Wednesday, March 19, 2008

Free the HRA in Texas 

By John LaPlante

Categories:  HSAs, etc., Texas

Health reimbursement arrangements (HRAs), like Health Savings Accounts (HSAs) give consumers the responsibility—and power—to control how health care dollars are spent on their behalf. Yet in Texas, state law constricts their use.

Writing for Texas Public Policy Foundation, and Kalese Hammonds and Mary Katherine Stout explain (PDF) what HRAs are, how they can benefit employers and employees, and what Texas policy makes can do to make them more useful.

• posted by John LaPlante
• 9:57 am
• 0 comment

Monday, December 10, 2007

Texas to Revamp Medicaid 

By John LaPlante

Categories:  Medicaid, Texas

Texas is making a step in the right direction by funneling Medicaid money from institutions to individuals. From the Dallas Morning News:

The state submitted a plan to the federal government Wednesday that would increase health coverage for low-income adults, though with benefits perhaps less generous than what Medicaid offers.

Texas wants federal rules to be suspended so it can take some money traditionally funneled to hospitals that treat a lot of poor and uninsured patients, such as Parkland Memorial Hospital in Dallas, and instead help financially strapped adults buy private health insurance plans.

Big hospitals that receive the bulk of those payments--called "DSH" funds--complain that the money will not only not go to them, but be dispersed throughout the state.

That actually sounds like a good thing. Customer service in establishments served by a disproportionate number of public dependents is usually not as good as is found in other establishments.

• posted by John LaPlante
• 7:50 am
• 0 comment

Thursday, November 29, 2007

850,000 Eligible for Texas SCHIP, Not Enrolled 

By John LaPlante

Categories:  SCHIP, Texas

In yet another example of why SCHIP expansion is unwise, officials in Texas estimate that up to 850,000 children there are eligible for the program, but not enrolled.

If we're going to have this tack-on to Medicaid--and I'm not conceding that point--then officials ought to reach children in the poorest of poor families. As the latest estimate from Texas shows, however, that's not yet the case.

• posted by John LaPlante
• 9:26 am
• 0 comment

Friday, October 5, 2007

Texas Hold 'Em: Doctors Flood Into Lone Star State! 

Medical Mapractice Reform Works

By John R. Graham

Categories:  Texas

The New York Times ran an article today on the success of med-mal reform in Texas: doctors, especially those in high-risk specialties, are flooding into the state since voters passed a referendum in 2003 that restricted non-economic damages to $250,000 and punitive damages to $1.6 million.  Word spread quickly in the medical community: license applications jumped 18 percent after the referendum passed, and 30 percent in the last fiscal year.

Of course, the New York Times must give the other side its due, quoting a trial lawyer that things had gone too far, and an injured patient who was operated on by a drug-addicted surgeon.  Obviously, with so many new doctors, there are more investigations of possible error.  Nevertheless, of the 10,878 physicians newly licensed since 2003, only 14 have been subject to disciplinary action - none for actually harming patients.

What a success! By the way, Texas is ranked in 11th place in the Medical Tort category of the U.S. Index of Health Ownership.  Where is your state, and is it considering similar reforms that have such a positive effect?

• posted by John R. Graham
• 1:19 pm
• 0 comment

Monday, September 10, 2007

Texas Chainsaw Massacre of Hospital Bureaucracy ---Or Not? 

Patients, Not Politicians, Must Drive Price Transparency

By John R. Graham

Categories:  Texas

Nobody should need convincing that one big obstacle to consumer-directed health care is that we don't know what health services cost. Worse, nobody wants to tell us. Over the last couple of years, this has led well-meaning, often conservative, legislators in many states to support legislation that attempts to compel hospitals to make their actual prices transparent.

I believe that my esteemed and more eloquent colleague from the Texas Public Policy Foundation, Mary Katharine Stout, and I, share the same wary view of these legislative initiatives. Unfortunately, Texas legislators have not been paying enough attention!

The “root cause” of price opaqueness is that hospitals are financially dependent on government, specifically, the Medicare Prospective Payment System, which determines how hospitals generate invoices. Private insurers, who administer government health programs, generate paperwork of the same opaqueness, and this bleeds over to privately-paid health services (because it would be too expensive to build a parallel, sensible, billing system).

Texas' recent law does not address this. Instead, SB 1731 imposes classical government regulatory interventions: “the hospital must do such and such within 30 days.” “The facility physician must do so and so within ten days.” These regulations are too confusing to enforce or for patients to understand, and attempt to make hospitals report potentially proprietary information to government for publication.

A simple metaphor explains why this is futile: When you bought a car, did you go to a DMV website to learn what the price would be?

I think the solution is much simpler. SB 1731 is 33 pages long. A price transparency law need only be one sentence long:

“No patient has an obligation to pay a health care provider unless he has entered into a contract with the provider to pay for a service.”

“Contract”, of course, does not mean that you bring a lawyer with you. It just means you agree on a price before hand.  Note that the contract is between the provider and the patient.  Currently, patients (or their employers) have contracts with insurers; and insurers have contracts with hospitals.  But contracts are not "triangular" (my neologism), as hospitals and insurers will try to claim. 

Imagine if BestBuy allowed you to walk out of the store with a computer that had no price tag on it, and then mailed you an invoice? It would be laughed out of court.  Same deal for hospitals, I'd say.

(Yes, I know some readers will say: "You jerk! What if I'm having a heart attack or a stroke, or dragged out of a burning car?", but I'll deal with that in a future post if there's any demand.  For now, let's just deal with SB 1731.)

• posted by John R. Graham
• 8:08 pm
• 2 comments