Healthy Vision 2010 Health Care Summit

In February and again in November 2005, the Texas Medical Association published Healthy Vision 2010. We put our stethoscopes to the heart of Texas' health care system, reached a diagnosis, and prescribed a rigorous course of treatment.

Our conclusion: This patient is sick, but not dying. We are confident that our prescription for accountability, efficiency, and effectiveness will heal the patient. Our treatment will ensure that the Texas health care dollar is actually spent on health care … not elsewhere. We called for innovative ways to make health care and health insurance affordable. We encouraged Texans to take better care of themselves - and take more responsibility for their health. Our cure involves improved patient safety and making life- and dollar-saving health care information technology readily available to physicians and patients.

We also realized that physicians cannot impose this treatment plan alone. Three times in 2006, the Texas Medical Association convened a Texas health care summit, bringing together the thought leaders and the decision makers from medicine, business, insurance, hospitals and other health care providers, and government. We implored the stakeholders to search for common ground. We realized that we cannot agree on all of the treatments we recommended as part of our Healthy Vision. But we expected - and found - stakeholders to agree on the need to dismiss the status quo and move forward.

Three times, our state's medical, political, and economic leaders came together to develop a collaborative legislative agenda that addresses some of Texas' most pressing health care problems. The first two Healthy Vision summits developed a joint vision of the two most promising areas for possible collaboration: reducing the number of uninsured Texans and increasing Texans' incentives to maintain healthy lifestyles. The third summit concluded with broad agreement on exactly how the state should move forward on both issues.

• The wellness bill would provide incentives and resources for employers to offer cost-effective wellness programs to their workers; it would offer wellness programs to all state employees; and it would ban smoking in all public places in Texas, without preempting more stringent local laws. (Full text of the final "bill" is attached.)
• To help Texas lose its designation as the "uninsured capital of America," the uninsured bill would educate businesses on the value of providing insurance benefits to their workers and provide them incentives to do so; convene a broad stakeholder group to define an affordable, basic, essential benefit package; and capture additional federal funds to help small businesses offer "Three-Share" type programs to their employees. (Full text of the final "bill" is attached.)

As health care reform, especially the need to address the problem of the uninsured, gains momentum both in Washington and in state capitals nationwide, advocates are routinely turning to coalitions such as the Healthy Vision 2010 summits.

In its Jan. 25 edition, the New York Times reported: "Employers, much of the glue holding the nation's piecemeal health care system together for half a century, have been reluctant to agree to a larger government role in medical coverage. But straining under runaway costs for providing health insurance - partly because of the costs imposed on the medical system by people with no insurance at all - many executives and their representatives see the time as ripe for starting to overhaul the system. … WellPoint, the largest health insurer, said it had been signing up about 380,000 previously uninsured people annually by devising new types of lower-price policies."

And the Jan. 16 Los Angeles Times reported: "In a sign of how the political climate is shifting, powerful business interests that once teamed up to defeat Democratic healthcare plans are joining with labor unions and other unlikely allies to advocate extending medical insurance to millions of Americans. Among the champions of change is the trade group representing the nation's leading health insurance firms. … Today, the president of the Service Employees International Union will stand with the director of the Business Roundtable, which represents the nation's leading corporations, to announce one campaign to overhaul health care."

Next Steps

As of mid-January, legislation had already been filed regarding both of the issues outlined during the Healthy Vision 2010 summits. Sen. Jane Nelson, chair of the Senate Health and Human Services Committee, has filed legislation dealing with the growing number of uninsured. Sen. Eddie Lucio has filed legislation on developing worksite wellness incentives for employers. Sen. Rodney Ellis has announced that he will file a bill calling for a statewide ban on smoking in public places. It is expected that a number of other pieces of legislation will be filed in both the House and Senate over the next couple of months. Already, the introduced version of Senate Bill 1 (the state budget bill for the 2008-2009 biennium) contains language directing the Health and Human Services Commission to seek federal Medicaid reform waivers that would "increase state flexibility in its use of Medicaid funding; … reduce the state's uninsured through private market-based solutions; and provide incentives for healthier behaviors." Last week, Lt. Gov. David Dewhurst announced that one of his top priorities would be a bill that provides tax incentives for employees of small businesses, which most often do not offer health coverage. And while Gov. Rick Perry hasn't laid out a Texas health care reform plan, most observers expect to hear something from him on Tuesday, in his State of the State address, based on the governor's promise at his inauguration to "find solutions to the high rate of the uninsured and to the high cost of health insurance."

