Here’s the deal: Texas Medicaid managed care covers 4 million Texans with the tailored coverage, care coordination, and access…

Disturbing trend: The New York Times recently added to a series of reports unravelling the financial motives behind a…

New Faces at TAHP: The Texas Association of Health Plans (TAHP) is thrilled to announce the addition of Greer…

Here’s the deal: Employer-provided coverage delivers high-quality, affordable access to care for nearly 14 million Texans, spanning across businesses…

What’s new: A recent AHIP and Blue Cross Blue Shield Association survey reveals the No Surprises Act (NSA) has prevented over 10…

Let’s dive in: While most Texans are covered through their employer, millions of Texas’ entrepreneurs, small business owners, and others…

What’s new: CMS has approved Texas as the 43rd state to extend full Medicaid and CHIP coverage for new…

Don’t Miss Out: Open enrollment for the ACA’s individual market ends on Tuesday, January 16, at midnight. This is…

What’s new: Just last week, the FDA approved a Florida proposal to purchase drugs directly from wholesalers in Canada—a…

What’s New: Starting January 1, 2024, Texas patients will benefit from new protections against surprise ambulance billing, thanks to…

What’s new? A new Texas law will significantly improve medication access for over 4 million Medicaid and CHIP patients,…

Open enrollment for individual coverage starts Nov. 1st, and Texans have more choices than ever. Leading the pack in…

What’s new: Kaiser Family Foundation released its 25th annual report on employer health benefits for 2023. After a year…

Happy Anniversary! This fall marks the 10th anniversary of open-enrollment for the Affordable Care Act’s “individual market” at healthcare.gov,…

A new secret shopper study by University of Texas researchers discovered that hospital prices posted online can be wildly…

Join us in Houston from November 6-8, 2023 for the biggest health care gathering in Texas, bringing together industry…

What’s new? Last week, the Federal Trade Commission (FTC) issued a policy statement signaling a clear warning to drug…

A new Blue Cross Blue Shield Association (BCBSA) study adds to evidence that in some cases the price for the same…

The big picture: U.S. employers heavily invest in health care, hoping their employees receive the best possible care. Too often,…

What’s new: Starting today, Texans have new protections when it comes to medical debt. SB 490 ensures patients receive…

Now that the pandemic is over, the State of Texas is reviewing the eligibility of nearly 2.7 million Texans who had their…

Today, we launched our End-of-Session Highlights Guide for the 88th Texas Regular Session, explaining all of the health care, health insurance,…

In a significant achievement for patient rights, SB 490 was signed into law this week by Governor Greg Abbott. Jamie Dudensing, CEO…

March 21, 2023 Today, the House Insurance Committee will hear HB 2021 which would apply state regulation of prescription…

The Texas Association of Health Plans supports HB 2802 and SB 1127 to expand the of use texting in…

Beginning January 28, Texans enrolled in Medicaid started receiving notice from HHSC informing them of the Medicaid unwinding. The end of continuous Medicaid coverage means millions of Texans who have not had to reapply for Medicaid in the last three years will have to go through the process soon. Members who have not signed up for alerts on YourTexasBenefits.com will receive a letter in the mail.

 A record-breaking 16.3 million Americans enrolled in ACA plans for 2023. Florida had the highest number with 3.2 million and Texas…

📲 State agencies and managed care organizations can now text Medicaid beneficiaries who provide their phone numbers anywhere on their…

This week, Sen. Drew Springer filed SB 605 which would give Texas employers the flexibility to select the best value in health insurance for their employees. It is the companion bill to HB 1001 by Rep. Giovanni Caprilione. Both bills would allow health plans to offer coverage that meets all the protections of insurance but is exempt from mandates that go beyond federal requirements.

TAHP’s agenda focuses on creating increasing affordable coverage and building on the success of Medicaid managed care in the state.

The full guide gives a comprehensive explanation of health insurance issues for the legislative session, the agenda focuses on key, proactive items.

This week, Rep. Capriglione filed legislation to give Texas employers the flexibility to select the best value in health insurance for their employees. HB 1001 would allow health plans to offer coverage that meets all the protections of insurance but is exempt from mandates that go beyond federal requirements.

TDI’s new biennial report on the state’s surprise billing law shows Texas patients are being protected from surprise billing, but that some physicians groups are misusing the law with overuse of arbitration and excessive billed charges.

