Democratic lawmakers have introduced a series of health-related bills in the upcoming legislative session that aim to improve access and equity in maternal, reproductive and mental health for Texans.
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Texas has both highest uninsured rate and the largest uninsured population in the country. Nearly 12% of children and a quarter of adults ages 19-64 (24.3%) in Texas were uninsured in 2021. Extend the Medicaid threshold to 138% of the poverty line would bring $15.3 billion in federal incentives to the state and qualify an additional 1.7 million uninsured residents for coverage.
Democrats have pushed for this expansion in Texas since the ACA passed in 2010, but have repeatedly encountered opposition from Republicans who have argued in previous sessions that poor management and fiscal unsustainability of the program promoted poor health outcomes and dependence on government. Texas remains one of 11 states that have opted out of expanding Medicaid programs under federal law.
The Legislature can expand Medicaid coverage through one of 3 options: an amendment to the state plan, 1115 Medicaid Waiver Amendments, or put the matter to Texas voters, which requires legislative approval by a two-thirds majority.
Sen. Nathan Johnson (D – Dallas) and Rep. Julie Johnson (D – Carrollton) have led legislative efforts on Medicaid expansion in recent years. The two lawmakers independently filed Senate and Accommodation bills for the next session which again propose to create a “Living Well in Texas” program. The state’s personalized expansion approach would use Medicaid waivers to incentivize working adults to manage their health care responsibly.
Speaking to State of Reform about his outlook for the next session, Johnson said he would pursue each of those three options this session. He added that while the level of commitment in Texas around the expansion is vastly different than it was four years ago when he first started advocating for it, his optimism about the possibility of progress is temperate.
“… if [Republicans] can find a way to announce to the public that we’re going to take this federal money, and here’s why it aligns with our ideals and goals…they need to be able to explain why this moment is distinct,” Senator Johnson said.
“In the last 10 years of rejecting Medicaid expansion, why is it okay now and it wasn’t 10 years ago? They can’t say right, because we got it wrong. So we have to be in a different place today.
The fact is, we are. We are because public support is much higher. It’s because we don’t wonder if the system will work or not. We have data from 10 years of experience in other states. We have financial incentives at levels we’ve never seen Texas ask for. Speaking of finances, [expansion] actually increases our state budget. So, is this going to be something that subjects Texas to the whims of the federal government, and I think that’s where Texas hangs in there. We don’t want the Feds telling us what to do.
The Health and Human Services Commission (HHSC) recently released a report That said, the state has taken important steps this year in the transition to value-based care.
This year, the state rolled out several quality and value-based incentive programs for Medicaid and CHIP that reward MCOs and providers for achieving high scores on important health outcomes, including efforts to to improve rural access and quality and the Comprehensive Hospital Augmentation Reimbursement Program (CHIRP), which provides increased Medicaid payments to hospitals for inpatient and outpatient services provided to individuals enrolled in STAR and STAR+PLUS.
Senator Johnson noted that while there are still issues with the Medicaid program, he thinks his managed care organizations are mostly well run.
“It would be consistent for any Republican who has opposed Medicaid expansion in the past to say that our Medicaid system was not ready to take it to the next level. But we fixed it and now it’s the If all of that happens, we skip it this session. Is that likely? No, but I have to keep pushing.
Several Democratic lawmakers have introduced bills (Senate Bill 73 and internal invoices 56 and 487) that call for extending postpartum Medicaid care from the current 6 months in Texas to 12 months and beyond.
Concerns about maternal health equity grew after the Department of State Health Services (DSHS) delayed its report on maternal mortality in September. DSHS officials are expected to release portions of the data and their recommendations to lawmakers on maternal health at the Dec. 8 meeting of the Texas Maternal Mortality and Morbidity Review Committee (MMMRC).
In response, Representative Shawn Thierry tabled several measures that address equity in maternal health, including creation of an Office of Health Equity within HHSC and the addition of another community member at the MMMRC.
Thierry proposed creating a maternal mortality and morbidity data registry that would protect patient confidentiality while sharing relevant maternal mortality information.
Representative Julie Johnson sponsors HBs 755, 756and 757all of which pertain to health plan prior authorization restrictions for chronic disease-related prescription drugs, utilization review requests, and certain health benefits, respectively.
“Not only do we have an uninsured problem, but we have an access problem for people who actually have insurance, but they’re not really able to access and use the benefits,” the rep said. Johnson. “There are a lot of unjustified refusals, and so I think those are very important for people with chronic health conditions to be able to access and get timely care.”
On the behavioral health front, Sen. Jose Antonio Menendez (D – San Antonio) filed SBs 112 and 113which propose the inclusion of a mental health course in the public school curriculum as well as the provision of on-campus mental health services by school districts that are reimbursable by Medicaid.
The mental and physical well-being of children and youth in Texas remains a primary concern after the tragic events in Uvalde.
“There is recognition regardless of ideology, that mental health is at a crisis level in our state, that [it] is underfunded in our state, especially among young people,” said Senator Johnson. “The evidence backs it up. So I think the Legislature will make a serious and concerted effort to fund mental health efforts, but also to work with the mental health community that has been doing smaller-scale field research to try to make the resources more available. .”
Senator Johnson said he would also introduce measures that would improve the school psychologist-to-student ratio and ensure that school counselors are not bogged down with substitute teaching or administrative duties, but can instead focus on the students.
Democrats have also tabled proposals regarding women’s reproductive health and rights. Joint Senate Resolution 21 proposes a state constitutional amendment establishing an individual’s right to personal reproductive autonomy, while HB 722 would establish employment discrimination protections for those who make medical decisions related to their reproductive health.
Rep. Donna Howard (D – Austin) filed HB 214, which would reinstate the Women’s Health Advisory Committee (WHAC). Howard says the committee has helped ensure the effectiveness of women’s health programs. Despite Howard’s overtime attempts in the final session, the WHAC was put out of action.
“Having service providers on the ground and having communications with the agency has allowed them to ensure that programs meet the needs we want them to meet and to identify barriers that can be resolved,” Howard said. “It was an extremely important committee, which was not allowed to continue despite the fact that I had already tabled legislation to extend the life of a committee because it was so valuable.
Unfortunately, that did not take into account the effectiveness of this particular committee. So we’ve been in communication with the vendors over the last few years, who have kept saying they have issues, they need opportunities as a group to speak with the agency and clarify them for us ensure that we have policies in place that will allow them to do their job. »
Howard said several providers and family clinics across the state have reported running out of funding for these programs since committee oversight was disbanded and have had to refuse services and fire people. She said some of the programs only serve 20% of community members who qualify for women’s health services due to lack of resources.
“Obviously it shouldn’t have come to this point,” Howard said. “Having regular communication that also includes public feedback and allows the public to engage in [women’s health] is really critical. We are again proposing that this group be reinstated in order to provide necessary input to the agency so that we can truly meet the needs of moms and babies in our state, which probably every lawmaker will tell you they support. Especially those considering being pro-life, we need to be there to protect the lives of these moms, especially the ones we will now be forcing into carrying their pregnancies.
The Texas Legislature officially meets on January 10, 2023.
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