In this issue:
Federal Updates
State Updates
Upcoming Hearings
Upcoming Events
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Federal Updates
Appeals Court Rules ACA Mandates Unconstitutional
Since its inception in 2010, the Affordable Care Act (ACA) has sought to address gaps in the health coverage system by making it more accessible to low-income individuals and adding key provisions that keep children covered longer and guarantee coverage for those with preexisting conditions, just to name a few. On Dec. 18, a federal appeals court in New Orleans struck down a major part of the Affordable Care Act, a decision that could jeopardize health insurance for millions of Americans. The court, in a 2-to-1 decision, ruled that the ACA’s individual mandate provision is unconstitutional, but punted on deciding whether the rest of the landmark healthcare law should be tossed out. Rather than strike down the entire law, the appeals court sent the case back to district court for additional analysis on whether the individual mandate can be severed from the rest of the statute. For now, it’s important that consumers know they are not affected by the court’s ruling this past week.
The case is expected to progress to the Supreme Court, which previously upheld the ACA in a narrowly divided 2012 ruling. The requirement for coverage, often referred to as an individual mandate, was inserted into the law to provide insurers a wide pool of customers since they were now required to cover people with chronic medical conditions. The impact of this healthcare repeal lawsuit could be devastating to many Texans. If courts move to strike down the ACA, roughly 1.7 millionTexans would stand to lose their healthcare coverage.
House Passes Healthcare Provisions in Fiscal Year 2020 Appropriations Act
On Dec. 17, House lawmakers voted 297-120 in favor of H.R.1865 “Further Consolidated Appropriations Act, 2020,” that appropriates $540.4 billion in discretionary funds to federal agencies and programs. Barring any unforeseen circumstances, the Senate must approve the legislation before the Dec. 20 funding deadline to prevent a government shutdown.
This governmentwide spending package is covered by eight appropriation bills for fiscal year 2020 and would include increasing funding for numerous programs and agencies such as the Centers for Medicare and Medicaid Services (CMS), Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC), the National Institute of Health (NIH), and medication-assisted treatment programs. The largest healthcare appropriation made under H.R. 1865 was $828.3 billion for CMS and $475.6 million for opioid overdose prevention and surveillance at the CDC. The bill continues to support critical research initiatives including Alzheimer’s disease research, suicide prevention, and increasing funding to improve maternal and child health.
Methodist Healthcare Ministries continues to demonstrate their commitment to advocate for public policy that ensures the longevity and ability for agencies and programs to provide access to healthcare services to Texans most in need.
House Passes Legislation to Lower Drug Pricing
The rising costs in prescription drugs, according to Health Affairs, can be blamed primarily on price increases, not from expensive improvements to existing drugs or new therapies as pharmaceutical companies often claim. On Dec. 12, House Democrats passed H.R. 3, the “Elijah E. Cummings Lower Drug Costs Act,” that would restrain the cost of prescriptions by allowing the government for the first time to negotiate the price of drugs. Senate Majority Leader Mitch McConnell, however, quickly declared the bill dead in the Senate saying the bill would result in dozens of fewer therapies coming to market. With a House version passed, it is now up to the Senate to pass its own drug pricing reform alternative.
The House vote on the bill passed 230 to 192, with two republicans breaking rank in support. H.R. 3 reinvests in improving Medicare for seniors and people with disabilities by placing out-of-pocket limits for prescription drugs, requiring manufacturers to adjust prices based on inflation, and allowing the government to negotiate prices for 50 to 250 drugs using an international price index. The price determined by the negotiation process would then be available to the commercial market, not just Medicare beneficiaries, ensuring out-of-pocket costs for all Americans are contained. In addition, the House bill would expand Medicare benefits to include dental, vision and hearing aid coverage. Projected cost savings would appropriate the additional funding to the National Institute of Health Innovation Projects, the FDA, and the Opioid Epidemic Response Fund. The bill would improve the overall health and well-being of millions of working families by removing the barrier of having to decide between lifesaving treatment and paying their bills.
