Testimony: HB 636 by Rep. John Zerwas (R-Richmond)
By: Susan Rudd Bailey, MD
March 1, 2011
Good afternoon, Chairman Smithee and members of the committee. My name is Susan Rudd Bailey, MD. I am a practicing allergy and immunology specialist and current president of the Texas Medical Association. On behalf of the Texas Medical Association (TMA) and nearly 45,000 physicians and medical student members, I would like to thank the committee for the opportunity to testify before you today on House Bill 636, relating to creation of the Texas Health Insurance Connector.
The Texas Medical Association supports the efforts by Representative Zerwas to establish a health insurance connector for the state of Texas. TMA strongly believes it is important for the state to establish a connector to help small employers and patients obtain affordable health insurance in a market that can be overwhelming. We agree with the premise that any “connector” serving Texas patients should be created, implemented, and run by Texas and Texans, with as little federal interference as possible. TMA believes HB 636 is a good starting point toward achieving that goal. Earlier this year, as TMA president, I signed a letter supporting Representative Zerwas’ legislative efforts to that end, along with the Texas Association of Business, the Texas Association of Health Plans, the Texas Hospital Association, and others.
TMA believes the following five items are important legislative actions for consideration in ensuring the long-term success of its connector:
1. Creation of a One-Stop Shop Opportunity
Connectors play a central role in making eligibility determinations for premium tax credits, for cost-sharing reduction payments, and for Medicaid and the Children’s Health Insurance Program (CHIP). If this committee and the legislature decide to capitalize on implementing its own connector, it should be a “one-stop shop” or “no wrong door” access to the purchase of health insurance — regardless of whether the person is or is not eligible for premium assistance subsidy. This is especially important for an individual or family who may not be able to obtain coverage through their employer. The connector must ensure small businesses and patients are not overwhelmed with bureaucratic hassles. You do not want potential users of the connector to become frustrated when trying to find the right coverage, at the right price, and at the right time, then abandon the process all together — thus remaining uninsured.
To achieve the goal, it will be important to fully integrate the connector's new screening and eligibility functions with the existing Texas Medicaid and CHIP system to ensure a truly seamless “no wrong door” approach.
2. Facilitate Comparison Shopping
TMA was pleased to see HB 636 requires the connector to be website based. A website-based system will allow potential users to obtain standardized comparative information on qualified plans. In addition, we strongly support the bill language requiring the connector to use a standard format about the various qualified plan options. TMA supported legislation before this very committee last session by Rep. Senfronia Thompson, fondly referred to as the “Nutrition Label Bill.” Had it passed, health plans would have been required to present their coverage benefits in the form of a nutrition label so patients could easily compare insurance plans.
3. Retention of the Role of the “Navigator” Is Important
TMA noted that language in the bill as filed establishing “navigators” is missing from the committee substitute. The Patient Protection and Affordable Care Act provides for “navigators” whose responsibility is to educate the public about qualified health plans, distribute information on enrollment and tax credits, facilitate enrollment, and provide referrals on grievances, complaints, or questions. The Texas connector should be directed to contract with a diverse array of entities as “navigators” to help uninsured patients and small businesses navigate coverage systems in a culturally and linguistically appropriate manner. Navigators could include entities trusted by individuals and employers, including trade, industry, and professional associations, commercial fishing industry organizations, ranching and farming organizations, community and consumer-focused nonprofit groups, and chambers of commerce. Many other states have opted for this provision. TMA would like to see the consideration of the use of navigators reinstated as the bill moves forward.
4. Clarification of the Role of the “Health Insurance Producer”
The committee substitute introduces a new term not found in the original filed version of the bill —“health insurance producer.” It appears the function of the “producer” is to help enroll Texans in qualified health plans through the connector or to write health benefit plan coverage for the patient. It appears this is the same or similar to the functions of a broker/agent in the market today. The role of a broker/agent or “health insurance producer” is to “produce” or “sell” the coverage that is appropriate. TMA does not want patients to be prohibited from accessing or purchasing their coverage directly through the connector.
In addition, the function of the “health insurance producer” should not be mistaken as a replacement for or synonymous to the functions of a “navigator” just discussed. The “navigator’s” role should be viewed as a guide or counselor, and his or her role in this new endeavor should not be diminished or dismissed.
5. Governance Without Conflict of Interest
All elements of the creation and administration of the connector should be as transparent as possible. It is important that Texans trust that the health care coverage they are receiving is free from outside influence. The governance of the connector should be free of any real or perceived conflict of interest. The interests of small business and of patients should be represented by the majority of the connector’s governing board. Health insurance industry members and those with possible financial conflicts of interest should not be allowed to control, dominate, or run the exchange.
The citizens of Texas must be confident that those who oversee the connector process have the interest of Texans in mind and not the personal interests of appointed members serving on the various boards and committees noted in the bill.
Chairman Smithee and members of the committee, thank you again for allowing me to testify today on HB 636. As I mentioned earlier, TMA believes the time is right for the creation of the Texas Health Insurance Connector. We ask that you support Representative Zerwas’ endeavor in making this a reality for Texans.
82nd Texas Legislature Testimonies