88% of Texas voters say it’s important to have a strong, sustainable Medicaid program according to a new Morning Consult poll. Why it matters: Texas Medicaid provides coverage…

What’s New With the No Surprises Act? Final rules for the arbitration process of the No Surprises Act have…

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. Medicaid managed care gives Texans with complex medical needs access to caring health plan nurses that provide one-on-one support and walk families through every step of the complicated and overwhelming health care system.

Yesterday, President Biden signed broad ranging legislation that includes several major health care initiatives, including extending the enhanced subsidies for ACA health plans. First part of the American Rescue Plan Act, these enhanced subsidies help make coverage affordable for many Americans, but were set to expire at the end of this year. Under the new legislation, the enhanced subsidies will go through 2025.

As the end of the COVID-19 Public Health Emergency approaches, the Texas Health and Human Services Commission (HHSC) is actively preparing to complete a large number of eligibility and enrollment actions. Beginning as soon as mid-October, an estimated 3.7 million Texans will need to have their Medicaid eligibility redetermined. For those individuals who found themselves needing Medicaid for the first time during the pandemic, this will be their first experience with the redetermination process. 

Health plans focus not just on the health of individual members, they also invest in the health of communities. By helping to build strong communities, health plans support better health outcomes for everyone. Since the beginning stages of the pandemic, Superior HealthPlan has worked with more than 70 schools and organizations in Texas to launch and fund hygiene closets for lower-income neighborhoods. Grants to the community-based organizations hosting the closets help organizations meet people’s basic needs and create community connection.

In 2021, 34.2% of adults in Texas reported symptoms of anxiety and/or depression. Experiencing mental health challenges can have long-lasting consequences, especially for vulnerable populations. Every Texan deserves access to mental health services. Today’s Texas Medicaid managed care organizations provide a broad spectrum of screenings and treatment services for mental health conditions and substance use disorders with timely access for members and appropriate follow-up care. Managed care allows for flexibility in developing new models of service delivery that are not possible in traditional fee-for-service. 

People with health insurance have better access to care, and importantly that includes mental health care. Two recent studies show that people with insurance not only have better access to mental health services, but they are overwhelmingly satisfied with the services they receive.

In Texas, the 1115 Medicaid Transformation Waiver allows the state to expand managed care, which allows for innovations not permitted in traditional fee-for-service Medicaid. Since the inception of managed care, ensuring high-quality care for members has been the work of managed care organizations. Here are some ways Texas managed care health plans go beyond the walls of a doctor’s office to increase community access to services, reduce unnecessary hospitalizations, and improve the quality of members’ lives.

At $15.3 billion annually, Texans spend more on prescription drugs than any other state in the country. Big Pharma continues to raise prices, making lots of prescription drugs unaffordable. During the COVID pandemic alone, Big Pharma raised prices on 832 drugs. Patients are taking to Twitter to express outrage and shock at the rising price of the sometimes life-saving medicine they need.

Today it was announced that since the No Surprises Act went into effect at the beginning of the year, Americans haveavoided more than 2 million surprise bills. The law protects patients from most surprise medical bills and removes them from the middle of negotiations between providers and insurers when it comes to disputes on what should be paid. That’s the good news.

The use of emergency rooms for primary care services is decreasing, thanks to Medicaid managed care. A recent report by the Texas Health and Human Services Commission (HHSC) shows a 15.5% decrease in the number of potentially preventable emergency room visits in Texas Medicaid and CHIP programs. This is great news for both Medicaid members and taxpayers. Utilizing preventative and standard care before conditions become emergencies leads to better health outcomes and to less costly care.

Can driving just a few miles save a patient thousands of dollars? If they’re in the market for health care, the answer is yes. In Dallas, according to a recent article in D Magazine, the cost of a gallbladder removal surgery can range from $5,000 to $35,000. And rarely are prices posted online—even though they’re supposed to be.

Did you know National Nurses Week is now Nurses Month? Extended in 2020 to recognize the extraordinary efforts of nurses during the early days of the pandemic, the American Nurses Association adopted the evergreen theme “Nurses Make a Difference.” At TAHP, we want to acknowledge the positive impact Medicaid managed care nurses have on the lives of their patients.

By Jessica Lynch As the public health emergency winds down, millions risk losing Medicaid coverage, not because they no…

by Jamie Dudensing and Alicia Pierce A recently announced change to the administration of the Affordable Care Act will…

By: Jessica Lynch and Alicia Pierce In an essay in the New York Times, health care expert Elisabeth Rosenthal…

New Census Data reports show that Texas still has the highest uninsured rates in the nation at 17.3 percent— a full 3 percentage points higher than the state with the next-highest uninsured rate, Oklahoma. Why does this matter? Because study after study shows that when families have health care coverage, they have better health care outcomes. Texans with insurance are more likely to receive preventative, primary, and specialty care services. 

There is a new billing scheme that is misleading Texas patients with  hidden costs—facility fees. These excessive hospital based fees, often in the thousands of dollars for very basic services, have long come under criticism from patients and consumers for creating surprise medical bills that Texans cannot afford. But, it’s not only hospitals that are charging these hidden fees anymore. The out-of-control expansion of these unreasonable fees is driving up the cost of premiums and out-of-pocket costs for Texas families and employers.

Throughout the COVID-19 pandemic, Texans have been tricked into a new type of health care price gouging – outrageous COVID-19 testing.

February 11, 2022 Jamie Dudensing Today, the Texas Association of Health Plans formally announced that Jessica Lynch will join…

Physician groups are facing far-ranging opposition in their lawsuit to overturn rules implementing new surprise medical billing protections. Opponents to the physician-led attack on the new law now include employer coalitions, unions, patient and consumer groups, health policy experts, and essentially any group that cares about controlling health care costs.

A record number of Americans signed up for health care coverage through Affordable Care Act marketplaces at the same time a number of new plans joined the market. About 14.5 millions Americans signed up for an ACA plan during the enrollment period that ended January 15. That’s 2 million more than ever before.

By: Madeleine Richter-Atkinson, Jamie Dudensing Social isolation, defined as having few relationships or infrequent social contact, was a common experience in…

Starting January 15, individuals with private health insurance will have coverage for up to eight at-home COVID tests per month, per covered family member.

Looking for some good news to start the year? We’ve got you covered. After a years-long debate, the end of unfair and outrageous surprise medical bills is finally here.

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.

AUSTIN—Texas Association of Health Plans (TAHP) CEO Jamie Dudensing issued this statement following the Texas Department of Insurance’s adoption of a rule establishing a process for an employer group or association to sponsor an employee health benefit plan:

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 are committed to curbing the virus and helping Texans receive the care they need from the safety of their homes — including waiving out-of-pocket costs for telehealth and expanding telehealth programs.

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 are committed to curbing the virus and helping Texans receive the care they need from the safety of their homes — including waiving out-of-pocket costs for telehealth and expanding telehealth programs.

The COVID-19 pandemic has posed unprecedented challenges for Texans and our nation, touching every facet of American life. In face of these challenges, TAHP and our members are doing all we can to keep Texans safe while providing continued support to and reducing burdens on patients and health care workers alike. Listed below are some ways health plans are proactively working to care for Texans and help them get access to the services and resources they need to stay healthy during the pandemic.

The COVID-19 pandemic poses unprecedented challenges for Texas and our nation, touching every facet of American life. During this crisis and into the future, Medicaid Managed Care Plans are connecting Texans to the personalized care and support they need to stay healthy and live their lives to the fullest. Learn more about how Texas Medicaid Managed Care Plans are responding to COVID-19.

oday on Veteran’s Day, we honor all those who served our country. We celebrate and honor America’s veterans for their patriotism, love for our country, and willingness to serve and sacrifice for the common good. 

COVID-19 crisis remind us of the value of affordable health insurance coverage and the peace of mind it brings to Texans and their families. The COVID-19 crisis has also provided many examples of problems with health care costs that plague Texas, such as questionable billing practices and price gouging. The New York Times, ProPublica, Politico, and other media outlets repeatedly turn to Texas when reporting on the worst examples of these problems.

Today marks 100 days until the beginning of Texas’ 87th Legislative Session. Last year, we had great success advocating for and passing several pieces of legislation that protect Texans from the high costs of surprise billing, expensive drug prices, and price gouging at freestanding emergency rooms, but our fight for more affordable, comprehensive health care isn’t over.

The seasonal flu is a serious illness that results in half a million hospitalizations and 30,000-50,000 deaths every year. With the ongoing threat of COVID-19, this flu season is expected to be more severe than usual. Texas health insurance providers are covering the vaccine with no patient cost-sharing and encouraging everyone — particularly older Texans, communities of color, and others who are more vulnerable to the flu’s worst outcomes — to get their flu vaccine.

