Administrative complexity, declining population health, payer payment policy, and market structures that encourage consolidation all “add cost, reduce competition, and ultimately harm patients.”
That’s the gist of testimony the Texas Medical Association shared with the backing of 10 other statewide medical organizations.
The written testimony, delivered to the House Select Committee on Health Care Affordability for its initial April 30 meeting, responded to the committee’s request to:
- Evaluate health care cost drivers, including statutory, regulatory, and administrative burdens, and the impact of fraud, waste, and abuse;
- Evaluate the impact insurance design, cost sharing, market structure, and payment policies have on consumers and employers;
- Examine the impact of consolidation on patient choice, market competition, and price and value in health care services; and
- Review the level of consumer transparency in health care markets to ensure consumers have access to clear, accurate, and actionable information on prices, benefits, and out-of-pocket costs.
Andrew J. “Jimmy” Widmer, MD, chair of TMA’s Council on Legislation, heads a TMA physician work group preparing to work with lawmakers on health care affordability fixes, one of the Texas House’s top priorities heading into the 2027 session.
Considering health care cost drivers, Dr. Widmer’s written testimony emphasized the role paperwork plays, especially prior authorization, in diverting practice resources and ultimately raising costs.
“As physicians know, the first thing that comes to mind is the administrative burden,” Dr. Widmer told Texas Medicine Today. “When we see that continue to escalate, we continue to see the grind that that has on our practice productivity, and ultimately, that leads to an access issue … and it’s perhaps no more evident than in the rural communities.”
The written testimony noted several findings from the American Medical Association’s 2024 prior authorization survey, including:
- Physicians complete an average of 39 prior authorizations a week, consuming 13 work hours per physician (between physicians and staff);
- 95% of practices report higher burden over the past three years; and
- 40% report needing three or more full-time administrative staff members per physician to handle prior authorization, denials, and reporting requirements.
While Dr. Widmer expressed TMA’s support for eliminating fraud, which is a criminal act that should be identified and prosecuted, he reminded the committee of other forces at play.
“Fraud and abuse should not be treated as a singular explanation for the affordability problem when we also see broad-based premium growth, high deductibles, and insurance products that only seem to innovate new ways to increase complexity and reduce patient and physician recourse,” he wrote. “A great start would be to address the administrative and regulatory burdens that make care more expensive without making it better.”
On other items within the call of the committee that TMA weighed in on:
Insurance design: Dr. Widmer cautioned health insurance plans with less comprehensive coverage but an attractive “sticker price” ultimately shift costs onto patients.
“Coverage is not truly affordable if patients cannot realistically use it,” he said, adding lower-premium plans can “impose high deductibles, burdensome copays, narrow networks, aggressive prior authorization, unstable formularies, or weak out-of-network protections that delay care and shift costs to patients and physician practices.”
Consolidation: TMA’s testimony noted that when faced with rising payroll, rising overhead costs, rising technology costs, rising compliance costs, insurer friction, and payment that doesn’t keep pace, pressure some practices toward consolidation or alternative practice arrangements out of sheer necessity. Additionally, in the insurance market, consolidation and “a lack of competition in the market leaves small employers with a false choice of paying higher costs for insurance or leaving employees uncovered.”
Transparency: Dr. Widmer identified four key areas where consumers need better and clearer information to navigate their health care costs:
- Cost of the premium;
- Which services are covered;
- Where and when care is available; and
- Out-of-pocket expenses.
Population health: Dr. Widmer also highlighted “avoidable downstream spending” tied to issues like smoking and food insecurity – which together add approximately $12.3 billion in health care costs in Texas annually – and emphasized that preventive care provided by primary care clinics is undervalued and underutilized.
“When patients cannot access continuous, physician-led care early and reliably, the system ultimately pays more for avoidable complications, higher-cost interventions, and worsening outcomes,” he stated.
Overall, reducing administrative complexity and burden, preserving meaningful coverage, supporting physician practices, and scrutinizing ill-incentivized market structures are the path to affordability that protects both patients and the physicians who care for them, TMA’s testimony emphasizes.
Dr. Widmer summarized it this way to Texas Medicine Today: “If we don’t control some of these drivers in health care costs, if costs continue to rise, patients are not going to be able to afford health care. Employers won’t be able to afford coverage for their employees. Ultimately, physicians aren’t going to be able to afford to stay in practice.”
Keep tabs on TMA’s legislative testimony as lawmakers prepare for the upcoming session.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.