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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.


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.


Medicine’s Monthly Bullhorn: First Tuesdays at the Capitol - 03/28/2019

First Tuesdays are important not only for getting medicine’s message across in the moment, but also for building and maintaining relationships that pay dividends in the future. The Vijjeswarapus experience it all as Texas Medicine follows them on the morning of this year’s first First Tuesdays.


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 6: Focus on Teamwork and Patient Safety - 02/13/2019

Texas needs more physicians and other health care professionals working in all parts of the state, especially in rural and border Texas.


Healthy Vision 2025’s Plan to Hold Insurance Companies Accountable for What They Sell - 02/07/2019

The Texas Medical Association’s Healthy Vision 2025 — released this week — seeks to draw a roadmap for how legislators can hold insurance companies accountable for the products they sell to patients.


Physician’s Emotional Tale Illustrates the Tragedy of Maternal Death - 02/07/2019

I’d never met Eugene Hunt, MD, but reached out to him last year as we were writing  Healthy Vision 2025 , the latest edition of TMA’s advocacy blueprint. A major section of the document details our legislative plans to address Texas’ alarming increase in maternal morbidity and mortality. I wanted to include the story of a physician who had been through the trauma of losing a new mother post-partum. I got a tip to call Dr. Hunt.


Healthy Vision 2025’s Plan to Ensure White Coats, Not Gray Suits, Practice Medicine - 02/04/2019

The Texas Medical Association’s Healthy Vision 2025 – released last week – draws a roadmap for how legislators can ensure that physicians are the ones treating their patients, not analysts or the finance department.


Section 5: Make Motherhood Safe - 01/30/2019

It Didn’t Have to Be Eugene Hunt, MD, estimates he’s attended the delivery of thousands  ¾ “three, four, five thousand?”  ¾ of infants in his 35 years of practice as a Dallas obstetrician. Two “sad, sad, sad” cases stick in his mind.


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 2: Protect Our Liability Reforms - 01/30/2019

Texas’ 2003 medical liability reforms swiftly ended an epidemic of lawsuit abuse, brought thousands of sorely needed new physicians to Texas, and encouraged the state’s shell-shocked physicians to return to caring for patients with high-risk diseases and injuries.


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.


Guidelines for Medicaid Radiology Prior Authorization - 05/03/2018

Texas Medicaid requires prior authorization for outpatient diagnostic radiology services. Follow these guidelines to help you sail through the process.


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.


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.