| Perspectives on Texas

This year, the U.S. Congress has worked hard to craft solutions to real challenges in the healthcare marketplace, but it is time to act. Currently, one out of every five Texans is uninsured. The individual insurance market needs to offer more health plan options at lower cost for Texans.

Throughout this debate, Ascension Texas, operating as Seton in Austin and Providence Healthcare Network in Waco, has sought to be a voice for patients, calling for legislation that meets three simple principles:

1. Preserve the safety net for the poor and vulnerable and work to assure access to affordable healthcare for all;
2. Strengthen and stabilize the vibrant and sustainable individual market that is essential to a successful, equitable healthcare system; and
3. Provide sufficient resources to transform to value-based rather than volume-based financing for care to lower healthcare costs over the long run. 

Over the last several months, our national health system leaders have talked with members of Congress and their staffs to communicate these three principles and to encourage them to craft legislation that achieves them. Unfortunately, the discussion draft of the Better Care Reconciliation Act of 2017 (BCRA) released by Senate leaders last week falls short.

That said, they did some things well. They tried to make sure individuals with pre-existing conditions are not charged significantly more for healthcare coverage. Their tax credit for older Americans who must buy insurance on the individual market is fairer than the House proposal, even though Americans closer to retirement will still have to pay significantly more than they do now because of the change in age rating bands. The Senate also proposed waiving an outdated Medicaid exclusion for inpatient treatment of addiction, which is sorely needed.

Unfortunately, BCRA fails to meet our reform goals for legislation because it would result in even deeper cuts to Medicaid than the House version and put the care for millions of poor and vulnerable children, parents, adults, Americans with disabilities and the elderly at risk. The bill would cap and cut Medicaid at a rate far below the actual cost growth, especially after 2026. In fact, it is the biggest restructuring of the Medicaid program in 40 years, and would impact the children and aged and disabled adults who need care the most. Medicaid pays for more than half of all births in Texas, covers more than 40 percent of our state’s children and funds the care for about two-thirds of Texas nursing home residents. The bill will have a devastating effect on Texas’s large populations of urban and rural poor, and the doctors, clinics and hospitals who serve them. We must do better than this.

The draft bill would further destabilize the individual insurance market because it removes the incentive for continuous coverage included in the House bill. States with laws guaranteeing insurance without strong legal incentives for continuous coverage have seen losses of coverage and spiraling  premiums. Senate leaders have diagnosed significant problems in the individual market but is prescribing the wrong medicine to address them. 

Thankfully, the Senate bill is a work in progress. I urge the Senate to address three crucial issues facing healthcare while “doing no harm”:

1. Go back to the drawing board and work to find viable solutions that focus on the three principles above.
2. Immediately pass a short-term bill to shore up the individual market and halt spiraling costs and losses of coverage being experienced there. 
3. Partisan efforts to pass legislation have failed to solve the very real issues facing our healthcare system. Please work with each other to find consensus on lasting solutions.

I urge the Senate to develop a viable short-term and long-term proposal that preserves coverage, strengthens and stabilizes the individual market, and continues the transformation of healthcare delivery to improve quality and lower costs.

Disclosure: Seton Healthcare Family has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.