The Texas Public Policy Foundation’s Right on Health Care campaign announced its reform agenda to give patients more control of their health care decisions. By focusing on patient-centered reforms, Texas can make prescription drugs more affordable, increase access to medical professionals, open up new models for delivering care, make pricing more transparent, and allow insurers and employers more flexibility in designing coverage options.
“Texas made great strides toward putting patients back in control of their health care decisions in the last legislative session,” said Right on Health Care Director David Balat. “Our agenda builds upon that success and goes even further in opening up new models for coverage, cutting out the middlemen driving up drug prices, and increasing access to physicians and other health care providers.
“We’re going to protect the rights of patients in billing disputes,” Balat added, “and make sure they have pricing information before they receive services. We want to give patients as many choices as possible by letting states take control of their ACA exchanges, approving licensure reciprocity for physicians and nurses, and helping under-served and rural areas get better access to care.
“Texas has a tremendous opportunity to be the national leader in patient-centered health care reform and to set the example for states around the country.”
TPPF’s Right on Health Care Agenda:
Allow doctors to provide drugs directly to patients. Texas should allow physicians to directly provide medications to patients in order to cut down wait times at pharmacies, improve patient health by increasing adherence rates, and lower costs by reducing the use of emergency care if they’ve had an adverse reaction. This model has proven to enhance adherence by patients and we believe there is a way physicians and independent pharmacists can make this model a reality this upcoming session.
Create association health plans. Texas should allow individuals and small groups to form an association for the purpose of spreading risk for a large group plan. Large group plans enjoy lower rates and better benefits due to the distributed risk, and these benefits may be enjoyed by independent contractors and gig workers alike who choose to form or join an association.
Approve licensure reciprocity for physicians and nurses. Texas already has more than 20 health care license reciprocity laws that allow for an increase in certain providers. Allowing out-of-state physicians and nurses to practice in Texas will open options for patients to get the kind of care they want and need, particularly considering strained facilities due to COVID-19.
Give patients pricing information prior to scheduled services. Patients rightly believe that receiving pricing information before they make health care decisions will lead to lower costs and better care, and will help them avoid surprise billing. Quick access to services, like COVID-19 testing, helps get patients healthier sooner, but patients need to know that exorbitant bills aren’t waiting for them after being treated. Texas should make it mandatory for medical providers and facilities to give patients the price for non-emergency procedures and treatments before performing them.
Protect patients from payment discrimination. Texas should ensure that a patient has the right to obtain funding for payment in whatever manner they choose. A health care provider may not prohibit an uninsured or cash pay patient from seeking funds from any third party that is not an insurance company or a health plan in exchange for a discount or cash price.
Strengthen patients’ rights in third-party negotiations. Texas should guarantee that a patient has the right to timely authorization of a third party to negotiate bills. A health care professional must, within five business days of a patient’s written request, authorize a designated third party to discuss an account or negotiate a bill on behalf of the patient. A health care provider may not send or threaten to send to collections a bill that is under a good faith negotiation with the patient or an authorized third party.
Approve licensure or pathway for assistant physicians. Texas should allow medical school graduates who did not match with a residency to practice and be reimbursed under a collaborative agreement, and to practice only in medically under-served rural or urban areas.
1332 waiver implementation. Texas should request a 1332 waiver, a component of the Affordable Care Act, that allows states to take control of their exchange and design the offerings with more flexibility consistent with the needs of the state.