The Texas Medical Association is leveraging its advocacy power against state insurance legislation that would compromise established physician and patient protections, often to the benefit of health plans, despite sometimes good intentions.
Fortunately, there also are several insurance bills in the hopper this session that TMA supports, including ones that would strengthen the state’s network adequacy rules, which state lawmakers are scheduled to consider in hearings this week after a short delay last week.
State lawmakers in both chambers have filed several bills that undercut guardrails established by the Texas Legislature in previous sessions. But TMA is fighting hard – leaning on its relationships with legislators and rallying physician testimony – to ensure these safeguards remain in place.
House Bill 3351 by Rep. Caroline Harris (R-Round Rock) would undo legislation that requires insurers to notify physicians of the methods used in health plan ranking and tiering programs before they are evaluated and to establish appeal processes through which physicians can contest inaccurate information.
“We understand and support the author’s intent to promote transparency and empower patients to shop for affordable insurance coverage. ... However, this bill seeks to accomplish that goal in a way that would create an imbalanced process that lacks accountability and could create confusion for patients and physicians,” Austin gastroenterologist Pradeep Kumar, MD, said in testimony before the House Insurance Committee against HB 3351.
Similarly, House Bill 1001 by Rep. Giovanni Capriglione (R-Southlake) and its companion, Senate Bill 605 by Sen. Drew Springer (R-Muenster), purport to offer Texans slightly more affordable health insurance premiums by reducing the value of that coverage and gutting certain consumer protections, including mandated benefits.
Athens family physician and TMA past president Doug Curran, MD, testified before the House Select Committee on Health Care Reform that their passage would be “a Pyrrhic victory,” akin to “addressing the affordable housing crisis by building homes without a roof, insulation, or plumbing.”
Likewise, Senate Bill 1581 by Sen. Paul Bettencourt (R-Houston) and its companion, House Bill 2403 by Rep. Dennis Paul (R-Houston), would favor health plans at the expense of patients and physicians in their establishment of a Texas Health Insurance Mandate Advisory Committee to analyze bills imposing new regulations on health plans.
“[W]e are concerned that [SB] 1581 is health plan-centric in that it places a great emphasis on health plan expenditures, rather than being primarily focused on enrollees or balancing other concerns related to population health, access to care, and the impact of ‘insurance mandates’ on other market participants,” Fort Worth radiologist Tilden Childs, MD, told the Senate Committee on Health and Human Services.
House Bill 633 by Rep. James Frank (R-Wichita Falls) also threatens to amplify health plans’ already-considerable market power by capping physician payments at the lowest contracted rate for many services.
“While it may be well intended, by setting a cap on charges in direct payment situations, [HB] 633 may be used by health plans to create a race to the bottom for physician contracts,” San Antonio radiologist Zeke Silva, MD, recently testified on behalf of TMA and the Texas Radiological Society. “This would seriously threaten independent practice viability – and therefore, patient access to care.”
TMA-backed bills
Amid this raft of bad bills, TMA strongly supports House Bill 3359 by Rep. Greg Bonnen, MD (R-Friendswood), a neurosurgeon, and its companion, Senate Bill 1765 by Sen. Charles Schwertner, MD (R-Georgetown), an orthopedic surgeon.
Together, this legislative pair from physician-legislators would promote adherence to the state’s strong network adequacy rules – which TMA was instrumental in developing – by putting them into statute and by strengthening enforcement by the Texas Department of Insurance (TDI).
A vast majority of health plans are taking advantage of the waiver process and are offering plans that don’t provide patients with a sufficient panel of in-network physicians, TMA Chief Lobbyist Clayton Stewart told physicians during TMA's April 4 First Tuesdays at the Capitol event.
More than 90% of the commercial health plan networks filed with TDI in 2022 didn’t meet state network adequacy standards and instead operated under a waiver, or “access plan,” detailing how the plan would cover such gaps, according to the state agency.
State lawmakers are slated to consider this legislation in a hearing this week.
In the meantime, Texas physicians recently testified on behalf of TMA in support of the following legislation:
- House Bill 3195 by Representative Bonnen, would strengthen anti-retaliation protections for physicians when reporting bad health plan conduct to agencies like TDI;
- House Bill 4067 by Rep. Hubert Vo (D-Houston), would require TDI to verify health plan compliance with prior authorization rules more regularly, aiding in more timely detection of violations;
- House Bill 4300 by Rep. Ryan Guillen (D-Rio Grande City), would expedite the credentialing process for physician practices seeking in-network status with a health plan on behalf of nurse practitioners and physician assistants; and
- House Bill 4367 by Rep. Philip Cortez (D-San Antonio), would clarify that health plans cannot rescind coverage after approving a prior authorization request for the service in question.
On the radar
Physicians are divided on House Bill 1073 by Rep. Lacey Hull (R-Houston), which would allow primary care physicians and other health care professionals to enter health plan contracts with a value-based payment model. While tracking the measure closely, TMA remains neutral on the legislation.
Dallas internist Sue Bornstein, MD, testified on behalf of the Texas Primary Care Consortium in support of the bill, which she said offered physicians another payment option.
“The traditional fee-for-service payment structure rewards high-volume, high-cost services while undervaluing comprehensive continuous and coordinate primary care services," she told lawmakers. “HB 1073 is smart public policy.”
However, Frisco anesthesiologist Zachary Jones, MD, testified against the bill on behalf of the Texas Society of Anesthesiology with concerns. For instance, it could dissuade primary care practices and multi-specialty groups from contracting with anesthesiology specialty groups because of their preference for fee-for-service payment models, given that they are paid based on time.
Find all the testimonies by TMA physician advocates during the current session on the in TMA's advocacy center.