For many of the five million uninsured Texans, our state’s health care safety net is their routine source of health care and final life line. Although critically important for these Texans, it’s worth asking, “why is a safety net the first and only option for so many Texans?” Proponents of safety net only policies fail to realize that safety net care should be a last resort, not a plan for a healthy Texas.

As we near the January 1, 2022 start date of the wildly popular new law to end the egregious practice of surprise medical bills, debate over the details has heated up. Following the release of interim final rules in October, the same physicians that initially fought to preserve the practice of sending patients unexpected bills are now complaining over the details of how they’ll be paid.

Experts agree that as much as 80% of a person’s health is determined by factors outside of direct medical care, including where they are born, grow, live, and work. To encourage better outcomes, health plans are working in communities to help address social barriers to good health, including the need for access to reliable and affordable transportation.

Today, the Texas Association of Health Plans (TAHP) announced that Blake Hutson is joining the team as Director of Public Affairs.

This week kicks off the open enrollment period to purchase health insurance through an ACA marketplace or exchange for 2022 coverage. Uninsured Texans may be surprised by the new options and affordable rates available to them. With new plan providers, increased subsidies, and help finding the best plan, this could be the most important open enrollment period in Texas yet.

Experts agree that as much as 80% of a person’s health is determined by factors outside of direct medical care. Whereas the conditions in which people are born, grow, live, and work — known as social determinants of health (SDOH) — play a much greater role. To encourage better outcomes, health plans are working in communities to help address SDOH, including the need for education.

Freestanding ERs made headlines again as a new report of a COVID test more expensive than a Tesla surfaced and another report of COVID test price gouging came out of Houston.

The third special session of the Texas Legislature wrapped up this morning shortly after midnight. This morning, the Legislature voted for the final passage of SB 8, which came out of conference yesterday and appropriates $16 billion in federal COVID relief funds from the American Rescue Plan Act (ARPA).

Experts estimate that direct medical care affects only 15-20% of a person’s overall wellness, whereas the conditions in which people are born, grow, live, and work — social determinants of health (SDOH) — play a much greater role. To encourage better outcomes, health plans are working in communities to help address SDOH, including the need for gainful employment.

Experts estimate that direct medical care affects only 15-20% of a person’s overall wellness, whereas the conditions in which people are born, grow, live, and work — social determinants of health (SDOH) — play a much greater role. To encourage better outcomes, health plans are working in communities to help address SDOH, including the need for healthy food.

Experts estimate that direct medical care affects only 15-20% of a person’s overall wellness , whereas the conditions in which people are born, grow, live, and work — social determinants of health (SDOH) — play a much greater role. To encourage better outcomes, health plans are working in communities to help address SDOH, including the need for safe, secure housing.

hroughout the day to maintain a healthy lifestyle—nutritious meals, regular physical activity, access to medical care and pharmacies, clean drinking water, and the opportunity to get a good night’s rest.

The 87th Regular Session of the Texas Legislature began in the midst of a pandemic that made health care and health care policy a central part of almost every debate. Not only did we see creation policies responding to the COVID pandemic, but we also saw greater emphasis on all areas of health care policy and what it means for Texans.

In the summer of 1965, President and Texan Lyndon Johnson signed the law that would put Medicaid into effect. Fifty-six years later, Medicaid is an essential program for the health of many Americans. In Texas, Medicaid connects more than 4 million Texans with the greatest medical needs to health care and coverage.

Today, the Texas Association of Health Plans released its agenda for the upcoming Texas Covered Conference + Expo, which will be held November 8-10 in Austin, Texas.

Act, which was adopted in December to provide patient protections against surprise billing.

In response to the pandemic, the Biden Administration created a special enrollment period for Americans that started on July 1 and runs through August 15. This gives consumers additional time to shop for coverage and to take advantage of new savings through the American Rescue Plan.

A recent external study showed that Texas’ STAR Kids program beats national benchmarks in the majority of areas. These areas include getting needed care (66% compared to 61%), positive customer experience (76% to 68%), specialist rating (82% to 74%) and access to prescription medications (75% to 69%).

Last month, AHIP, the national organization for health plans, released state-by-state data breaking down employer-sponsored health coverage in each state. In Texas, almost 13.5 million Texans were covered by an employer-sponsored plan, the way the majority of Texans (52%) have health insurance coverage.

