PUBLIC BENEFITS: HEALTH CARE ACCESS


The center focuses on health care access, immigrants' access to services, food and nutrition, the state's eligibility and enrollment system, and TANF.

Recent Health Care Access Publications

Statement on Approval of Waiver That Allows Texas to Expand Medicaid Managed Care (12/12/2011)

Associate Director Anne Dunkelberg on the approval of the “Texas Healthcare Transformation and Quality Improvement” Medicaid 1115 Waiver. (Note: This waiver is different from the waiver to block grant Medicaid, which the Health and Human Services Commission has not yet submitted and about which the Center has grave concerns.)

Texas Medical Loss Ratio Adjustment Request A Bad Deal for Consumers (12/7/2011)

The health of our entire state is improved when every one of us has access to quality, affordable health care. A key new consumer protection from the national health reform law will make it easier for Texans to purchase health care plans that provide better value for our money. Insurers are now required to meet minimum standards for how much of each premium dollar is used for health care, and to make rebates to consumers if they miss those standards. A recent request from the Texas Department of Insurance (TDI) seeks to delay full implementation of this new consumer protection, which will redirect to insurance companies hundreds of millions of dollars in rebates due by law to Texas consumers.

Press Release: Texas Consumers Stand to Lose $260 Million in Health Insurance Rebates Under State Proposal (11/29/2011)

(AUSTIN, Texas) - On Monday, Federal officials finalized an application from the Texas Department of Insurance (TDI) to delay full implementation of a new rule that requires insurers to increase the value of health insurance or provide rebates to policyholders. If approved, Texans who buy insurance on their own outside of the protection of an employer could lose $350 in forthcoming rebates on average.

Better Texas Film (11/19/2011)

The Better Texas film. Together we can make our state a better place for all of us. A place of opportunity and prosperity. Because we all do better when we all do better.


Comments on Affordable Care Act (National Health Reform) Implementation (11/1/2011)

CPPP submitted comments on several proposed federal rules that implement pieces of the Affordable Care Act related to Medicaid, Exchanges, premium tax credit eligibility and enrollment, and uniform summaries of insurance benefits. Taken together, these rules outline a sweeping vision for consumer-friendly tools and processes to help people understand and enroll in affordable coverage through Medicaid, CHIP, and the Exchange.

How Texas Measures Up in the 2010 American Community Survey (09/22/2011)

American Community Survey

New data from the Census Bureau’s 2010 American Community Survey (ACS)1 illustrates that poverty and uninsured rates vary dramatically by age, race and ethnicity, and across Texas’ metropolitan areas. Our analyses of the ACS data, released September 22, focus on 10 of the most striking findings.

New Census Data Show Texas' Uninsured Rate Tops Nation (09/13/2011)

The September 13 data released by the U.S. Census Bureau’s Current Population Survey shows that in 2010, Texas remained the state with the highest uninsured rate in the nation at 24.6 percent. The total number of uninsured Texans is 6.2 million people, roughly 250,000 fewer than in 2009.

Children continued to lose coverage through their parents’ job-based insurance. A significant positive note for Texas was the decline for a second consecutive year in the number and percent of uninsured children. This improvement is largely due to more children signing up for Medicaid and CHIP’s public insurance (which more than made up for the loss in job-based coverage), showing the essential role of these programs in protecting children during economic hard times.

Get the full story in the links below.

Major Medicaid-CHIP 2012-13 State Budget Decisions (07/25/2011)

The 82nd Legislature’s state budget for 2012-13 includes Medicaid-CHIP provisions with a mix of specific direct cuts and spending reductions totaling $2.03 billion general revenue (GR: state dollars) including $805 million GR in cuts to fees paid to Medicaid service providers; other benefit and spending cuts totaling about $843 million GR; managed care expansion savings of nearly $386 million GR; and roughly $4.8 billion GR in under-funding"an IOU that will come due early in 2013. This Policy Page summarizes high-level Medicaid-CHIP decisions adopted for health and human services agencies; key funding developments for non-Medicaid health programs will be featured in an upcoming August analysis.

Comments Submitted to U.S. Health and Human Services on Rate Review (07/14/2011)

CPPP submitted comments to the U.S. Department of Health and Human Services (HHS) urging HHS to protect health insurance consumers by broadly applying rate review and disclosure provisions from the Affordable Care Act. Rate review is an important tool for expanding health insurance coverage by controlling costs. HHS requested comments on whether health insurance sold through “association health plans” should be treated like other insurance sold to individuals and small businesses, and subject to new rate review protections.

