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Texas Medical association (TMA)
To curb rising health care costs, physicians say Texas must reduce administrative waste, preserve meaningful coverage, and scrutinize market structures that reward consolidation and higher-cost settings.
That’s the gist of testimony the Texas Medical Association (TMA) delivered as lawmakers with the Senate Committee on Health and Human Services and House Select Committee on Health Care Affordability examined the reasons for high health care costs.
“Texas patients, employers, and physicians all feel the pressure of higher premiums, higher deductibles, rising drug costs, narrower [insurance] networks, administrative complexity, and increasingly difficult access to timely care,” reads testimony by TMA Council on Legislation Chair Andrew James “Jimmy” Widmer, MD.
He said physicians see evidence of these problems every day.
“A patient may technically have insurance but still delay or skip care because the deductible is too high, the prescription is unaffordable, the network is too narrow, or the insurer’s policies and practices make care difficult to obtain,” he said.
Dr. Widmer noted areas that drive health care costs: administrative burden and complexity; population health issues and coverage instability, which force people to forego preventive care; and lower cost flexible health plan designs that strip out protections and provide “coverage” in name only.
“Policymakers should evaluate whether a plan design lowers total cost or merely shifts cost to patients, physicians, hospitals, or taxpayers,” the testimony reads.
TMA offered senate committee members six solutions to address rising costs:
1. Reduce administrative waste, including strengthening enforcement of prior authorization/utilization review reforms. In prior authorization, health insurers require physicians and their staff to seek insurers’ permission to provide needed care or prescriptions for a patient.
2. Scrutinize pharmacy benefit manager practices such as aggressive cost-shifting tactics and switching of patients’ prescriptions solely to save the pharmacy or insurer money – not for medical reasons.
3. Protect meaningful health insurance coverage through clear consumer disclosures and patient and physician protections while pursuing innovative, lower cost health plan designs.
4. Strengthen physician autonomy and practice viability, including rejecting legislation that increases administrative burden imposed on physicians or threatens a physician’s clinical decision-making that is in the best interest of the patient.
5. Improve transparency that patients can actually use, including clear information about insurance premiums, deductibles, networks, coverage rules, utilization management, prescription drug costs, and estimated out-of-pocket obligations – not just posted prices.
6. Address population health as an affordability strategy, by investing in better patient access to preventive care, primary care, behavioral health, maternal care, and chronic disease management to limit avoidable downstream spending.
“Texas should pursue policies that lower costs, increase meaningful competition, and preserve access to physician-led care,” said Dr. Widmer.
TMA is the largest state medical society in the nation, representing more than 60,000 physician and medical student members. Located in Austin, TMA works with 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.
Information source: TMA