To ensure the principles outlined during the summits are included in any finally passed legislation, TMA and other summit participants will:

• Meet with bill authors, sponsors, and relevant committee members to review Healthy Vision 2010 and the summit recommendations and to ask that the recommendations be included in their legislation.
• Propose news conferences and other publicity avenues to promote the bills, the need to address the uninsured and enhance wellness activities, and the TMA Healthy Vision Summits.
• Encourage our respective members and employees to contact legislators at the appropriate time to provide grassroots support for the summit bills.

SUMMITBILL 1 (Wellness)

To enhance wellness from both the employer and the community perspective, the State of Texas should:

Launch pilot educational programs on health, nutrition, and fitness through government entities at all levels, in collaboration with private businesses and organizations. These would include both school- and community-based programs that:

• Strengthen health education requirements and evaluations in schools to include evidence-based classes on wellness, nutrition, physical activity, and tobacco/alcohol/drug abuse prevention;
• Require school-year-round physical education in all grades, K-12;
• Offer incentives for community organizations and local governments to provide wellness education and programs for residents of all ages;
• Encourage and incentivize wellness classes for adults enrolled in community health care programs; and
• Provide incentives for school districts and state-supported institutions of higher education to offer wellness programs to faculty, teachers, and employees.

Led by the Department of State Health Services and the Governor's Council on Physical Fitness, partner with medical and health care organizations and private companies that have established wellness programs to offer the following resources to employers, health plans, local governments, school districts, and community leaders:

• Technical assistance,
• Best practices guidance,
• Employee educational materials,
• Templates for rudimentary programs,
• Health risk assessment tools that promote employee health, wellness, and disease prevention, and
• Information on tax and other incentives.

Undertake a campaign to educate employers about the positive return on investment from wellness programs.

Study the development of and pilot test benefit design incentives to encourage healthy behavior and discourage unhealthy behavior.

Offer all state employees an evidence-based wellness program and encourage their participation. Measure and publicize the return on investment of this program. These programs should be flexible for employees' special medical needs.

Ban smoking of tobacco in all public places, without preempting more stringent local laws. Fund the Department of State Health Services' statewide tobacco cessation program.

SUMMITBILL 2 (Reducing Texas' Rate of Uninsured)

To facilitate public-private partnerships that will help small employers provide health coverage for their workers, the State of Texas should:

Establish a public-private partnership including business organizations, physicians and other health care organizations, and appropriate state and local agencies to educate businesses on the need to provide health insurance for employees. Provide additional tax incentives, which may include tax credits, for businesses to offer health insurance benefits to employees, if those benefits include wellness programs and preventive services.

Convene stakeholders (business community, physicians, academic centers, other health care providers, insurance companies, hospitals, consumers) to define a basic essential benefit package and make recommendations for the development of insurance products that include such covered benefits. The package should:

• Be feasible and affordable,
• Not be constrained by current state-mandated benefits,
• Include evidence-based benefits,
• Support public health needs, and
• Promote the establishment of a medical home.

Maximize federal match available for Medicaid/CHIP to capture dollars currently left on the table and remove any unnecessary administrative barriers for obtaining those dollars. Some of the captured funds would be used to incentivize small businesses to offer "three-share" type programs to their employees.

Expand recent legislation allowing governmental agencies to give bid points/preferences to employers who provide some type of health insurance to their employees. These preferences would be expanded to include all forms of government statewide.

TMA House of Delegates: TexMed 2007