House Energy & Commerce Committee Pushes to Extend Coverage for Moms
An estimated 700 women in the United States annually die from pregnancy-related complications within the first year after giving birth, despite 60 percent of these deaths being preventable with appropriate care. On Nov. 20, the House Energy and Commerce Committee advanced legislation by voice vote, H.R. 4996 , “Helping Medicaid Offer Maternity Services Act” (Helping MOMS Act). In an effort to prevent maternal mortality, the bill incentivizes states to extend Medicaid or CHIP coverage for up to one year for low-income mothers by offering a 5 percent federal match in the first year.
Last year, Texas’ health department and the Texas Maternal Mortality and Morbidity Review Committee found that almost 400 Texas mothers died between 2012 and 2015. The committee created by the Governor and the Texas Legislature concluded that extending Medicaid coverage from 60 days to a full year would help more Texas mothers’ gain access to primary, specialty and behavioral care during a critical window of time following the birth of their baby. In support of the continuation of funding and strengthening of current programs to achieve healthy outcomes for women and children, Methodist Healthcare Ministries has co-signed a letter of support in collaboration with our funded partner, Texans Care for Children, advocating to increase coverage for low-income mothers and encouraging the House to include the Helping MOMS Act in its end of year bill package.
State Updates
Texas House and Senate Release Interim Charges
Following the conclusion of the 86th legislative session earlier this year, Lieutenant Governor Dan Patrick and Speaker of the House Dennis Bonnen have published their respective Senate and House interim committee charges. Over the course of the next year, the Texas House of Representatives and Senate committees will meet to discuss and hear from stakeholders on key issues in preparation for the next legislative session. Their findings will affect actions taken during the 87th Texas Legislative Session which begins Jan. 12, 2021.
Methodist Healthcare Ministries submitted topics for consideration to the state delegation related to improving access to healthcare services for Texas families. To deliver care for our uninsured and underserved families, we will continue to monitor charges and legislation during the interim that affects our four priority areas: access to care, behavioral health, healthcare workforce and women in children. A key priority for Methodist Health Care Ministries is addressing the rising cost of healthcare. We will be monitoring charges related to increasing access to affordable and quality healthcare, access to mental health care services through telehealth and the progression of the San Antonio State Hospital (SASH) Phase II committee work, expanding Texas’ current and future workforce pipeline to closing skill gaps, as well as providing recommendations to developing a postpartum care package for new mothers to develop strategies to ensure continuity of care.
House Select Committee on Statewide Health Care Costs
House Speaker Bonnen also moved to create and appoint Texas House members to the House Select Committee on Statewide Health Care Costs . The committee is comprised of 11 members that will examine the primary drivers of increased health care costs in Texas, study opportunities to better coordinate how public dollars are spent on healthcare, as well as identify emerging and proven delivery system improvements and sustainable financing models that could reduce the cost of healthcare. The committee is required to submit a final report on their findings before the start of the 2021 legislative session.
HHS Releases Blueprint for a Healthy Texas
The Texas Health and Human Services (HHS) unveiled its inaugural business plan in November 2019, Blueprint of a Healthy Texas, which provides measurable initiatives to improve the lives of more than 7 million Texans who rely on the services provided by the agency. The business plan includes 12 initiatives and 72 goals focused on providing a transparent framework for how HHS will move forward and improve services to Texans.
It is estimated that one in five Texans have mental health needs, with more than 1 million suffering from a Serious Mental Illness (SMI). Meeting the mental healthcare needs of Texans requires critical policy analyses to ensure coordinated systems of support and services are effective and appropriate. The HHS business plan hopes to address the gaps in behavioral health and meet a person’s need in the most integrated settings.
The inaugural business plan works to improve health outcomes for women, mothers, and children by enhancing access to long-acting reversible contraception, increasing prenatal and well-child visits, and addressing disparities in breastfeeding and breast cancer. Additionally, FY 2020 initiatives also focus on improving accountability and sustainability of supplemental and directed payment programs to achieve positive outcomes.
New Report Shows High Poverty Rates for Children in Webb County
In a new report commissioned by Methodist Healthcare Ministries and produced by the Center for Public Policy Priorities, data findings conclude children in Webb County are not faring as well as Texas children overall, lacking access to health care at greater rates and scoring poorer on many indicators of health, education and financial security.
