The Weekly Insight March 27 – Updated

27th Mar 2017

The Week in Review

An updated version of the newsletter published earlier today.

Last Week from Texas Insight

  • Congressional Republicans have unveiled their bill to ‘repeal and replace’ Obamacare. The bill includes provisions that would adversely affect older Americans and place financial strains on states and hospitals, and may even break the individual health insurance market. Even if this bill is ‘dead on arrival,’ it contains many of the main points of discussion in the repeal and replace campaign, and provides insight into a possible future iterations.
  • The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have produced an estimate of the budgetary effects of the American Health Care Act. While the proposed legislation offers large reductions in the federal deficit, these savings come at the cost of millions of people losing their healthcare.
  • With the recent filing of the American Health Care Act, it is useful to ensure that everyone has a clear understanding of the scale of the potential impact. While the AHCA (and the ACA, even more so) did lots of different things, the primary focus of both has tended to be on the reforms to the individual health insurance marketplace, and, to a slightly lesser degree, the increased federal financial participation for Medicaid expansion. The reforms to the individual market, on the other hand, represent a significant restructuring of a small but very important slice of the health insurance market. Understanding how the ACA has already changed the individual health insurance market is an important foundation to understanding changes proposed by the GOP.

Read More from Texas Insight

Below are the most recent reports and articles from Texas Insight on healthcare policy, both Texas and national.

Other Healtcare Policy News

  • GOP leadership finally concedes that they lack the necessary votes to pass the American Health Care Act. Three Texas Republicans were among those pushing for changes to the bill before agreeing to support it.
  • Telehealth comes in many forms; virtual visits can take place by video, phone or text, or even online or on a mobile app. These appointments can be quick and often save patients travel and waiting time. For rural individuals, the Telehealth appointments can potentially life-saving. A recent study examines the cost differences between Telehealth and traditional in-office appointments, finding Telehealth appointments are convenient but costly.
  • Following the death of AHCA legislation, voices from both parties are appealing for bipartisanship. While Trump has predicted that “Obamacare will explode,” there has been no plan set forward about how to stop it. Reince Preibus calls for “folks to come together” on “Fox News Sunday,” and this bipartisan message has been echoed by members of Congress.
  • While AHCA has failed, the GOP’s last-minute efforts to gain more conservative support by dumping standards for health benefits is something to watch in their second attempt. By ditching these essential benefits, insurance companies would not be required to include services like hospitalization, prescription drugs, and mental health treatment. This could exclude the chronically ill from the insurance system, and put consumers at greater financial risk if they do need care.
  • Following a request from three influential U.S. senators, the Government Accountability Office has announced plans to investigate potential abuses of the Orphan Drug Act. First, the office must determine the full scope of the investigation, which will take some months. The Orphan Drug Act gives drugmakers lucrative incentives to develop drugs for rare diseases. Kaiser Health News published an investigation in January that found the orphan drug program is being manipulated by drug makers to maximize profits and to protect niche markets for medicines being taken by millions.
  • Representative Ted Poe of Texas’ 2nd District is the first casualty of the House Freedom Caucus following the AHCA failure. Poe said Monday morning that the arch-conservative group was guilty of moving the goal posts for the bill’s backers. The bill ultimately failed thanks in no small part to the Freedom Caucus, whose members generally opposed it because it did not go far enough in undoing certain provisions of Obamacare. Poe was one of a handful of Freedom Caucus members to support the legislation, said the conservative group was asking for too much.


Texas Legislation to Watch

The Senate Finance Committee passed out SB1, the General Appropriations Act,  from Committee and scheduled it for floor consideration the week of March 27th. With regard to Health and Human Services the Bill:

  • Provides $3.4B for Child Protective Services, an increase of $430M over FY 16-17 levels, including:
    • $180M increase to continue pay raises and the 828 additional caseworkers and support staff approved over the interim;
    • $116M to strengthen foster care capacity by increasing rates and expanding community-based foster care to four additional regions; and
    • $55M to hire 386 new conservatorship caseworkers to reduce caseloads;
  • Provides an additional $15M in child abuse prevention funding to maintain programs and services;
  • Allows the Department of Family and Protective Services to allocate $3M to address youth homelessness and human trafficking;
  • Provides a $780M commitment for new construction and significant repairs to the state hospital system, plus $145M for other critical life and safety capital needs at state hospitals and state supported living centers;
  • Adds $244M for mental health services in Article II, including:
    • $63M to eliminate waitlists for community mental health services;
    • $44M to maintain indigent behavioral health services to former clients of the NorthSTAR program;
    • $10M to maintain level funding for current purchased psychiatric hospital beds; and
    • $35M to maintain state hospital service levels and increase maximum security capacity;
  • Provides $20M for the Texas Veterans + Family Alliance, a grant program to assist veterans struggling with post-traumatic stress and other mental health issues;
  • Adds $18.2M for an additional 276 Home and Community-based Services waiver slots for foster children aging out of the system;
  • Increases funding for Medicaid to provide caseload growth at FY 18 levels and assumes over $400M in cost containment initiatives; and
  • Maintains funding for women’s health programs at current appropriated levels, a $31M increase over current spending levels, and requires additional program reporting requirements.

The Texas Autism Council met where one of the important items discussed was that CMS has communicated to states that they will have more time to implement the HCS rules.  March of 2019 is no longer the date, though the new date has not been clarified.  HHSC is backing off the elimination of the center based Day Hab option.

The e-Health Advisory Committee met and there appears to be significant opportunity through the further development, refinement and interface with MCOs on the MEHIS system, providing an accessible electronic record for health and health services for patients and providers alike.  This has the potential to eliminate duplicate services, maintain control on opioid usage and drug shopping and other benefits.  

The workgroups addressing interoperability will meet over the next several months addressing:

  • Defining infrastructure including connectivity and how data is being extracted and exchanged.
  • A common vocabulary was seen as important.
  • Exploring the current state of governance.  
  • Business and Technical Operations  will most like have to interact with the group exploring infrastructure
  • Barriers to practice have to be identified.  
  • Experts will be brought in to discuss issues and input is being sought.

The Week Ahead

The uncertainty continues as the session proceeds.   The Senate will be taking up SB1 on the Senate Floor and it is anticipated that the House will take up their bill (HB1) sometime after.  HB 2, the supplemental appropriations bill was pulled last week and has been rescheduled for Wednesday, March 29th.  At this same hearing it is anticipated that HB1 will be passed out of Committee since both bills are scheduled.  With the focus being on appropriations, there are no meetings scheduled at HHSC this coming week with several meetings being scheduled for early next week.

April 3, 2017

10:00 am — Austin

April 4, 2017

10:30 am — Austin

April 5, 2017

10:00 am — Austin

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