Despite some promising bills that were filed in the 87th Texas Legislature, it looks like any efforts for the state expanding Medicaid under the Affordable Care Act have been scuttled. Instead, House Speaker Dade Phelan has supported some very modest improvements to healthcare, as well as a slew of bills that would make it harder for patients to seek care.
In a Wednesday morning press conference on healthcare priorities, Phelan was noncommittal about support for House Bill 3871. Written by State Rep. Julie Johnson (D-Dallas), it would have created the Live Well Texas program, a proxy organization that would have all but embraced the proposed Medicaid expansion that Texas has consistently turned down since the ACA was passed in 2010. There was hope that the self-destruct mechanism written into the bill where Live Well Texas would cease existence should the federal government ever stop paying for 90 percent of the expansion, would woo some Republican champions. Beyond the 7 Republicans officially signed on last month, none have since signed on.
Phelan did offer his backing to two other bills that would very modestly increase patient access to care. One was House Bill 133 from State Rep. Toni Rose (D-Dallas). Her bill would significantly increase Medicaid coverage for people after giving birth. As of right now, post-natal Medicaid coverage for birthing parents is only for 60 days. HB 133 would increase that coverage up to a year.
Such increased access is top of the list of recommendations from the Texas Maternal Mortality and Morbidity Review Committee (MMMRC), who mentioned the need for more post-natal care in their annual report.
“MMMRC recommends that health care coverage be extended to 12 months postpartum to help identify and properly manage health conditions before they become life-threatening,” the report said. They found that 31 percent of pregnancy-related deaths happen in the post-partum period.
State Rep. Philip Cortez (D-San Antonio) also got some support for House Bill 290. It would extend Medicaid eligibility for children to twelve months without additional financial review, reducing the costly and onerous verification process many families have to do twice a year to once a year. Both HB 290 and HB 133 passed committee favorably.
Phelan threw his support behind several other health-related bills which purport to “increase the affordability of care” by offering more health insurance options including:
House Bill 3924 from State Rep. Tom Oliverson (R-Houston) – The bill would remove health coverage provided by non-profit agricultural organizations from the rules and restrictions of the Texas Department of Insurance. Practically, this means that such groups can offer coverage to employees that may not adhere to standards. Many red states have pushed such exemptions, including Iowa, and it can lead to inadequate coverage for farm workers who may believe that they have better benefits than they actually do. The bill was left pending in committee.
House Bill 3923 from State Rep. Tom Oliverson – The bill seeks to align state law regarding multiple employer welfare arrangements (MEWAs) offered by business or professional associations to their members to federal rules finalized in 2018. These rules were vacated by a federal appeals court in 2019. It was appealed, but the court ruling remains in effect. This means even if this bill were to pass today, those provisions would not be implemented. The bill also applies certain state consumer and provider protections to MEWAs if they provide comprehensive coverage; however, it does not provide consumer protection on “par with traditional coverage.” The bill still allows MEWAs to raise cost for small employers and individuals based on gender, age, size of business or pre-existing conditions. Current state law has few consumer protections in place for these types of plans with a history of fraud, abuse, and unpaid claims because of insolvencies, but those are weakened by this bill. The bill was left pending in committee.
House Bill 3752 by State Rep James Frank (R-Wichita Falls) – This is a similar bill that aims to do for small employers what HB 3924 does for farm organizations. It would allow employees to purchase Texas Mutual Health Coverage plans, which would also not be subject to the standards of the Texas Department of Insurance. This bill is also pending in committee despite the Speaker’s support.
Combined, the three bills serve as a backdoor to the return of ineffective health coverage plans that often were not adequate to cover medical expenses and would allow discrimination of people with pre-existing conditions. The creation of a federal marketplace under the ACA was supposed to eliminate these plans, as they are often considered predatory for lower-paid occupations. However, because Texas did not move forward with the Medicaid expansion, there is a significant gap between who is eligible for Medicaid under Texas’ strict guidelines and those who qualify for subsidies or plans from the federal government. The bills by Oliverson and Frank represent a step backwards for employee coverage, even as Phelan does support extending benefits for some of the most vulnerable Texans.