The 2019 State of Texas Children in Webb County report highlights that although Webb County is a vibrant binational landscape and has one of the best employment rates across the state, nearly 70 percent of children live in high poverty neighborhoods (compared to 17 percent in Texas overall). As a result, children are less likely to have access to doctors, quality schools and groceries. Additionally, children living in Webb County were three times as likely to be undercounted in the census as in Texas overall. An undercount of children in the upcoming 2020 census could mean fewer federal dollars flowing into the county for education, Head Start, SNAP and Medicaid/CHIP programs.
The report noted Webb County can capitalize on its strengths and invest in child-well-being by ensuring workers receive family-sustaining wages, expanding access to comprehensive health insurance, improving access to family planning, and promoting an accurate 2020 census. Working with local officials and state lawmakers to support equity-focused policies will ensure all children have access to the basic building blocks to reach their full potential. On Nov. 21, Methodist Healthcare Ministries and CPPP shared the report's findings with the Laredo Health Coalition, City of Laredo Health Department, Webb County Commissioner Rosaura Tijerina and other elected officials.
RGV Equal Voice Network Hosts Access to Specialty Care Summit
Rio Grande Valley residents continue to face challenges in accessing health care due to serious economic barriers, a shortage of providers, and a lack of health insurance coverage. Many low-income working families rely on the local safety net clinics to receive low-cost primary care. However, when patients are referred to specialists for more serious ailments, such as cancer, surgery or dental care, nearly two out of five residents said they could not access the specialty care they needed. On Dec. 12, the RGV Equal Voice Network Health Working Group held a summit in Weslaco, Texas, where they laid out 18 recommendations to help address the lack of access to specialty care in the RGV. Over 150 healthcare administrators, community organizers and regional leaders were in attendance, including State Representative Armando Martinez, Hidalgo County Judge Richard Cortez, and Hidalgo County Commissioner Ellie Torres.
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Rep. Armando “Mando” Martinez delivers keynote address at EVN’s Access to Specialty Care Summit.
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During the summit, the EVN Health Working Group identified the economic and environmental barriers limiting access to specialty health care services. The data gathered from over 600 individual surveys and 12 focus groups found that most individuals needed referrals to obstetrics/gynecology, dental and optometry/ophthalmology. They also found that three-fourths of households stated cost as the primary barrier to seeing a specialist. Proposed solutions included increasing collaboration between safety net clinics and the UTRGV School of Medicine, increasing residency training slots, increasing transportation options for patients living in rural areas and studying the feasibility of establishing a public hospital district in the RGV. Details on these recommendations will be shared in a white paper scheduled to be released this coming spring.
This project, funded by Methodist Healthcare Ministries and the Marguerite Casey Foundation, will help elected officials and community organizations develop robust public health agendas with concrete goals and actions aimed at reducing inequities and increasing access to care for vulnerable individuals living in Texas’ Rio Grande Valley region.
Upcoming Hearings
Upcoming Events
Jan. 26-27: Texas Impact – United Methodist Women Legislative Event (Austin)
Jan. 29: The Texas Tribune – Future of Health Care: A Daylong Exploration of Health Care in Texas (Edinburg)
Feb. 3-6: San Antonio Chamber of Commerce – 2020 SA to DC (Washington, D.C.)
Feb. 13-14: Texas Hospital Association – Annual Conference and Expo (San Antonio)
Feb. 16-18: Texas Impact – Texas Interfaith Advocacy Day Conference (Austin)
Mar. 2: Texas Association of City & County Health Officials – 2020 Premier Public Health Conference (Houston)
For more information on health care research, policy or advocacy, please contact Chris Yanas at cyanas@mhm.org.
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Since 1995, Methodist Healthcare Ministries of South Texas, Inc. has provided over $1 billion in healthcare services through our clinics and programs, as well as through our partnerships. Methodist Healthcare Ministries is proud to partner with organizations that share our mission and organizational objectives of increasing access to care to the least served across South Texas. 
The holiday season can include plenty of parties and gatherings, but Gonzalez said that it’s perfectly fine to skip them. “You can skip the parties or the invite to drive with friends to see Christmas lights downtown, but don’t stop caring for yourself. Keep track of your health and stay in touch with your circle of friends and family members.”