ACA

The ACA Marketplace - 09/19/2019

Physicians find themselves in a land of confusion months after the debut of the Affordable Care Act health insurance marketplace. Pervasive problems with the exchange rollout, including enrollment delays and questionable health plan networks, disrupt physicians' office operations and affect patients' access to care.


Where Do We Go From Here With Our Health Care System? - 03/04/2019

To say that Medicare works well, denies the fact that in many patients are no longer able to go to the doctor of their choice. In fact, even finding a doctor is difficult. Additionally, many doctors no longer participate in the Medicare program. This program is only one step away from a single payer health care system, which was once referred to as socialized medicine.


Section 10: Lift the Federal Regulatory Burden - 01/16/2019

TMA focuses most of its advocacy activities on the Texas Legislature and state agencies and courts. Because the federal government plays such an outsize role in health care policy and programs, however, TMA also conducts extensive advocacy with the U.S. Congress and federal regulatory agencies. As on the state level, much of TMA’s work in Washington is intended to ensure physicians receive fair payment for the medical services they provide to patients, and to win relief from onerous government regulations.


ACA Ruling An Opportunity to Improve Health Care Access - 12/19/2018

The Texas Medical Association believes a Texas federal judge’s recent ruling that the Affordable Care Act (ACA) is unconstitutional provides a bipartisan pathway to strengthen access to health care and provide coverage for the 4.5 million Texans without health care coverage.


Texas Medical Association Eager to Work Alongside Governor Abbott to Improve Access to Health Care in Texas - 12/18/2018

The Texas Medical Association (TMA) believes a Texas federal judge’s recent ruling that the Affordable Care Act (ACA) is unconstitutional provides a bipartisan pathway to strengthen access to health care and provide coverage for the 4.5 million Texans without health care overage.


Enrollment in Health Insurance Through the Marketplace After Implementation of the Affordable Care Act in Texas - 11/29/2018

The Journal — October 2016 Tex Med. 2016;112(10):e1. By Gordon Gong, MD, MS; Cassandra C. Huey, MS; Coleman Johnson, JD; Debra Curti, MEd, RHIA; and Billy U. Philips Jr, PhD, MPH Gordon Gong, MD, MS; Coleman Johnson, JD; Debra Curti, MEd, RHIA; and Billy U. Philips Jr, PhD, MPH, F. Marie Hall Institute for Rural and Community Health, Texas Tech University Health Sciences Center, Lubbock, Texas; and Cassandra C. Huey, MS, F. Marie Hall Institute for Rural and Community Health, and Department of Human Development and Family Studies, College of Human Sciences, Texas Tech University, Lubbock, Texas.  Send correspondence to Billy U. Philips Jr, PhD, MPH, Executive Vice President and Director, The F. Marie Hall Institute for Rural and Community Health, Marie Hall Chair and Professor, Family and Community Medicine, Texas Tech University Health Sciences Center, Suite 2B440, 3601 4th St, MS 6232, Lubbock, TX 79430-6232; e-mail: billy.philips@ttuhsc.edu.  Abstract One ...


Health Care Sharing Ministries Are Not Typical Health Insurance, Doctors Caution - 08/08/2018

TMA asked TDI to inform consumers that health care sharing ministries are not insurance. TMA also sought a response about ministries’ promoting themselves using PPO language. TDI responded that it would review TMA’s recommendation.


TMA Asks AMA to Stay Out of Affordable Care Act Suit - 06/20/2018

Leaders of the Texas Medical Association on Tuesday publicly objected to the American Medical Association’s plans to get involved in a high-profile federal lawsuit — filed in Texas — challenging the constitutionality of the Affordable Care Act.


Why Did I Get That Medical Bill? - 04/26/2018

A new epidemic has hit; call it "insurance illiteracy." Numerous studies (like this national research and this Texas study) show the public's growing lack of understanding of basic health insurance terms, such as "copay," "out-of-pocket expense," and "network." Reasons given for the problem include the addition of large numbers of people newly insured under the Affordable Care Act and the health insurance industry's growing array of confusing new products and cost-containment strategies.


Trump Signs Executive Order on Association Health Plans: “All Any of Us Can Do Now Is Wait” - 04/20/2018

Texas physicians could see a flood of new insurance plans — including some to cover themselves and their employees — under President Donald Trump's executive order that directs federal agencies to design lower-cost plans outside the Affordable Care Act.


Law Sheds Light on Industry Payments to Physicians - 04/17/2018

Later this year under the Physician Payments Sunshine Act, the Centers for Medicare & Medicaid Services will make public physician payments reported by manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs.