The COVID-19 pandemic poses unprecedented challenges to Texas and our nation, touching every facet of American life. Since the beginning of the COVID-19 pandemic, Texas health insurance providers have been fully committed to helping solve this crisis, including waiving out-of-pocket costs for telehealth and expanding telehealth programs, so that Texans can access the care they need from the safety of their own homes.

On Saturday, the national investigative journalism organization ProPublica published its second article in the past month highlighting how freestanding emergency rooms are price gouging Texas patients for COVID-19 tests. This time, Physicians Premier ER in Austin charged one of its own doctors nearly $11,0000 for a test.

Last month Chron.com reporter Alison Medley wrote an article about Laurie Delgatto-Whitten, a woman who received a $3,000 medical bill after visiting a drive-thru COVID-19 test site in Spring operated by United Memorial Medical Center.

touching every facet of American life. During this crisis, Managed Care Plans are connecting Texans to the personalized care and support they need to stay safe and healthy and to live their lives to the fullest.

touching every facet of American life. Texas health plans are heavily invested in the health of the Texas communities in which we live and serve, and we are doing all we can to keep Texans safe and support our provider partners. Learn more about how Texas health plans are taking action to help Texans get access to the prevention, testing, and treatment they need to stay healthy.

The COVID-19 pandemic poses unprecedented challenges to Texas and our nation, touching every facet of American life. In the face of these challenges, Texas health plans are committed to curbing the virus and helping Texans receive the testing and care they need to stay healthy—including eliminating out-of-pocket costs for Texans by covering COVID treatment and testing at no cost and expanding access to telemedicine. The health and well-being of millions of Texans is our highest priority.

AHP sent a letter to state officials opposing the Texas Association of Freestanding Emergency Centers’ (TAFEC) recent request for a waiver or rule change that would allow them to provide non-emergent care, including COVID-19 testing. Under their current licensure, freestanding emergency rooms (FSERs) may only provide medical care in emergency situations.

Over the weekend, national investigative journalism organization ProPublica published an article demonstrating how freestanding emergency rooms are price gouging Texas patients. In this case—as in hundreds of others around the state—a freestanding ER billed a Houston woman $2,500 for her son’s drive-thru COVID-19 test. The test itself was only $175, but the facility tacked on $2,300 in unnecessarily high facility and physician fees.

HOUSTON — Some consumers who thought they were getting a simple COVID-19 test instead got a surprise bill charging their insurance company thousands of dollars. The Texas Association of Health Plans called it a dangerous new trend from a small number of providers.

The COVID-19 pandemic is highlighting the importance of health coverage when it comes to financially protecting Texas families from our state’s high health care costs. Texas already had the highest percent of uninsured residents  and some of the highest health care prices in the country—now, both of those problems have been exacerbated by the coronavirus.

TAHP, its member companies, and our employees are heavily invested in the health of the Texas communities in which we live and serve, and we are fully committed to meeting this challenge. Texas health plans are working to help contain the virus, ensure people have coverage for and access to needed testing, and help patients who are infected receive the care and treatment they need.

TAHP Statement on Commitment to Work with Gov. Abbott and State Leaders on Coronavirus Response

The Texas Association of Health Plans, its member companies, and our employees are heavily invested in the health of the Texas communities in which we live and serve, and we are fully committed to meeting this challenge. Texas health plans are working to help contain the virus, ensure people have coverage for and access to needed testing, and help patients who are infected receive the care and treatment they need.

A group of health sector stakeholders has launched a new learning collaborative designed to help Texas Medicaid health insurance plans develop and implement strategies to address the non-medical, root causes of poor health for patients across the state. The 12-month project will focus on access to healthy food, housing conditions, transportation, and other social factors that often have a direct impact on a person’s health.

The Texas Association of Health Plans recently delivered the below letter to each member of the Texas Congressional delegation urging them to act swiftly to delay the Health Insurance Tax

AUSTIN—The Episcopal Health Foundation, Texas Association of Health Plans, and Texas Association of Community Health Plans jointly launched the Texas MCO Social Determinants of Health Learning Collaborative this week to develop and implement new ways to address social determinants of health (SDOH) in Texas.

State and national legislators recently turned their attention to an issue that truly needs it: surprise medical billing. Insurers, physicians, and politicians agree we must protect patients from surprise billing in situations where they receive care from a provider they did not specifically choose, such as when they are treated by an out-of-network ER doctor during an emergency.