Premiums Lowered in Federal High-Risk Pool (07/13/2011)

Federal and state high-risk pools provide key coverage options for Texans


The health of our whole state is ensured when all of us have access to quality, affordable health care-when we can count on the preventative care we need to stay healthy and see a doctor when we are sick. For many of us with pre-existing medical conditions, we can only get coverage through a high-risk pool. The Pre-existing Condition Insurance Plan (PCIP) is a federally administered high-risk pool created by the Affordable Care Act. Recently, the federal government announced changes that will help increase access to this coverage"premiums in Texas were reduced by 24 percent and applicants can now prove they have a pre-existing condition by providing a letter from a health care professional, instead of waiting to receive a rejection letter from an insurance company. PCIP is one of two high-risk pools that provide coverage options for Texans.

Threats to Health Care: Attacks on Medicaid, Medicare, CHIP, and Health Reform in Austin and Washington (06/30/2011)

Over 4 million Texans"3 million children and 1 million seniors, adults with disabilities, expectant mothers, and very poor parents"rely on Medicaid or CHIP for the critical health care and community supports they need.

Now, Medicaid and CHIP are targeted for extreme cuts in Austin and Washington.

Memorandum on Medical Loss Ratio Adjustments (06/24/2011)

Under the Patient Protection and Affordable Care Act (ACA), health insurers must spend a reasonable share of premium dollars on medical care and quality improvement efforts, as opposed to administration, marketing, and profits. These standards, known as medical loss ratio (MLR) requirements, hold insurers accountable for how they use consumers’ premium dollars.

HB 5 Texas Medicare-Medicaid Block Grant Compact (06/6/2011)

CPPP testified in opposition to House Bill (HB) 5 of the first called Session. HB 5 would allow Texas to ask Congress’ permission to convert all federal health spending for Texas into a block grant based on 2010 levels. Medicare, Medicaid, CHIP, and all public and mental health block grants would be included; only military, veterans, and Indian Health funding would be excluded. As proposed, Texas could choose to eliminate any current federal standards for these programs (including who cover). The House Committee on State Sovereignty approved the bill for a vote by the full House.

April and May 2011 tracking polls from the Kaiser Foundation find most Americans oppose the idea of converting Medicaid to block grant financing to reduce the federal deficit, and the public remains opposed to major Medicare spending cuts as a way to reduce the federal deficit.

Testimony: Senate Bill 7 by Nelson (06/2/2011)

CPPP testified in favor of Senate Bill (SB) 7 of the first called Session. SB 7 includes elements from the 82nd Regular Session’s SB 23, SB 7, House Bill (HB) 32, HB 3537, and SB 8, plus some additional provisions. CPPP registered concerns about selected provisions of the bill, as well.

Alert: Special Session Health Care Bills Have Public Hearings Thursday, June 2 (06/1/2011)

Major health care bills have been quickly re-filed in the 82nd Texas Legislature’s First Called (“special”) Session. Bills set for a hearing on Thursday, June 2"the third day of the new session"include a stand-alone proposal for Texas to ask Congress to turn Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and all mental health and public health funding into a Block Grant to be run by Texas state government, and to end all federal minimum standards for who gets health care and how federal funds are used [Senate Bill (SB) 5 and House Bill (HB) 5]. Also set for hearing are nearly-identical large “omnibus” bills (SB 7 and HB 7) which set the stage for generally-positive health care payment and delivery reforms, with some troublesome provisions included.

Wrong-Headed Decimation of Family Planning (05/24/2011)

Access to birth control for low-income Texas women will be critically wounded under the conference committee proposed budget, collateral damage in battles over abortion. Contraceptive services"not abortion"will be gutted in the state budget on two fronts. Like all states, Texas funds family planning through federal block grants and through Medicaid coverage. It should be noted that these programs provide not only birth control, but also preventive care and basic check-ups to low-income and largely uninsured women (one-third of Texas working age adults are uninsured). Sadly, the Texas legislature now proposes to profoundly undermine both areas of birth control access (again, not abortion services, which are not covered under either funding source, or funded in any way through our state budget). As proposed, these budget actions will cause over 400,000 Texas women to lose family planning and basic health services.

