Health Insurance Reform

Far-Reaching Implications: The Ripple Effects of Texas' Uninsured Rate - 12/04/2019

Data compiled by the Texas Medical Association and other organizations, as well as physicians’ own anecdotal experiences, show how 5 million uninsured patients in Texas become 5 million dominoes. As they fall, so do countless others representing the health of Texas: The economy and well-being of entire communities. The classmates and friends of uninsured children. And yes, the physicians who deal with the burdens of treating uninsured patients in emergency rooms and providing uncompensated care.


Big Noises Big Issues: Health Care Takes Center Stage One Year Out From 2020 Election - 11/11/2019

One year from now, Texas voters will hit the polls. They’ll be voting for president, for Congress, and for seats in the Texas Legislature. At the state and national levels, health coverage, Medicaid access, and prescription drug costs have gotten plenty of attention already, and they’ll get plenty more between now and the closing of the polls on Nov. 3, 2020. Here’s a look at some of the major health care debates taking center stage during the 2020 election cycle, what voters are and will be hearing about, and what Texas Medical Association policy says on those particular issues.


Section 3: Hold Health Insurers Accountable - 01/30/2019

Beaumont anesthesiologist Ray Callas, MD, is tired of beating his head against the wall trying to get “in-network” with health insurance companies. And he’s tired of the surprise bills his patients receive when he can’t get in.  


TMA Supports Bill to Improve Balance-Bill Mediation - 04/27/2018

Balance or “Surprise bills” may occur when a person insured under a preferred provider organization (PPO) unexpectedly receives services out of network. The mediation process for out-of-network billing is working well in the state of Texas and has been a tremendous patient protection with the narrowing of insurance networks. We have seen growth in the utilization of the mediation process grow from 14 requests in 2010, to 1,677 requests in 2016. Therefore, TMA is supportive of its expansion to all out-of-network health care providers at an in-network facility along with emergency care.  Additionally, we are pleased to see that the legislation maintains the $500 threshold as well as personal responsibility of the patient.


TMA Offers Remedies to Ease Surprise Billing - 04/27/2018

Texas patients sometimes feel the pain from unexpected out-of-pocket costs not covered by their health insurance, known as “surprise billing” or “balance billing.” The Texas Medical Association (TMA) is taking aim at the problem, which occurs when a health insurance company pays less than what a doctor charges, leaving the patient to pay the balance of the bill.


Transparency in Out-of-Network Payments Needed - 04/27/2018

Since the health plan’s contract or agreement is with the enrollee, we hope health plans don’t use the same argument, saying, “It’s proprietary” to circumvent the spirit of this legislation when their own enrollees make the same inquiry about the out-of-network payment methodology.


Texas Physicians Offer Legislators Fix for Surprise Billing Problem - 04/27/2018

The Texas Medical Association (TMA) and its physician members recognize surprise medical billing is a problem, and are offering lawmakers solutions that address the root causes. Physicians point to a confusing health insurance system they say leaves policyholders/patients too-often unaware, subject to unexpected out-of-pocket costs, inadequate coverage, and physicians frustrated by limited access to patients and their health plan networks.


Balance-Billing Ban Back in 2015 Legislature - 04/27/2018

Renewed attention in the 2015 Texas Legislative over balance billing stems in part from interim charges that tasked the Senate State Affairs and House Insurance committees to look at whether existing laws dating back to 2007 are working to inform patients ahead of time when out-of-network physicians might balance-bill them for services their health plans don't fully cover. The issue is in the national spotlight, too, with the proliferation of high-deductible and narrow-network plans sold in the Accountable Care Act insurance marketplace. New federal rules take aim at ACA plans' inadequate networks and inaccurate physician and hospital directories. The Texas Medical Association is pushing for similar health plan accountability measures at the state level, with a careful eye on legislation that could restrict out-of-network physicians' ability to balance-bill for services they legitimately provide.


Capitol Success - 04/26/2018

This legislative session, medicine resolved to ensure physicians can give their patients the best care possible. The hard work paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes.


AMA Analyzes Potential Aetna-Humana, Anthem-Cigna Mergers - 04/17/2018

The combined impact of proposed mergers among four of the nation's largest health insurance companies would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within Texas and 16 other states, according to new special analyses of commercial health insurance markets issued by the American Medical Association.