Like every session, the 87th Texas Legislature was full of action and surprises. Throughout the 140 days of the regular session, Texas Association of Health Plans was monitoring and actively participating every step of the way, all with the goal of helping our members as they endeavor to make Texas a healthier place.

Throughout the COVID-19 crisis, Texas has seen a dangerous trend of outrageous bills for COVID-19 testing, including numerous bills over $10,000. Most of these excessive bills are often tied to freestanding emergency rooms. Not only do these facilities overcharge for the test, they often pile on thousands of dollars in physician, facility, and observation fees. In many of these cases, Texas patients received drive-thru testing, where no medical care was delivered other than a simple COVID test.

Covered Conference + Expo that will take place in person in Austin (COVID permitting) from November 8-10. The conference is the largest event of its kind in Texas and brings together decision-makers from across the health care spectrum—from major health plans, providers, and regulators, to legislators, journalists, academics, and more.

June 7, 2021 One week ago today, the 87th Texas Legislature completed the regular session. This Medicaid Monday we’re…

A recent survey of small business owners provides a warning for policy makers. Nearly one in three small business owners that provide health coverage to employees has considered dropping it—the vast majority because costs are too high.

May 24, 2021 The managed care model has transformed Texas Medicaid from a disjointed, ineffective system to a more…

When people visit a hospital, they are often in the most vulnerable position of their lives. They need to be able to trust that tests and treatments ordered for them are both safe and medically necessary.

In the last decade, Medicaid managed care transformed Texas Medicaid into a more efficient and effective system that helps Texans live healthy and full lives. The COVID-19 crisis has highlighted how managed care can respond to patient and community needs beyond what is available through a fee-for-service model.

heduled to hear two bills that would allow “insurance-like” products that would create instability in the market, drive up premiums, and expose Texans, particularly those with pre-existing conditions, to significant liabilities.

Thursday kicks off Nurses Week, which runs from May 6 through 12 this year. While all nurses deserve to be celebrated, TAHP would like to highlight a special group of nurses in Medicaid managed care. Texans with complex medical needs in Medicaid have access to health plan nurses who provide one-on-one support and walk families through every step of the complicated and overwhelming health care system.

When members of the Texas Legislature consider a bill, they often consider the fiscal note (an estimate of what new legislation would cost the state) to weigh the costs and benefits of the legislation and make a decision. But when it comes to health care, legislators also need to understand the financial impact new health insurance mandates have on Texas employers and families.

While the Texas Legislature has devoted considerable resources to combating fraud, waste and abuse in the state’s Medicaid program, little has been done to combat the same issues in the commercial insurance market where abuse is 50% more prevalent and costs $75 billion more than in Medicaid.

Today’s Texas Medicaid health plans provide more than health care coverage—they connect Texans to the personalized care and support they need to stay healthy and live their lives to the fullest. Texas Medicaid health plans also provide services that go beyond the walls of a doctor’s office, including helping with transportation, coordinating meals, helping with housing and navigating challenges at school and work.

As the old joke goes, drug dealers always offer you the first hit for free because once they get you hooked, you’ll be back for more and willing to pay. When similar incentives are offered by Big Pharma for high-priced prescription drugs, the joke’s on patients and employers who pay for health coverage.

Today’s Texas Medicaid is more than health care coverage—it connects Texans to the personalized care and support they need to stay healthy and live the fullest lives possible while creating efficiencies that benefit everyone.‍

Over the past 20 years, Texas has transformed an outdated Medicaid system that provided fragmented care into a modern, patient-centered health insurance program providing more than 4 million Texans with the coverage and care they need.

Texas taxpayers and patients. Drug costs had almost doubled from 2001 to 2011, and patients received fragmented care that didn’t produce the most efficient or effective results.

Every Texan deserves the best health care possible—that means ensuring their care is safe, effective, and clinically appropriate. Prior authorization (PA) is the most important tool health insurance providers have to get patients that care. It reduces inappropriate care by catching unsafe or low-value care and targeting care that is not consistent with the latest medical recommendations—both of which contribute to potential harm and unnecessary costs for patients.

