The COVID-19 pandemic strained an already overburdened primary health care system in Texas, making it vital that state lawmakers back measures that encourage patients to see a physician and catch up on delayed care before it gets even worse, Tyler pediatrician Valerie Smith, MD, told the Texas House of Representatives Select Committee on Health Care Reform.
For instance, the mental health of many children was damaged by the interruption of medical care, drastic changes in daily routines, social isolation, and stress of living through a pandemic.
“I cannot remember a day in clinic over the past summer when we did not identify at least one child who was struggling with depression and anxiety during a well-child visit,” Dr. Smith testified on behalf of the Texas Medical Association, Texas Pediatric Society (TPS), and several other physician organizations.
The 11-member committee met to address an interim charge to study the impact of delayed care on the state’s health care delivery system, health care costs, and patient outcomes. In this second round of hearings, the committee examined best practices for getting patients who’ve ignored or delayed health care back to the health care system. It also studied ways to improve outreach to families with children who are eligible for, but not enrolled in, Medicaid or the Children’s Health Insurance Program. This includes children in rural areas.
The Texas Public Health Coalition and Texas Women’s Healthcare Coalition, both of which TMA is a member, also testified in support of boosting funding for and eliminating barriers to care for Medicaid and maternal health programs, among other changes.
Dr. Smith added that behavioral health care remains a major concern, which is why the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children’s Hospital Association declared a national emergency in child and adolescent mental health in 2021. But the pandemic interrupted all types of preventive care, especially in the early months of 2020.
“While rates of preventive care rebounded in 2021, well visits – including well-child exams, immunizations, and screenings – have not fully recovered to prepandemic levels,” Dr. Smith emphasized.
These same disruptions have led to increases in factors that cause obesity for many age groups – more sedentary time, decreased physical activity, changes in diet due to food insecurity, and changes in routine.
“Primary care physicians have the training and tools to diagnose and treat these risk factors, which are often key components of well-child visits – if we can get patients back in the door,” she said.
Texas and the U.S. already had low rates for access to preventive health care services before 2020, the physician organizations highlighted in their testimony. Only 79.4% of children between 3 and 6 years old and 66.7% of adolescents had at least one well-care visit with a primary care physician in 2018, according to Medicaid data reported to the Centers for Medicare & Medicaid Services.
Given that, the committee should look beyond the barriers to health care created by the pandemic and seek solutions that address long-standing problems, such as the Texas Legislature’s investment the Child Psychiatry Access Network. TMA, TPS, and the other medical groups also urged Texas lawmakers to mitigate or reverse the impact of delayed care by:
- Directing the Department of State Health Services to implement a public health campaign to encourage Texans to get back in to see their doctor;
- Eliminating copays, which are shown to discourage patients from seeking care, for primary care in the Employees Retirement System of Texas and the Teacher Retirement System of Texas;
- Holding Medicaid managed care organizations accountable for getting families in to seek preventive care;
- Increasing the number of Texas residency positions by improving funding for the state’s graduate medical education expansion grant program and other primary care medical education pipeline programs through the Texas Higher Education Coordinating Board; and
- Adequately compensating physicians to keep primary care practices viable in all areas of the state and to ensure families can access care in a timely manner.
That last point includes boosting Medicaid physician payment rates, which lag at about half of what Medicare pays, which amounts to only about half of commercial insurance rates, Dr. Smith emphasized. Improved payment also can come in different forms, for instance by creating payment parity for telehealth and in-office visits, which also would boost access to care.
Medicaid patients – those most in need – often cannot find physicians who accept their insurance plan because physicians cannot afford to take them as patients, she said.
“We must as a state address low Medicaid rates to ensure network adequacy in Medicaid.”