Bill Would Address Inaccurate Insurance Directories - 04/17/2018

With modern technology, there should be no issue in business daily updates to a health plan’s online provider directory.


TMA Seeks New Standards for Health Insurance Sold Across State Lines - 04/17/2018

The Texas Medical Association (TMA) is pushing for national consensus on standards to protect consumers who purchase health insurance across state lines.


“Hey, Doc,” TMA’s Education Campaign, Returns - 03/14/2018

“Hey, Doc” is back to help Texas’ patients and reporters understand the 2015 Affordable Care Act (ACA) health insurance marketplace. Open enrollment begins Nov. 15.


“Hey, Doc,” who must enroll in the marketplace? - 03/14/2018

Enrollment for the health insurance marketplace begins in three days — Nov. 15. Texas physicians want to ensure you have the information you need to start the enrollment process. They week’s “Hey, Doc” segments discuss who must enroll for health insurance and possible penalties for those who decide not to purchase insurance.  


“Hey, Doc” Answers Questions About the ACA Marketplace - 03/14/2018

Enrollment for the Affordable Care Act's health insurance marketplace opened last week. Texas physicians want to make sure patients have all the information they need to make informed decisions when purchasing their insurance coverage, so this week's "Hey, Doc" info segment answers some frequently asked questions about health insurance. 


At Last: Answers About Picking Marketplace Health Insurance - 03/14/2018

This week: If insurance is mandated by the government, how do you know if the plan you pick is OK? And how many plan options do consumers have? For that matter, how do you pick a plan? Can you keep your current plan? Read on, for answers.


Can I Keep My Doctor with This Health Insurance? - 03/14/2018

It’s probably one of the most common questions for anyone shopping health insurance: Can I keep my doctor on this plan? The Texas Medical Association’s (TMA’s) “Hey, Doc” educational campaign about the health insurance marketplace (created by federal health system reform, or the Affordable Care Act) answers that question this week, and more.


Hey, Doc, Can Health Insurance Subsidies Help Me? - 03/14/2018

This week’s segment in Texas Medical Association’s (TMA’s) “Hey, Doc” health insurance marketplace education campaign answers questions about the tough part — paying for insurance — and how to get assistance. 


Hey, Doc, When I Can I Renew My Marketplace Health Insurance? - 03/14/2018

This week’s segment in Texas Medical Association’s (TMA’s) “Hey, Doc” health insurance marketplace education campaign answers more questions about aid provided to some Texans who enroll in the Exchange, called subsidies, and how to renew your marketplace plan.


How to Buy Marketplace Insurance - 03/14/2018

Knowing what’s important when choosing a health plan, how to use benefits, and where to turn for help can be challenging for most of us when purchasing health coverage. That’s why the Texas Medical Association started the “Hey, Doc” educational campaign in 2013. This week we’re discussing the different kinds of health insurance plans available and costs. 


What If My ACA Marketplace Health Plan Excludes My Doctor? - 03/14/2018

This week’s installment of Texas Medical Association’s (TMA’s) “Hey, Doc” education campaign offers some suggestions for what to do if you find your marketplace health plan excludes your doctor.


What is The Marketplace & How Do I Get Ready to Sign Up? - 03/14/2018

This week, TMA’s “Hey, Doc” education campaign explains the marketplace, why Texas patients who need insurance should care, and how they can get ready to sign up for marketplace insurance.


When & How Do I Enroll (or Re-Enroll) in the Marketplace? - 03/14/2018

This week, TMA’s “Hey, Doc” answers Texans’ questions about when they can sign up for marketplace insurance, how to apply for coverage, and where to get help enrolling.


Where Can I Get More Information About the Marketplace? - 03/14/2018

In this week’s installment of “Hey, Doc,” TMA provides a list of reliable resources for Texans to learn more about the marketplace ahead of open enrollment on Nov. 15.


With Marketplace Health Insurance, Who Will Care for Me? - 03/14/2018

This week’s Texas Medical Association (TMA) “Hey, Doc” educational segment explains health insurance networks and how they influence patients’ ability to pick a doctor to take care of them.