Commonsense regulations for a consumeroriented health insurance market

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Common-sense regulations for a consumer-oriented
health insurance market

• Lobby Day March 10, 2009

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The Current Environment

• More than ¼ of the Texas population uninsured
  higher in urban areas/border.
• This means more than 5.7 million people do not
  have health insurance the highest rate in the
  nation!
• The primary driver of the uninsured in Texas is
  the lack of affordable, meaningful health
  insurance options for individuals and small
  businesses.
• The majority of businesses in Texas are small
  employers who struggle to provide ESI

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The Texas Department of Insurance

• TDI monitors the financial health of insurance
  companies operating in Texas to ensure that
  carriers are able to fulfill obligations and pay
  future claims.
• TDI has no strategic mission to focus on the
  availability and affordability of health coverage
  in Texas.
• TDI does not have the mandate, authority or tools
  needed to implement regulations to improve health
  insurance coverage in the state.
• H.B. 505 by McClendon creates the health
  benefit plan innovations program in the Texas
  Department of Insurance
• S.B. 78 by Nelson promoting awareness and
  education about the purchase and availability of
  health coverage

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TDI Health Insurance Regulation

• Texas does not regulate health insurance as
  heavily as it does other insurance lines.
• TDI does not have the oversight tools needed to
  ensure that Texans pay health insurance premiums
  that are fair and not excessive.
• In addition, more than 80 percent of Texans
  receive their care through Preferred Provider
  Organization (PPO) plans that are not regulated
  by TDI.

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An Opportunity for Change

• With TDI under sunset review, the enhanced debate
  over health care insurance regulation will give
  the Legislature the opportunity to remove
  barriers that contribute to making health
  insurance coverage unaffordable or inaccessible.
• H.B. 2203 by Isett
• S.B. 1007 by Hegar

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Key Insurance Bills

• Provide consumers with greater transparency about
  health plans by requiring health insurers to
  report and TDI to publish more robust information
  about insurers business practices, such as
  administrative costs, calculation of premium
  quotes and amount of premium dollars paid in
  medical claims.
• H.B. 531 by Anchia disclosure of medical loss
  ratios
• S.B. 485 by Deuell disclosure of medical loss
  ratios of health benefit plan issuers
• S.B. 900 by Deuell limits the collection and
  use of certain information by health benefit plan
  insurers
• H.B. 1932 by Thompson and S.B. 815 by Watson
  consumer labeling requirements for certain health
  benefit plans

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Key Insurance Bills

• Make premiums more affordable in the states High
  Risk Pool, which covers individuals who cannot
  obtain coverage elsewhere, often due to
  pre-existing conditions.
• H.B. 532 by Anchia Reduces the preexisting
  condition exclusion period under the Texas Health
  Insurance Risk Pool
• S.B. 879 by Averitt and H.B. 2064 by Smithee -
  creates premium discounts for certain
  participants in the Texas Health Insurance Risk
  Pool
• H.B. 1066 by Naishtat and S.B. 781 by Watson
  allows individuals whose employers participate in
  certain regional or local health care programs to
  access the THIRP

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Key Insurance Bills

• Improve the ability of small businesses and the
  self-employed to pool and share risk and use
  greater bargaining power to get a fair price for
  insurance.
• H.B. 663 by Susan King - participation by
  single-employee business in private purchasing
  coops
• S.B. 77 by Nelson - allows single-employee
  businesses to join a health group cooperative
• S.B. 813 by Watson - expands the eligibility of
  certain sole proprietors to participate in small
  employer health benefit plans
• S.B. 972 by Averitt and H.B. 2586 by Smithee -
  expands small and large employer health group
  cooperatives

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Key Insurance Bills

• Enact reasonable limitations on the degree to
  which health status can drive up premiums and the
  length of preexisting condition limitations.
• S.B. 350 by Shapleigh continuation of certain
  health benefit plan coverage
• S. B. 614 by Shapleigh modifies preexisting
  condition provisions in individual accident and
  health insurance policies
• H.B. 1856 and H.B. 2458 by Eiland requires
  insurers to offer conversion of group policies
• S.B. 1158 by Wendy Davis regulation of health
  benefit plan rates

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Other Key Initiatives

• Establish a business tax credit for companies
  that provide health insurance for their
  employees.
• H.B. 1122 by Bolton - increases the franchise tax
  incentive for small employers that provide health
  care benefits to employees
• Support for innovative health coverage programs
  such as local and/or regional 3-share
  initiatives.
• H.B. 535 by Anchia and H.B. 1246 by John Davis
  provides for a preference in state purchasing
  decisions for vendors that provide health
  benefits to employees
• Invest in Healthy Texas, a program to help small
  businesses and their employees access lower-cost
  health insurance by using state-funding to cover
  some high cost claims. (H.B. 1578 by Isett)
• H.B. 1573 by Thompson requires recipients of
  money from the Texas Enterprise Fund to provide
  health benefits to employees

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Questions?

• John M. Hawkins
• Senior Vice President, Government Relations
• Texas Hospital Association
• jhawkins_at_tha.org
• [phone]
• www.gettexascovered.com