As election season winds down and the 81st legislative session draws nearer, the focus now turns to legislative tactics and fulfilling campaign promises. Advocates of Medicaid expansion have already begun their push to extend Medicaid’s eligibility enrollment period, an effort to incrementally increase the number of people receiving subsidized health care.
In contrast, just last month, in an effort to reign in state spending on Medicaid, the federal government announced stricter guidelines on what Medicaid will cover. Texas would be well advised to follow suit and seek ways to cut Medicaid spending by reducing the public’s reliance on the program.
However, talk of extending Medicaid’s eligibility enrollment period from six months to 12 has been in the air in Austin since the legislature pulled a similar move last session that extended the Children’s Health Insurance Program (CHIP) eligibility period. That maneuver, along with other reforms, resulted in a 42 percent growth in CHIP enrollment and a dramatic increase in costs.
The growth of CHIP recipients and the growth in Medicaid recipients that would likely follow an extension of the eligibility period is the result of people remaining enrolled in government programs long after they have exceeded the income limit.
If the goal of extending eligibility periods is to increase individuals’ access to health care, then we can improve that without expanding government programs or spending taxpayers’ dollars.
The way to create more access to health care is to create a more diversified market with more points of access and more provider options.
Today, we funnel people to the highest cost provider – where either the patient pays a nominal fee and the insurance company picks up the rest, or the government pays the entirety of the bill. Why are patients getting eye exams in the hospital or paying more than $100 to be diagnosed with strep throat and prescribed medication?
What if consumers had an alternative to the highest cost provider; the “Wal-Mart” version of health care, if you will? Someone who could make the diagnosis, prescribe the medicine needed, and send you on your way for less than $50 and all in under 30 minutes.
A provider like this exists, they are nurse practitioners and physician’s assistants and many of them work in what people in the medical community call retail clinics. These clinics offer a new model of providing primary care that focuses on providing convenient patient care at low prices.
Often located in retail shopping centers and open late with no need for an appointment, they are directly responding to the demands of their consumers, many of which are the uninsured targeted by government programs.
Forty-three percent of their patients are between the ages of 18 and 24 – the population with the highest uninsured rate – and 33 percent of their patients pay out of pocket for their care, a practice unheard of at a traditional primary care provider’s office.
Unfortunately, Texas is missing out on the rapid growth of this health care option. Laws that limit the scope of practice and require strict oversight for nurse practitioners and physician’s assistants hamper the development of these clinics and limit access to care.
These clinics are a direct response to the needs of patients, but protectionist regulations aimed at ensuring job security and enforced under the guise of consumer safety are limiting Texas’ ability to adequately respond to the needs of its citizens.
These providers could also serve as way to meet the growing demand for health care providers in our state; however, additional requirements that force these providers’ to operate under the watchful eye of physicians make it difficult for these caregivers to provide services in the areas where they are most needed.
Legislators have the opportunity to give Texans the option of affordable, convenient health care by eliminating onerous state regulations. The question is, will they seize the opportunity.
Kalese Hammonds is a health care policy analyst at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin.