By Ted Shaw, President/CEO, Texas Hospital Association
Following a year of uncertainty, stress, and burnout in 2020, many of us were hopeful that the 2021 legislative session would be relatively quiet, focus on the important issues and short on political posturing. While the session may have begun that way, tranquility and order rarely last to sine die. On top of the many consequences of the COVID-19 pandemic, the state also had to grapple with a less than stellar fiscal outlook and the fallout from Winter Storm Uri and the state’s failed power grid. It was among the most difficult sessions many of us have experienced in quite some time. Still, for a session bogged down by some of the state’s most significant challenges, state lawmakers made a number of policy and funding decisions to support Texas hospitals and the health care infrastructure.
When the session kicked off, the state had fewer funds available to spend than originally projected. State agencies were asked to cut their budgets and rumors of other across-the-board cuts were rampant. But the state economy quickly turned around over the course of a few months, which the Comptroller of Public Accounts credited to the statewide COVID-19 vaccination effort. With a new positive balance and an increased federal Medicaid match rate, programs like Texas Medicaid, which always is under threat, sustained no cuts this budget cycle. Budget writers maintained state funding for safety net, trauma and rural hospitals’ Medicaid rate enhancements. They also provided new funding to further boost rural hospitals’ inpatient Medicaid rates. The budget also includes a number of key wins for the health care industry, including:
Early in the session, Gov. Greg Abbott (R) declared liability protections for health care providers an “emergency item” for the legislature to address ahead of the regular order or business. Lawmakers successfully passed this legislation for health care providers acting in good faith during the COVID-19 pandemic and other future disasters.
In addition, Houston-area lawmakers Sens. Borris Miles (D) and Joan Huffman (R) and Rep. Tom Oliverson (R) passed a measure to remedy dialysis treatment access that many Houstonians struggled to find during Hurricane Harvey and Winter Storm Uri. The new law strengthens requirements of end-stage renal disease facilities statewide to ensure patients’ access to dialysis treatment during emergencies.
Texas hospitals again defended against harmful revisions to the Texas Advance Directives Act that would hinder patients’ autonomy and providers’ expert medical judgement. Another hard-fought win was preserving hospitals’ ability to require staff to be vaccinated against various vaccine-preventable diseases, including COVID-19.
Texas hospitals deployed a comprehensive grassroots and digital advocacy campaign to encourage health care coverage expansion. This work contributed to the most extensive coverage expansion discussion the state has seen in nearly a decade, and hospitals were instrumental in garnering the support and interest of many Republican lawmakers who will be critical to future coverage expansion conversations.
While the legislature ultimately did not opt to expand health care coverage for low-wage working Texans, it passed three new laws to improve coverage for postpartum moms, children and prescription drugs. Postpartum moms now will have six months of Medicaid coverage after delivery, up from 60 days. Another law maintains kids’ continuous Medicaid coverage, without the need for multiple burdensome eligibility checks, for at least six months. Eligible uninsured Texans also can access discounted prescription drugs through a new drug discount program.
The legislature also made important strides to connect Texans in rural communities with better access to health care services and reliable broadband needed to support it. An Amarillo-area lawmaker passed a new law that makes permanent the telemedicine flexibilities that were put in place during the pandemic to ensure access to care for Medicaid and Children’s Health Insurance Program beneficiaries.
The COVID-19 pandemic shined a light on the noble work health care providers do each day. With that recognition also came scrutiny over regulatory, funding and policy issues impacting Texas hospitals and health care providers. At the end of the day, though, the need to protect patients and providers’ ability to deliver care was top of mind for state lawmakers. While this past Memorial Day marked the end of a whirlwind legislative session, lawmakers are sure to soon return to Austin for another special session or two. Texas hospitals are working closely with state agency leaders on rulemaking needed to implement the new laws and will hold the line to defend industry successes this session and ensure no “bad” bills become law.