When Patients Don’t Pay Their Premiums in the ACA Marketplace - 04/17/2018

Will physicians have to refund payments to an insurer if a patient who bought coverage from that insurer in the Affordable Care Act marketplace doesn’t pay his or her premiums?


CMS to Enforce Payment Transparency Law - 04/17/2018

The Centers for Medicare & Medicaid Services (CMS) will explain the provisions of the National Physician Payment Transparency Act, also known as the Open Payments Act or Sunshine Act, in a teleconference at 1:30 pm CDT on Wednesday, May 22. The act is part of the Patient Protection and Affordable Care Act and requires manufacturers of drugs, medical devices, and biologicals that participate in federal health care programs to annually report payments and items of value they give physicians and teaching hospitals.


Untested Waters - 04/17/2018

It got off to a really rough start, but the federal government launched the insurance marketplace under the Affordable Care Act (ACA) on Oct. 1. And physicians could encounter their own challenges if they are not vigilant in their business practices with the health plans in the marketplace that take effect Jan. 1, Texas Medical Association officials say. Topping the list is widespread physician uncertainty about whether having existing contracts with insurers means they're already included in an exchange network. Right after that is a federal rule that jeopardizes physician payments if patients with subsidized marketplace coverage don't pay their premiums. Exchange regulations give those patients three months to pay their premiums and allow health plans to deny or later recoup payments from doctors for services provided to patients who end up delinquent.


TMA to Congress: No Sneak Torts - 04/17/2018

The Texas Medical Association, the Texas Medical Liability Trust, and other liability insurers are asking Congress to make sure the Patient Protection and Affordable Care Act does not create new theories of liability or alter the rules governing medical professional liability lawsuits.


TMA Takes Physicians’ Grievances to Washington - 02/28/2018

TMA leaders and the Coalition of State Medical Societies have descended on Washington, D.C., to meet with elected officials and Centers for Medicare and Medicaid Services leadership.


CHIP Rings In a New Year – Sort Of - 01/19/2018

According to a recent survey by the T.H. Chan School of Public Health at Harvard University, renewing funding for the Children’s Health Insurance Program (CHIP) is the public’s top priority for Congress. Yet here we are, three months past its expiration, with no resolution in sight despite a fresh new year full of promise and hope.


Fontenotes: Three Things to Watch in 2018 - 01/19/2018

As 2018 peeks over the horizon, it promises to be another year of health care headlines and talking heads, with political free-for-alls, wins, and losses. I promise you there will be at least three things to be watching in the year to come, and I would like to give you a quick preview of each.


Analysts: Ending ACA Cost-Sharing Payments to Affect Middle Class - 12/05/2017

The Trump administration made a splash in October by announcing an end to government subsidies that help insurers provide discounts to low-income enrollees in the Affordable Health Care (ACA) marketplace. However, analysts say it won't be low-income people who will feel a financial hit from President Donald Trump's decision on the cost-sharing reduction (CSR) payments. Instead, people with higher incomes pick up the tab, analysts said.


The American Sickness: A Clinical Perspective - 11/17/2017

American medicine has done more to relieve suffering and forestall death than any other health system in history. Today, this system is facing a major challenge: steadily rising cost. To understand the state of health care in the United States, we must understand the historical perspective and how our modern system of reimbursement evolved.


Remind Your Patients to Review Their Options for Health Care Coverage Now - 11/16/2017

This is a good time to remind those who do not have coverage through an employer that open enrollment in plans sold on or off the Affordable Care Act exchanges is occurring right now.


TMA, Other States to Congress: Lift Bans on Physician-Owned Hospitals - 11/15/2017

The Affordable Care Act’s moratorium on physician-owned hospital growth has limited patients’ access to high-quality health care and unnecessarily increased costs for the Medicare program and its patients, a coalition of state medical associations told federal lawmakers last month.


Texas Doctors See Post-Election Opportunity to Reshape Health Care - 10/19/2017

The 2016 elections brought physicians an excellent opportunity to rebuild America's health care systems, TMA officials say.


Purchasing Insurance Across State Lines - 05/25/2017

The Affordable Care Act, signed by the President in 2010, actually provides for the sale of health insurance across state lines. States may form interstate compacts that would allow states in those compacts to sell qualified health plans to purchasers in other states in the compact.


Can I Pay My Patient’s ACA Premium to Ensure Coverage? - 03/30/2017

If I receive notice that patients who are covered by a health plan in the Affordable Care Act exchange are within the three-month grace period for paying their premiums, may I just pay their premiums to make sure they have coverage while I provide services?