Health Care

Chairman: Senator Donna Campbell

Objectives: The objectives of the Health Care Task Force are to prepare Texas to work with a new federal administration beginning in January 2017 in terms of the state’s Medicaid program and the Affordable Care Act, and to continue to pursue reforms that create a strong free market for health care in Texas.

Topics: Texas Medicaid program (including waiver requests, co-pays, and patient responsibility agreements), the Affordable Care Act, reducing Medicaid fraud, health insurance, prompt pay regulations, urgent and convenient care clinics, telemedicine, and pharmacy benefit manager regulations.

Overview: The Task Force will focus on ensuring that Texas is prepared for a new federal administration in January 2017 and either (a) a post-Affordable Care Act (ACA) or radically modified ACA scenario (assuming a Republican presidential victory) or (b) an innovation (or “1332”) waiver proposal (assuming a Democratic victory). In either scenario, Texas must be prepared to argue for greater flexibility to enable the state to implement market-based reforms to the Medicaid program, such as patient co-pays and patient responsibility agreements, and in order to tailor the Texas Medicaid program to the unique needs of the state so that the program is run as efficiently and effectively as possible.

Beyond Medicaid and the ACA, the Health Care Task Force will develop recommendations to strengthen Texas’ health care marketplace in a variety of areas, including the following:

  • A review of the state’s prompt pay regulations in order to ensure that health plans continue to be incentivized to pay claims in a timely fashion, but without creating unintended opportunities for lawsuit abuse.
  • An evaluation of balance billing statutes in relation to urgent care clinics in order to provide transparency to consumers regarding the costs that they may incur at such clinics, compared to other settings such as convenient care clinics and physician offices, while continuing to ensure that convenient care clinics, urgent care clinics, and other innovative methods of health care delivery are able to continue to provide high quality, affordable health care in a retail setting.
  • Continuing to develop telemedicine and health care technology in order to improve access to quality care and to reduce hospitalization rates.
  • Improving accountability by expanding existing efforts to combat Medicare and Medicaid fraud.
  • Using the competition-based Medicare Part D as a model for other programs.
  • Highlighting the role of Pharmacy Benefit Managers in the health care system to ensure that unnecessary regulatory efforts to diminish their role are rejected.