Improve Access to Care for Working Texans

Testimony Submitted on behalf of

Texas Medical Association
Texas Academy of Family Physicians
Texas Pediatric Society
American College of Obstetricians and Gynecologists – District XI (Texas)
Texas Association of Obstetricians and Gynecologists

Senate Finance Committee
Article II
Texas Health and Human Services Commission 

Feb. 6, 2019

On a variety of indicators, Texas is the envy of other states, including job creation, entrepreneurial zeal, and its bevy of world-renowned universities and medical centers. Yet while Texas undoubtedly excels in many sectors, on the issue of access to care for working Texans and their children, there is still much room for improvement.  

• Texas remains the uninsured capital of the nation. Despite a thriving economy, the number of Texans who lack coverage is increasing, up from 16 percent in 2016 to 19 percent today. Among children, one in five uninsured children in the country live in Texas, though most currently are eligible for children’s Medicaid or the Children’s Health Insurance Program (CHIP). As proud Texans, surely each of us can acknowledge just how alarming and unsettling these numbers are.    
• According to the state’s September 2018 report on maternal mortality and morbidity, women’s lack of access to regular preventive, primary, and specialty care before and after pregnancy contributes to Texas’ high rates of poor maternal health outcomes.  Further, the vast majority of pregnancy-related deaths occur 60 days or more postpartum, a time when many women lose their pregnancy-related Medicaid services. We thank Chair Nelson for her leadership in creating Texas’ current women’s health programs – Healthy Texas Women and the Family Planning Program – both of which provide essential preventive health and basic primary care services to low-income women. Nevertheless, Texas’ own data clearly show that the lack of health care coverage costs too many women their lives. 
• Finding physicians who will care for Medicaid patients is a daily struggle across the state, though far worse in underserved communities. The majority of Texas Medicaid physician fee-for-service payment rates – which are what most Medicaid managed care organizations pay physicians, too – have not received a meaningful, enduring increase in more than two decades. Physician payments are not indexed to inflation, meaning that each year Texas fails to increase payments, the farther Medicaid payments fall behind commercial payers and Medicare. 

Healthy Texans underpin Texas’ economic health. To ensure Texas can sustain its economic momentum over the long haul, it must invest in its greatest asset – its people. Our organizations call upon lawmakers to adopt a patient-centered legislative agenda to boldly address Texas’ access to health care challenges. Specifically, we ask you to support:

1. Revitalizing the Medicaid and CHIP physician networks to ensure low-income Texans’ timely access to health care services by increasing physician Medicaid payments to Medicare parity for all primary and specialty care physicians. As part of such a plan, we support efforts to expand the use of value-based payment initiatives to improve patient outcomes while constraining Medicaid cost growth. While we wholeheartedly support continued efforts to reduce Medicaid red tape and associated administrative costs to help retain participating Medicaid physicians, those efforts simply cannot make up for years of stagnant Medicaid payments. Data from TMA’s biannual survey show that increasing physician Medicaid payments is the number one way to attract more physicians to participate.
   
   While our organizations highly value Medicaid, a Medicaid card does not access make. Medicaid payments are the least competitive among all insurers, ranging from 48 to 87 percent of Medicare and 41 to 73 percent of commercial insurance payments. These rates are hardly enticing, particularly when many practices can barely keep up with demand for their services from better-paying, privately insured patients.
   
   As roads and bridges are fundamental to our transportation system, physicians are integral to Medicaid’s infrastructure. Without them, efforts to reduce costs by improving preventive care, improving management of chronic diseases, or reducing unnecessary emergency department care will fall short. Attracting more physicians to Medicaid will require Texas paying competitive Medicaid and CHIP rates.
2. Improving child health and well-being by establishing 12 months’ continuous coverage for children on Medicaid. Texas already provides such continuous coverage to children enrolled in CHIP. By providing 12 months’ coverage to children on Medicaid, the state would enact the single most important step it can to increase health insurance coverage among children.
3. Promoting better birth outcomes by providing women of reproductive age 12 months’ comprehensive coverage before and after pregnancy to promote healthier mothers and babies. We respectfully direct you to testimony the testimony of Emily Briggs, MD, for details on this funding request. 

Thank you for the opportunity to submit these comments. 

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