State Budget Conference Committee Medicaid Decisions: Cuts, IOUs, and Gray Areas (05/24/2011)

The conference committee on the state budget for 2012-13 adopted recommendations for nearly all health and human services issues on May 16. Medicaid provisions adopted include a mix of specific direct cuts and spending reductions totaling $1.65 billion general revenue (GR: state dollars) including $805 million GR in cuts to fees paid to Medicaid service providers; and a $4.8 billion GR under-funding or IOU that will come due early in 2013.

Bills Harmful to Texans Health (05/13/2011)

CPPP has teamed up with nine other consumer, patient, and faith-based organizations to voice our opposition to a group of bills in 2011 Legislature which fundamentally undermine or radically restructure Texas Medicaid and health reform.

Budget Bills Short on Health Care for Texans (05/12/2011)

The Texas House and Senate have adopted two different budget bills, and a conference committee has begun to work out a compromise budget.

Both chambers provide less money for Texas health and human services than was budgeted in 2010-2011. But the Senate’s version of the budget provides substantially more money for health care and social services than the House version.

Testimony for SB 7: Reforming Texas Medicaid Payment and Delivery Incentives (05/11/2011)

Associate Director Anne Dunkelberg testified for Senate Bill (SB) 7 by Senator Jane Nelson.

Smart Move to Keep our Options Open (05/11/2011)

As the 2011 Legislature winds down, time is running out for Texas to pursue its surest route to a state-based health insurance exchange. A health insurance exchange is a competitive marketplace where individuals and families can purchase private health insurance starting in 2014. Exchanges are established by the Affordable Care Act (ACA or federal health reform), which lets each state choose whether to design and run its own exchange, or turn the task over to the federal government. The ACA’s timeline gives states a limited window in which to pursue a state-based exchange before the federal government assumes the responsibility. Inaction this legislative session does not guarantee that Texas will ultimately have a federal health insurance exchange, but it certainly makes that outcome much more likely.

Medicaid Co-Pays: Proposals Moving Ahead (05/10/2011)

The 2011 Texas Legislature is considering a range of bills that would make major changes to Medicaid, from block granting the program along with Medicare and all other federal health funding, to using Medicaid as the laboratory for testing new models of care delivery and payments. Several bills, including the House and Senate budget bills, assume provisions to start charging some level of co-payments in Texas Medicaid. Given the current extreme revenue shortfall, the pressure to introduce co-payments is greater than ever before; for example, adoption of co-payments for visits to the emergency room that involve non-emergency medical care is considered likely. This Policy Page describes the Health and Human Services Commission’s (HHSC) proposals for Medicaid and the Children’s Health Insurance Program (CHIP) co-payments, the changes proposed in current bills, and the federal law and rules that Texas must comply with when imposing Medicaid and CHIP co-payments.

Testimony on House Bill 5: Will Texas Block Grant Medicare, Medicaid, and all Public Health and Mental Health Services? (05/10/2011)

Associate Director Anne Dunkelberg testified against House Bill (HB) 5 by Rep. Lois Kolkhorst.

Testimony for House Bill 2723: Improving Consumer Notices of Health Insurance Rate Increases (05/9/2011)

House Bill (HB) 2723 by Representative Walle ensures that people who buy health insurance in the individual market (directly from an insurer, not through an employer) will be sent notices of premium increase at least 60 days in advance. This mirrors the notice timeline for job-based health insurance, giving families sufficient time to either shop around for more affordable coverage, or adjust their budgets to be able to absorb the increase.

Testimony on Senate Bill 1430: Authorizing a New Health Insurance Option (05/9/2011)

Senate Bill 1430 authorizes a new type of fully insured health benefit plan, an exclusive provider organization (EPO), that combines features from preferred provider organization (PPO) plans and health maintenance organizations (HMOs). EPOs have the potential to lower premiums, which can increase access to coverage for small employers and families. However, lower EPO premiums come with tradeoffs for consumers"less access to out-of-network care than a PPO and higher and less predictable out-of-pocket costs (deductibles and coinsurance) than an HMO.

Medicaid Selected Article II Analysis (05/3/2011)

The House’s adopted budget and the Senate Finance Committee’s approved budget (the full Senate has not yet voted on this bill) take significantly different approaches to allocating and cutting funding for Texas Medicaid and CHIP. Still, one important approach used by both chambers is a substantial under-funding of the program overall that is not associated with particular policy changes or program cuts. Since Medicaid is an entitlement, an underlying assumption is that the state will keep paying Medicaid and CHIP health providers for services every month as long as there is money available, and can cover the “unassigned” budget cuts with a supplemental appropriations bill in the 2013 session as long as funds do not “run out” before January 2013.

