TMA: Put Health Back Into Health Care

January 28, 2019

TMA’s Healthy Vision 2025 Sets 75 Ambitious Goals for Lawmakers

The Bottom Line: Addressing Texas’ maternal health crisis, improving Medicaid coverage and payment, and making health insurance work for patients are among the Texas Medical Association’s (TMA’s) top priorities in its new advocacy agenda, TMA Healthy Vision 2025.

As the 86th Texas Legislature zeroes in on problems to solve this legislative session, physicians urge lawmakers to prioritize improving the health of Texans.

TMA President Douglas W. Curran, MD, lists several causes for concern: Tragic, preventable maternal deaths and illness; millions who lack access to regular health care; private health insurance that confuses more than it covers. TMA’s Healthy Vision 2025 advocacy agenda presents 75 recommendations for lawmakers to consider.

“We must assume responsibility for improving and protecting patient care for all Texans,” says Dr. Curran. “We should neither take our health for granted, nor be blind to that which is curable though proper patient care or legislative reform.”

Physicians share their personal stories throughout the report, describing how the system of health care harmed their patients — and in some cases the doctors themselves, too.

A Sample of Healthy Vision 2025 Recommendations:

Make Motherhood Safe

Having a baby and becoming a mother in Texas is a hazard. As many as 18 women die for every 100,000 births. Nearly all are preventable deaths. Many more suffer serious illness, and African-American women die more than twice as often. Poor or no prenatal care (leaving diabetes, blood-pressure problems, and other conditions unchecked), substance use disorders, and post-partum depression all contribute to their deaths.

Dallas obstetrician-gynecologist Eugene Hunt, MD, tells the heart-wrenching story of one patient who took her own life shortly after delivering her first child.

Medicaid covers more than half of Texas births. The comprehensive coverage ends 60 days after mom delivers her baby, leaving the women lacking support for complex chronic conditions. Most mothers who die do so after that coverage ends.

Healthy Vision 2025 has several recommendations to improve women’s health and outcomes before, during, and after pregnancy, including:

  •     Pursue federal funds to extend comprehensive services for low-income women before, during, and after pregnancy;
  •     Ease the transition into the Healthy Texas Women (HTW) program;
  •     Give more women access to substance use disorder treatment; and
  •     Make long-acting reversible contraceptives (LARCs) easier to access.

Boost Access to Care, and Enhance Practice Viability

Dr. Curran is an east Texas family physician who cares for many Medicaid patients. His hometown is like the rest of Texas, where more people lack health insurance than any other state. One in three patients visiting his local hospital is uninsured. Dr. Curran tries to keep his uninsured patients — too poor for private insurance and too wealthy for Medicaid — healthy enough to avoid making trip to the emergency department.

Dr. Curran supports finding ways to insure more Texans, not only for them, but for the entire state.

“If you keep people healthy, they’re producing, they’re generating, they’re keeping things going,” he says. “But if that populace is not properly cared for and supported and empowered, then we’ll see the people that we really need to keep our business environment pristine begin to drift away. It’s going to hurt all of us.”

McAllen ophthalmologist Victor H. Gonzalez, MD, provides expert eye care for many low-income patients. More than half of his patients are covered by both Medicare and Medicaid (“dual-eligibles”). Caring for those patients used to earn Dr. Gonzalez a fee equal to Medicare’s standard payment — which was enough for his practice to get by. Then the state slashed its share; enforcing a 20-percent revenue cut for more than 60 percent of his patients.

That and other problems forced several physician partners to move away. He and his smaller team struggle to squeeze in all of his patients, and he had to trim the practice’s charity care. His patients must wait longer to see him, while their complex conditions like diabetic retinopathy worsen. Patients have lost some of their vision.

“Unless we can change this, we’re going to revert back to where we were 20 years ago when I first showed up here, with a lot of people with very advanced disease, going blind,” he says.

Healthy Vision 2025 recommends improvements for Medicaid payment and plans, and proposals to shore up Texas’ physician workforce, including:

  •     Boost Medicaid payments to match inflation and cost of practice increases;
  •     Reduce unnecessary prior authorization requirements and other administrative and bureaucratic burdens for physicians in Medicaid and other health benefit programs;
  •     Increase state oversight of Medicaid managed care plans;
  •     Increase funding for graduate medical education to keep more Texas medical school graduates in Texas; and
  •     Repeal the payment cuts for Medicaid/Medicare dual-eligible patients.

Hold Health Insurers Accountable

Health insurance is supposed to protect policyholders — patients — in case something goes wrong, saving them from potential financial disaster. But health insurance companies make more money if people don’t use insurance to pay for care. In that case patients pay more, while their insurance pays less. Insurers achieve this several ways: They publish inaccurate network directories; confuse patients about their coverage; and limit the number of in-network physicians — forcing patients to pay for expensive out-of-network care.

“I’ve tried time and again to negotiate with networks and still can’t get in,” says Ray Callas, MD, a Beaumont anesthesiologist and member of TMA’s Board of Trustees.

Two out of three Texas physicians lack a health plan contract although they have attempted to join a network. But out of network, their patients receive an unexpected medical bill. As many as 60 percent of Americans have received one of these “surprise bills”.

Healthy Vision 2025 calls on the state to require strong, adequate insurance networks, and accurate, current information in their network directories. TMA also seeks to protect physicians’ rights to set their charge and collect outstanding balances, and to continue mediation for patients to resolve surprise bills. Also, require health insurers to clearly explain exactly what a patient’s health plan will and won’t cover, as well as patients’ financial responsibility — before they purchase a policy.

You can read TMA’s entire Healthy Vision 2025 online (which includes all of the personal stories referenced in this release) or download a copy.

Section 1: Let Doctors Be Doctors
(With Dr. Lisa Ehrlich’s story – “Stretched to the Limit”)

Section 2: Protect Our Liability Reforms

Section 3: Hold Health Insurers Accountable
(With Dr. Ray Callas’ story – “Let Me In, Let Me In”)

Section 4: Enhance Practice Viability
(With Dr. Victor Gonzalez’ story – “There Goes the Cavalry”)

Section 5: Make Motherhood Safe
(With Dr. Eugene Hunt’s story – “It Didn’t Have to Be”) 

Section 6: Focus on Teamwork and Patient Safety

Section 7: Invest in Public Health and Behavioral Health

Section 8: Boost Access to Care
(With Dr. Doug Curran’s story – “It’s Going to Hurt All of Us”)

Section 9: Don’t Let Corporations Play Doctor
(With Dr. Dieter Martin’s story – “The Last Line of Defense”)

Section 10: Lift the Federal Regulatory Burden

Special Report: Texas Physicians Inject Billions Into Lone Star State Economy

TMA is the largest state medical society in the nation, representing nearly 53,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

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Contact: Brent Annear (512) 370-1381; cell: (512) 656-7320; email: brent.annear[at]texmed[dot]org

Marcus Cooper (512) 370-1382; cell: (512) 650-5336; email: marcus.cooper[at]texmed[dot]org

Connect with TMA on Twitter, Facebook, and Instagram.

Check out MeAndMyDoctor.com for interesting and timely news on health care issues and policy.

Last Updated On

January 28, 2019