TONL Legislative Update Summary

Summary of session “State of Healthcare and Trends” by Steve Love, President/CEO of Dallas-Ft. Worth Hospital Council.

Mr. Love started his presentation with a look at Medicaid in Texas and how 20% of Texans rely on Medicaid for their health insurance (about 4 million people). In 2016, 40 billion was spent on Medicaid programs, but despite this, Texas still has the highest uninsured rate in the country (about 20% of Texans) while only about 25% of providers in Texas accept Medicaid. Mr. Love highlighted the need to consider Medicaid spending on addressing social determinates of health, citing some staggering statistics about Texas having some of the highest maternal death rates in the nation.

The impact of the pending Medicaid Fiscal Accountability Regulation (MFAR) was discussed and its potential impact on Texas. If MFAR is passed as is, Texas stands to lose 13 billion, with 2.5 billion in the Metroplex alone. Furthermore, MFAR would impact rural hospitals increase the closure rate we are currently experiencing. Mr. Love expects MFAR to be challenged by the states in federal court.

Mr. Love explained the state of declining 1115 waiver in Texas to help offset some costs associated with not expanding Medicaid in Texas, and how the bulk of that work is going to mental health programs in many DSRIP projects in the DFW area. 1/3 of people seen in DFW EDs have a mental health issue. Mr. Love explained the current administrations plan to increase the public charge, which could affect legal immigrants and their willingness to seek out public benefits including Medicaid. This would affect about 1.8 M kids in Texas and possible increase the uninsured rates.

Lastly, Mr. Love provided a rundown of state and federal legislative agenda items that could affect healthcare, such as end of life care spending, chronic illness management, need to continue DSRIP projects, and possibly expanding and marketing the insurance exchange in Texas. On the federal level, items discussed included price transparency, drug pricing, and the current debate around “Medicare for all” plans.

Of note, the main questions posed to the group and the political debate swirling right now revolves around whether healthcare is a right or a privilege. There are many moral and ethical undertones that surround the legislation related to this question and there is no clear answer. We do know that without reform, we will continue to see overutilization of emergency departments. Furthermore, we need to help fix some of the social determinants of health to make healthcare more accessible and affordable.

 Brandon "Kit" Bredimus, DNP, RN, CEN, CPEN, CNML, NE-BC, QMHP-CS
TONL District 2 Director