The Texas Health Care Primer (Revised 2011) (05/2/2011)

The Center for Public Policy Priorities and Methodist Healthcare Ministries are pleased to release this updated primer, designed to give readers an introductory overview of factors shaping Texans' access to health care. Readers will be better able to contribute to federal, state, and local debates about how to improve health care access.

Designing a Health Insurance Exchange: The Right Choices for Texas (04/19/2011)

The Affordable Care Act (federal health reform) creates new health insurance “exchanges” or marketplaces that will open in 2014. Each state will have an exchange, and will decide whether to design and run its own exchange, or turn that job over to the federal government.

If Texas chooses to set up and run its exchange, the state will have broad flexibility to design a health insurance marketplace that meets the needs of Texans. If Texas leaders do not act soon, the federal government will have the responsibility of designing Texas’ exchange. Whether decisions are ultimately made by the Texas Legislature or the Obama administration, Texas’ exchange should be designed to give Texas families and small businesses more control, high-quality choices, and better protections when buying health insurance.

Testimony: House Bill 13 Strips Medicaid Protections from Most Vulnerable Texans (04/14/2011)

House Bill 13 by House Public Health Committee Chairman Lois Kolkhorst would direct The Texas Health and Human Services Commissioner to seek a “waiver” of federal law to dramatically restructure the Texas Medicaid program. In laying out the Committee Substitute for her bill, Chairman Kolkhorst identified a recent Rhode Island “1115 waiver” as a model for what Texas might seek. CPPP testified in opposition to the bill. Our testimony details our objection to overly broad terms of the bill that do not give any guarantee of protections for current beneficiaries, covered populations and services. We detail a list of specific provisions which would prevent the concept from being workable in Texas without substantial additional changes to Texas law and protections for Medicaid’s vulnerable population of children, seniors, Texans with disabilities, and expectant mothers.

Current Budgets Would Place Texas Medicaid and CHIP in Critical Condition (04/8/2011)

Texas Medicaid and the Children's Health Insurance Program (CHIP) provide vital health care and life-saving supports for some of our poorest and most vulnerable.

Updated Medicaid Spending Losses by County Under CSHB 1 (04/7/2011)

Medicaid funding in the House’s budget falls $5.8 billion in general revenue (GR) below what is needed to maintain the program benefits and populations (state dollars; $13.7 billion all funds). This is after the House added $1.8 billion in GR ($4.3 billion all funds).This is still six times the size of the painful cuts to Medicaid and the Children's Health Insurance Program (CHIP) made by the Legislature in 2003.

Why Texas Should Not Jump Into an Interstate Health Care Compact (03/21/2011)

Opponents to national health care reform are proposing to use federal dollars to fund alternative interstate health care compacts that effectively Block Grant federal health care funding.

Testimony on TDI and OPIC Sunset Bills (03/21/2011)

Texas Department of Insurance (TDI) and Office of Public Insurance Council (OPIC) are under “Sunset review” this session and must be reauthorized by the Legislature to continue. Both agencies are needed to protect Texas insurance consumers.

Medicaid and the State Budget: Mortal Injury? (03/9/2011)

House Bill (HB) 1 and Senate Bill (SB) 1 under consideration today fall short of continuing all state services by at least $27 billion in state General Revenue (GR). The Legislative Budget Board (LBB) estimates Medicaid alone is short $7.6 billion GR"$18 billion including the loss of federal-matching funds. This under-funding would be more than seven times the depth of the disastrous 2003 Medicaid and Children’s Health Insurance Program (CHIP) cuts.

HB 636, Health Insurance Connector: Testimony to the House Insurance Committee (03/3/2011)

The health insurance connector (or exchange) will play a critical role in expanding coverage to low- and moderate-income working Texas families. Under health reform, connectors must both create a consumer-friendly, competitive marketplace for purchasing health insurance and determine eligibility for and facilitate enrollment in exchange premium subsidies, Medicaid, and CHIP. House Bill 636 will establish a Texas health insurance connector. Decisions made by the Texas Legislature in designing a state-based connector will determine whether it can serve the best interest of Texas small businesses and families and enhance constructive competition.

What is a Health Insurance Exchange? (03/2/2011)

The Affordable Care Act (commonly called federal health reform) creates new health insurance “exchanges” that will open in 2014. An exchange is a competitive marketplace for health insurance"think of Travelocity for airplane tickets and Amazon for books"that will give consumers more control, quality choices, and better protections when buying health insurance.

