing arrangements divert from traditional Medicare. They reimburse hospitals at slower paces and lower rates, and audits show they use prior authorization and unjustly deny care more often. MA plans put rural hospitals – particularly critical access hospitals – at a disadvantage. Congress must act to align MA plan policies with those of traditional Medicare. That will reduce both financial instability and administrative burdens on our hospitals, and help patients access the care they need.
As we represent hospitals in the state with the highest uninsured population in the country, THA will continue working alongside Congress, the state and the Centers for Medicare & Medicaid Services to ensure the state’s Medicaid 1115 Transformation Waiver (which runs through 2030) provides stability for our state’s health care safety net. The waiver helps fund uncompensated care and also allows for the implementation of directed payment programs that help our hospitals treat Medicaid patients. THA has been unwavering in its support of expanding affordable and adequate insurance coverage for the uninsured. Regardless of whether that’s achieved, the waiver will always play a critical role in care delivery across the state. We will continue our efforts with our state’s congressional delegation to guarantee all patients in Texas have access to the care they need.
Originally published by the Houston Medical Journal.
Jan. 24, 2023