Surprise medical bills are a major problem nationally, and almost everyone agrees patients must be protected from receiving them. Surprise billing typically occurs in situations where patients receive care from a provider they did not specifically choose, such as when they are treated by an out-of-network ER doctor during an emergency. After treatment, the provider sends a bill to the patient’s insurer, which pays what it determines is appropriate based on market rates. Once the provider receives payment from the insurer, they may send a bill for the remaining balance to the patient. This final bill is called a surprise bill and can saddle patients with unexpected medical bills for thousands or tens of thousands of dollars.

AUSTIN – Consumer credit reporting agencies are now prohibited from including medical debt collection accounts in consumer reports thanks to Senate Bill 1037 by Sen. Larry Taylor, R-Friendswood, and Rep. Eddie Lucio III, D-Brownsville, which was signed Friday by Gov. Greg Abbott. The law takes effect immediately and represents a major step in protecting consumers from the long-lasting damage that can result from surprise billing in Texas, where patients are at an uncommonly high risk of receiving expensive surprise bills.

AUSTIN—The Texas Legislature acted today to keep prescription drug costs down by passing HB 2536 by Rep. Tom Oliverson, R-Cypress, which requires drug pricing transparency by drug manufacturers, health plans and pharmacy benefit managers (PBMs).

Too often, government programs make headlines due to inefficiencies and cost overruns. But what if the state could adopt a program with a decades-long track record of containing health care cost growth to rates four times lower than national averages, while improving clients’ quality of care? While that may sound too good to be true, Texas was one of the first states to embrace this initiative, known as Medicaid managed care.

Jordan is now a senior at McAllen High School, but has come across some challenges getting to class, as he is also a member of his school’s band.

The facilities aim to add convenience by allowing patients to be seen faster than in full-service hospitals’ ERs — where overcrowding has been an issue — and by making emergency care more accessible in areas without a hospital nearby.

LAKEWOOD, Colo. (CBS4) – Coloradans who need medical treatment often walk into free-standing emergency rooms thinking they are simply urgent care facilities or clinic and they don’t realize what the visit will cost them. When the bill arrives, they owe thousands of dollars.

House Insurance has scheduled a hearing next week on Wednesday December 6th to hear all of its health care-related charges. These includes charges on stabilizing the health insurance market in Texas, balance billing, prescription drug coverage and PBM transparency. The posting can be found here.

On behalf of all major commercial and public health plans operating in Texas, including all plans that manage the Children’s Health Insurance Program (CHIP), the Texas Association of Health Plans (TAHP) is writing you today to strongly urge you to work with your colleagues to pass legislation reauthorizing CHIP—or risk 380,000 Texas children losing their health care coverage. Now six weeks since the missed October 1 deadline, funds that states—including Texas—are using to keep CHIP afloat will soon expire, threatening this life-saving program for one of our country’s most vulnerable populations

It had happened so fast, a moment of play turned to blood and panic. Just before lunch 7-year-old Ava was on the floor with the family’s German shepherd. Pettit held out a pizza roll, but the dog lunged just as his daughter popped it in her mouth. Two holes opened in the little girl’s face where the dog’s teeth had been and she started to scream.

AUSTIN—The Texas Association of Health Plans (TAHP), the statewide trade association representing commercial and public health plans operating in Texas, today issued the following statement in response to the Trump Administration’s decision, announced late last night, to end funding for Cost-Sharing Reduction (CSR) benefits for millions of Americans:

The Texas Association of Health Plans (TAHP), the statewide trade association representing commercial and public health plans operating in Texas, including all Medicaid managed care organizations that manage the Children’s Health Insurance Program (CHIP), today issued the following statement urging Congress to act immediately to reauthorize CHIP or risk 380,000 Texas children losing their health care coverage. As of Oct. 1, Congress allowed CHIP to expire by failing to reauthorize funding for the program by the Sept. 30 deadline. CHIP provides low-cost health coverage to roughly 9 million children across the country.  

ov. Greg Abbott is making major changes in his office after his first two regular sessions — and a special session — bringing in several new senior staffers with deep legislative experience, according to aides.

oday, the Texas Association of Health Plans, sent the below letter on behalf of all health plans operating in Texas, to U.S. Senators and Representatives of the Texas Congressional delegation urging them to act swiftly to delay the onerous Health Insurance Tax. A copy of the letter can also be found here.

It’s been more than a week since Harvey ravaged the Texas Coast and left Houston — the nation’s fourth-largest city — grappling with unprecedented flooding. Do you need help? Or do you want to help those in need? Check out the resources below.

