The Weekly Insight – June 13

13th Jun 2017

This Week in Review

Last Week from Texas Insight

  • Private Insurance in Texas: This posting provides an overview of the private insurance landscape in Texas with some national context provided as well. The private insurance industry is a critical piece of the American health care system and at least from this writer’s perspective, less transparent than other key players in the system, with the exception of entities in the system that set health care prices.
  • Texas’ Overhaul of Child Welfare: Part II – House Bill 5: This article is the second in a series discussing the four major child welfare bills signed by Governor Abbott. This piece provides a summary of the contents of House Bill 5, relating to the powers and duties of the Department of Family and Protective Services and the transfer of certain powers and duties from the Health and Human Services Commission.

  • Public Hearing on Rates for HCS and other Waiver Programs: Hearing. The Health and Human Services Commission (HHSC) conducted a public hearing to receive comment on proposed Medicaid reimbursement rates for Supported Home Living (SHL), SHL Consumer Directed Services, and SHL Community First Choice in the Home and Community-Based Services (HCS) Waiver Program, and Community Support Services (CSS), CSS Consumer Directed Services, and CSS Community First Choice in the Texas Home Living (TxHmL) Waiver program.

  • HHSC – Proposed Adjustments to Fees, Rates or Charges for the Medical Policy Review of Outpatient Mental Health Services: Hearing. On May 18th, The Health and Human Services Commission (HHSC) conducted a public hearing to receive public comment on proposed Medicaid payment rates for the Medical Policy Review of Outpatient Mental Health Services. The hearing was held in compliance with Texas Human Resources Code §32.0282, which requires public notice of and hearings on proposed Medicaid reimbursements.

  • Uncompensated Care in Texas: This posting describes uncompensated care in Texas and Uncompensated Care Pools that offset some of these costs. These concepts are a critically important piece of the Texas health care system, defining costs and payments associated with the uninsured and low Medicaid reimbursement rates. Because Texas has the highest proportion of uninsured individuals in the nation (17 percent) and it has elected not to expand Medicaid per the Affordable Care Act (ACA), it shoulders high uncompensated care (UC) costs.

  • HHSC: Hospital Payment Advisory Committee: The Hospital Payment Advisory Committee met to receive information (no vote taken) on the impact of the new definition of rural hospital under SB1, General Appropriations Act, 85th Legislature. Two expedited rules were presented.

Health Policy News

  • The Trump administration still hasn’t said how long it will continue the cost-sharing payments to insurers. These payments decrease out-of-pocket costs for low-income ACA consumers.
  • The effects of this uncertainty is playing out in marketplaces across the country. Anthem announced last week that it has pulled out of Ohio’s ACA marketplaces for 2018, citing the unpredictable nature of the federal debate over healthcare as one of their main concerns. This departure will leave approximately 10,500 Ohio residents, across 18 counties, without an option for insurance. Two rural Washington state counties have been thrust into the national spotlight, as recent rate filings show that no insurers will offer coverage next year. This pullout affects approximately 3350 people. Many other states, and rural areas, are vulnerable to similar insurer departures.

  • Meanwhile, the GOP continues struggling with the healthcare debate. Many in the Senate are trying to alter the bill so that older citizens do not pay such hefty costs. GOP members are trying to strike a balance with a provision that would cap the premium increase at three times that of younger adults.

  • As Majority Leader McConnell tries to find the necessary 50 votes to pass the AHCA, gaining two in particular may necessitate dropping an anti-Planned Parenthood funding provision in the AHCA. To gain votes of two Republican moderates, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, McConnell may need to revise the bill to keep federal funding for the organization intact.

  • Proposed cuts to Medicaid in the GOP’s AHCA also threaten treatment for the opioid addiction crisis.