The COVID-19 crisis poses unprecedented challenges to Texas and our nation, touching every facet of American life. In the face of these challenges, Texas health insurance providers, Medicaid managed care plans, and Medicare Advantage plans are taking decisive actions to help patients and curb the spread of the virus,

Access to care is an essential part of any health care delivery system, and the Texas Medicaid program is no exception. Like private health insurance, Texas Medicaid managed care organizations (MCOs) establish a network of providers to connect Texans to the personalized care and support they need to stay healthy and live the fullest lives possible. As a result, Medicaid managed care allows Texans on Medicaid to access and choose from a variety of doctors and hospitals in their area.

AUSTIN – The Texas Association of Health Plans supports House Bill 2029, which was heard yesterday in the House Public Health Committee. The bill, by Chair Stephanie Klick, will remove unnecessary and outdated mandates that are preventing Advanced Practice Registered Nurses (APRNs) from providing more health care access and options to Texas Patients.

throughout the COVID-19 crisis, Texas health plans and Medicaid health plans have expanded access to care by encouraging and expanding telehealth services and waiving cost sharing, helping Texans receive the care they need from the safety of their homes. The crisis brought with it an explosion in the use of telehealth across Texas—regardless of patient age and type of health insurance. So far, telehealth appears to be fulfilling its promise as a significant part of the health care system.

The Texas Association of Health Plans opposes House Bill 907, which creates a new, unfunded health insurance mandate that prohibits preauthorization requirements for all drugs prescribed to treat a chronic or autoimmune disease. This would eliminate most prior authorizations for prescription drugs. HB 907 is scheduled to be heard in the House Insurance Committee on Tuesday, March 16.

Throughout the COVID-19 Crisis, health plans have done their part to help Americans get and stay healthy. Now, they are helping to increase vaccinations, especially for the most vulnerable populations who may have the toughest time getting to vaccine sites.

insulin has been around for decades, but no generic alternatives exist. That is because the pharmaceutical companies that control the market make small tweaks to extend the patents—gaming the system, artificially inflating prices, and keeping generics off the market. Even though the original patent for insulin was bought for only $1 a hundred years ago and the average cost to produce insulin is only about $6 a vial, the average price of insulin has grown by more than $300 a vial in the last 20 years.

There are opportunities for Texas lawmakers to help lower the cost of health insurance for Texas families and employers, but broadly eliminating prior authorizations is not one of them. Unfunded government mandates that eliminate prior authorizations undermine important patient protections and drive up the cost of health coverage for Texas employers.

In a recent op-ed published by the Dallas Morning News, Bill Hammond, chief executive of Texas Employers for Insurance Reform, outlined one of the biggest problems faced by employers today: the rapidly increasing cost of health care.

As Texas Legislators meet to consider changes to Texas law, many are understandably upset about the practices of free-standing emergency rooms (FSERs). News stories of $10,000 COVID tests from FSERs have populated the headlines for months, and many want to take action.

The COVID-19 crisis reminds us of the value of affordable health insurance coverage and the peace of mind it brings to Texans and their families. Medicaid managed care has played a key role in helping provide coverage during this economic and health care crisis. Texas Medicaid managed care plans cover medical expenses, coordinate complex medical care, and help Texans stay as healthy and active as possible—all while providing caring, compassionate one-on-one support. The focus on prevention, wellness, and care coordination—getting Texans the care they need to get healthy, stay healthy, and live in their communities—has translated into better care and lower costs. As a result, millions of Texans—including children and pregnant moms—have seen improved outcomes and Texas taxpayers have saved over $5 billion.

While Big Pharma is posting record profits, too many hardworking Americans have to choose between paying their bills and accessing life-saving medicines. Today, more than 21.5 cents of every health care dollar still go to pay for prescription drug costs—more than any other health care expense. That’s why TAHP is prioritizing health insurance provider and PBM efforts to lower drug prices this legislative session.

The COVID-19 crisis has underscored just how important it is for Texas to address our systemic health care provider shortage. Before COVID-19, over 7 million Texans were already experiencing shortages of primary care and over 15 million Texans were already experiencing a shortage of behavioral health care. During the 87th Session, the Texas Association of Health Plans will be advocating to increase affordable access to high-quality health care through more options, better quality, and lower costs.