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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.


Open Enrollment 2020: Be Prepared for Coverage Changes - 11/13/2019

You’re probably already aware that open enrollment for commercial health insurance plans, including those on the Affordable Care Act Exchanges, opened Nov. 1 and will run through Dec. 15. While some patients won’t make any changes to their coverage, others will make significant changes, including enrolling with a completely different health plan.


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.


Texas Continues to Lead Nation in Uninsured Adults and Kids - 09/30/2019

As of 2018, 11.2% of Texas children younger than 19 were uninsured, up from 10.7% in 2017, according to data the Census Bureau released last week. All told, Texas has led the nation in uninsured residents over the past two years, Census data show.


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.


Raise Taxes on Vape Products to Decrease Youth Usage - 04/09/2019

HB 4013 and HB 3364 would deposit tax revenues to the state’s general revenue fund, while HB 1144 directs tax revenues to the Children’s Health Insurance Program (CHIP). Evidence shows more smokers favor tobacco taxes when they are not a general revenue raising tool – in a study of current smokers, only 25% favored increasing taxes on cigarettes, but support climbed to 60% if taxes funded health care programs.


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 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.  


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 ...


Webinar Can Help You Clear Medicaid Telemedicine Static - 10/12/2018

Do you understand telemedicine in Texas, particularly when treating Medicaid patients? If not, you might want to register for a live, free webinar on telemedicine and telehealth services scheduled for the end of October.


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.


Cleanup, Recovery Continue in Harvey-Affected Areas - 05/10/2018

Since Hurricane Harvey slammed the Texas Coast on Aug. 25, state agencies have deployed resources to the affected areas, health plans have made policy changes, millions of dollars have been raised through donations, and thousands of Texas physicians have put in extra time and effort to address the public health concerns.


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.


TMA: CHIP Managed Care Plans Responsible for Out-of-Network Payments - 04/27/2018

Because federal law prohibits patients covered by the Children's Health Insurance Program (CHIP) from paying anything other than a copay, the state of Texas should require managed care organizations in CHIP to cover the costs for out-of-network physicians. That's the position TMA takes in a formal letter to the Texas Health and Human Services Commission.


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.


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.