Medicaid and Health Care Access Issues for the 82nd Texas Legislature (02/24/2011)

Medicaid funding proposed in HB l is estimated by the Legislative Budget Board (LBB) as falling $18 billion (All Funds) below the amount need to maintain current benefits, provider fees, and eligibility standards. This underfunding would be more than 7 times the depth of the disastrous 2003 Medicaid and CHIP cuts. While delivery reforms and best practices can and should be aggressively implemented, the best program improvements combined cannot achieve savings anywhere near the $7.6 billion GR shortfall. The Legislature should begin immediately looking for ways to mitigate the damage to our state’s most vulnerable through a balanced approach to balancing the budget that looks to savings and new revenues, not a cuts-only approach.

Standards for State Review of Proposed Insurance Rate Hikes Should be Strengthened (02/23/2011)

CPPP, La Fe Policy Research and Education Center, Texas Legal Services Center, and Texas Public Interest Research Group submitted comments to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius in response to the notice of proposed rulemaking for Rate Increase and Disclosure Review. While the proposed rule gives consumers and regulators more information on proposed rates hikes, we urge HHS to strengthen the standards for effective state review to better protect consumers and help constrain the growth in health insurance rates.

SB 1 Must Protect Progress in Rebuilding Eligibility System (02/23/2011)

The Texas eligibility system delivers over $25.7 billion in benefits annually, and more than 6.4 million needy Texans rely in these services. When our eligibility system fails, Texas loses out on billions of federal dollars that fuel our state and local economies"particularly during a recession when unemployment has risen and consumer spending has dropped.

We need to provide adequate funding to support the Texas Health and Human Services Commission's eligibility system and DSHS WIC/Farmer's Market Nutrition services.

Proposed Medicaid Cuts More Than Seven Times Deeper Than 2003 (02/16/2011)

Medicaid funding proposed in HB l is estimated by the Legislative Budget Board (LBB) as falling $18 billion (All Funds) below the amount need to maintain current benefits, provider fees, and eligibility standards. This underfunding would be more than 7 times the depth of the disastrous 2003 Medicaid and CHIP cuts. While delivery reforms and best practices can and should be aggressively implemented, the best program improvements combined cannot achieve savings anywhere near the $7.6 billion GR shortfall. The Legislature should begin immediately looking for ways to mitigate the damage to our state’s most vulnerable through a balanced approach to balancing the budget that looks to savings and new revenues, not a cuts-only approach.

Proposed Medicaid Cuts More Than Seven Times Deeper Than 2003 (02/16/2011)

Medicaid funding proposed in HB l is estimated by the Legislative Budget Board (LBB) as falling $18 billion (All Funds) below the amount need to maintain current benefits, provider fees, and eligibility standards. This underfunding would be more than 7 times the depth of the disastrous 2003 Medicaid and CHIP cuts. While delivery reforms and best practices can and should be aggressively implemented, the best program improvements combined cannot achieve savings anywhere near the $7.6 billion GR shortfall. The Legislature should begin immediately looking for ways to mitigate the damage to our state’s most vulnerable through a balanced approach to balancing the budget that looks to savings and new revenues, not a cuts-only approach.

SB 1 Must Protect Progress in Rebuilding Eligibility System (02/8/2011)

The Texas eligibility system delivers over $25.7 billion in benefits annually, and more than 6.4 million needy Texans rely in these services. When our eligibility system fails, Texas loses out on billions of federal dollars that fuel our state and local economies"particularly during a recession when unemployment has risen and consumer spending has dropped.

We need to provide adequate funding to support the Texas Health and Human Services Commission's eligibility system and DSHS WIC/Farmer’s Market Nutrition services.

Scott McCown's Remarks on Federalism and the Affordable Care Act (01/18/2011)

On January 13, CPPP Executive Director Scott McCown was invited by the Texas Public Policy Foundation to debate Ted Cruz, former Solicitor General of Texas, on federalism and the constitutionality of the Affordable Care Act. Scott explained why conservatives should support the Act and the advantages for Texas.

Texas Top Five: Key Steps to Make the Most of Health Reform (01/7/2011)

What do we want Texas to be? A state that won’t squander an opportunity to properly implement the new health reform law.

The new law changes the health care landscape in Texas. It is an important tool Texas can use to achieve our own health policy goals, such as increasing coverage, improving transparency and quality, and controlling costs.

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