Texas Medical Association Board Trustee John Carlo, MD, had a blunt message for Texas lawmakers in recent testimony before the House Select Committee on Health System Reform.
“We need to reduce health care costs,” the public health physician told the panel, which met for two days Aug. 4-5 to start diving into its interim charge to examine the delivery of health care services in Texas.
Speaker Dade Phelan (R-Beaumont) earlier this year announced the formation of a new 11-member select committee, which includes Rep. Greg Bonnen, MD (R-Friendswood), and Rep. Tom Oliverson, MD (R-Cypress), and chair and vice chair Rep. Sam Harless (R-Spring) and Rep. Toni Rose (D-Dallas), respectively.
“We know in this country we spend over $12,000 per year per person, and it’s only getting worse,” said Dr. Carlo, past chair of TMA’s Council on Legislation.
Those high costs deny people access to health care, he testified. But Texas can address these critical problems by pursuing five goals:
- Reduce the number of people who cannot afford health care;
- Produce higher value care;
- Better utilize the health care resources we have;
- Reduce health care disparities; and
- Eliminate waste and inefficient care.
Dr. Carlo testified on behalf of TMA as well as the Texas Academy of Family Physicians, Texas Pediatric Society, Texas Association of Obstetricians and Gynecologists, Texas Chapter of the American College of Physicians Services, and American College of Obstetricians and Gynecologists, District XI (Texas).
Problems of affordability and access remain especially severe in the Texas health care system, which has been buffeted by excessive administrative costs, the consolidation of health care markets, the fragmentation of health care delivery, an erosion in primary care, growing health care disparities, rising rates of uninsured patients, and COVID-19, Dr. Carlo told the committee.
Texas has the fifth-highest rate of adults with unpaid medical bills and the highest rate of adults without health insurance – 23.6%.
“[Texas physicians] really stand up and continue to say we have to do something for the 4.5 million Texans who lack health insurance and the 625,000 children,” he said.
Dr. Carlo recommended Texas follow the example of other conservative states such as Arizona, Arkansas, and Utah and design a health care initiative by Texans and for Texans that would take advantage of federal funding to increase coverage among working-class patients.
Other recommendations TMA and the other physician groups put forth to improve health care affordability include:
- Extending Medicaid postpartum coverage for women who’ve been pregnant to 12 months, from two months;
- Mitigating the impact for people who will lose Medicaid coverage once the COVID-19 public health emergency ends; and
- Promoting value-based care, in part by using Texas’ new all-payer claims database to help consumers, physicians, employers, and payers obtain better information so they can assess health care trends and costs.
Primary care, Dr. Carlo added, can also be a big part of the solution.
He told committee members about a 23-year-old patient who had never known what it was like to have a regular physician. Unfortunately, that man is not alone. In 2021, 29% of Texans reported they did not have a usual source of health care or relied on emergency department care.
Medical staffing shortages, physician burnout, low Medicaid payments, and other problems are exacerbating this already severe problem, Dr. Carlo recounted.
“We’re now at generations in which people have not had health care access,” Dr. Carlo said.