Texans enrolled in Medicare that had medical supplies that were lost or damaged due to Hurricane Harvey will have access to an altered set of rules for a short time.

The Texas Association of Health Plans (TAHP), the statewide trade association representing commercial and public health plans operating in Texas, today shared a growing list of its members’ efforts to assist Texans who were impacted by Hurricane Harvey. TAHP members serve more than 17 million people in Texas, and more than 50,000 of their employees call Texas home. Health plans and related entities in Texas are responding to the storm, both in the form of donations to relief efforts and also in offering 24-hour hotlines, free consultations with telemedicine physicians, assistance with emergency prescription refills and medical equipment, and more. 

The Texas Department of Insurance is urging health insurers in Texas to loosen restrictions and show flexibility for people who have already sought or may need medical or mental health treatment in coming weeks.

The 85th Legislative Session has come to a close, and the Texas Association of Health Plans is pleased to report on a number of important achievements made possible through comprehensive communications, education, and advocacy strategy carried out in coordination and collaboration with each of our members.

The Texas Association of Health Plans (TAHP), the statewide trade association representing commercial and public health plans operating in Texas, today applauded Senate passage of Rep. Tom Oliverson’s HB 3276, which requires independent freestanding emergency rooms in Texas, which are almost all out-of-network for insured Texans, to be more transparent and upfront with patients about their network status. HB 3276 now heads to the Governor for his signature.

HHSC has released the Fact Book for 2017, which provides overview of Medicaid programs and caseloads and the 11th Edition of Medicaid/CHIP in Perspective (aka The Pink Book). You can view the Pink Book here.

HB 1917 (attached) was filed this week by Raymond, Zerwas, and Four Price. The bill extends the sunset date of the state run VDP Medicaid formulary to 2030. Current statute gives MCOs full control of the formulary in 2018. TAHP is strongly opposed to this bill and has begun making visits to share reasons for opposition. See our one-page legislative guide on the benefits and savings that will be achieved by transitioning the formulary to MCO management here.

The Texas Association of Freestanding Emergency Centers (TAFEC) issued a press release this week claiming 3,400 requests for mediations in Texas are complaints and have resulted in $750,000 in payments to providers as a result of underpayment by insurance companies. Here is a link to the report requested by Rep. Workman from TDI. TAFEC failed to mention that these 3,400 mediation requests to challenge surprise bills from providers totaled more than $6 million in billing and the ultimate result is that consumers were protected against more than $5 million in over-billing by providers. It is also important to note that as it stands, consumer mediation protections do not apply to FSERs. TAHP pointed out these discrepancies to the Dallas Morning News this week; stay tuned for a piece running later this week.

his week HHS released a proposed rule that takes steps aimed at stabilizing the individual and small group health insurance markets. The proposed rule “would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.” Read more from AHIP here.

.HAC started meeting this week with presentations by the Legislative Budget Board. On Wednesday the LBB provided an overview of Medicaid. Total Medicaid funding in the 2016-17 adjusted base is $26.3 billion GR and $64.6 billion in AF. This includes an estimated $1.2 billion in GR funds above the 2016-17 Budget to complete fiscal year 2017 expenditures, which includes revenue adjustments, transfers, and assumed supplemental funding. House Bill 1, as introduced includes $27.0 billion in GR funds and $65.5 billion AF for Medicaid in 2018-19, which is an increase of $0.7 billion in General Revenue-Related Funds and $1.0 billion AFs. The committee had many questions about Medicaid managed care, capitation rate setting and savings, and STAR Kids. TAHP staff immediately started meeting with offices to educate them on the value of managed care and will continue meetings over the next several weeks.  LBB Recommendations for HB 1 can be found here.

This week, TAHP, TAB, TALHI, TAHU, and TORCH launched a coalition to raise awareness about freestanding ERs, their exorbitant pricing and misleading advertising that are confusing consumers and contributing to a serious emergency care cost crisis in Texas. Texans For Affordable Healthcare (TAHC), a healthcare advocacy coalition, seeks to educate the Legislature and Texas consumers about the non-transparent, anti-consumer tactics frequently used by freestanding emergency rooms, as Texas is home to more than half the nation’s FSERs. TAHC will be reaching out to Texans who have experienced surprise bills and confusions at FSERs and are willing to share their stories with others and the Legislature. Our coalition is seeking the following solutions to better protect consumers: