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2019 Health Care Task Force Report

I. Introduction

Healthcare is one of the most personal issues that we as human beings face and, as such, is an issue that ignites fiery political and philosophical debates. From the degree to which the government or a third- party entity should be inserted in between you and your doctor, to birth and complex end-of-life care decisions, it touches every facet of our society regardless of gender, race, ethnicity, or socioeconomic status. And, although individuals may have very different experiences within the healthcare system depending upon geography, fitness level, and myriad other factors, one shared experience that has affected virtually every American is its ever-increasing costs.

The purpose of the following chart, developed by the American Enterprise Institute, was to depict price changes in US consumer goods and wages over the past 20 years. And while it is very helpful on that front, it also paints a disturbing image of America’s healthcare cost trends, with “medical care services”on par with childcare and outpacing hourly wages, housing, and sustenance, while the growth in the cost “hospital services” outranks every single category on the chart.

This rate of escalation simply isn’t sustainable and, based on current trends, is not headed toward any kind of course correction. The total cost of healthcare in the U.S. reached $3.3 trillion in 20162 and, according to the federal Centers for Medicare and Medicaid Services (CMS), is projected to grow to an astounding $5.7 trillion by 2026.3 A multitude of factors have contributed to this meteoric rise- some are positive, such as longer life expectancies- while others, such as rising costs of prescription drugs, larger segments of the population with chronic conditions such as diabetes and heart disease, and intrusive government mandates- are not.

The challenges facing our healthcare system did not happen overnight, nor will they be solved that way, but the enormity of this task cannot be delayed any longer. While there are no “quick fixes” to theseseemingly insurmountable issues, there are reforms that state leaders can adopt. To that end, the Texas Conservative Coalition Research Institute’s (TCCRI) Task Force on Health and Human Services metmultiple times over the last 18 months to explore policy solutions focused on two key principles: lower healthcare costs and raise patient outcomes. Over the course of the past interim, TCCRI staff met with the Task Force’s legislative co-chairs, legislative staff, and interested private sector stakeholders to discuss crucial public policy issues within the Task Force’s purview.

The “Healthcare Reform” section of this Report delves into the latest Affordable Care Act (ACA) ruling from December 2018 which, if it stands, would strike the law down in its entirety. This section also discusses reforms that the Legislature should consider in both the private and public health care sectors in the 86th Legislation Session as this lawsuit continues to work its way through the legal system- policy initiatives which TCCRI has continued to champion for many years. Within the private sector, these reforms include rolling back, and rejecting any new, unfunded mandates; passing an option for a catastrophic coverage plan free of state-mandated benefits; and rejecting additional regulations on association health plans (AHPs). The public sector discussion focuses on the Medicaid program and changes that are within the jurisdiction of state leadership, such as pursuing a block grant waiver from the federal government, structuring Medicaid to function more like private insurance, injecting greater personal accountability into the taxpayer funded program, staying the course on the state’s current useof Medicaid managed care, and continuing the move to outcomes-based payments within the managed care system.

The “Price Transparency” section of this Report is largely adapted from the white paper TCCRI released late last year on the advantages of a more transparent healthcare system. Specifically, the Task Force recommends that the Legislature pilot a model known as Right to Shop in the Texas Employees Retirement System (ERS). More broadly, the legislature must ensure that any transparency initiatives apply to all facets of the healthcare system, and not target only certain providers or entities.

With respect to the “Teacher Retirement System” (TRS) section, this Report recognizes the ongoing challenges faced by TRS, particularly in the Medicare coverage of its retirees and their dependents. Here, TCCRI recommends studying an idea that has merits in almost any publicly-funded system- examine the feasibility of allowing TRS-Care consumers to use funds the government would have spent to purchase their own lower-cost private health insurance products.

In the “Increasing Access to Care” section, this report explores Texas’ well-documented physician shortage and discusses non-physician providers that can help fill access to care needs in both the medical and dental fields. Policy recommendations include allowing the independent practice of advanced practice registered nurses, exploring how physician assistants and pharmacists can be better utilized to meet patient need, allowing dental hygienists to administer local anesthesia under the delegation of a licensed dentist, and increasing access to teledentistry services.

The “Opiates” section looks at data related to opiate-related prescriptions and deaths specific to Texas, steps the state has taken to curb inappropriate prescription drug use, and examines electronic prescribing of controlled substances.

This final Task Force Report lays out the public policy issues that the Task Force and TCCRI staff focused on over the past interim. The recommendations made in this final Report range in subject matter and scope, but all should be strongly considered in 2019 when the Texas Legislature meets for the 86th Legislative Session.

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