Complete Coverages

Tue, 20 September 22

Surprise Billing Rules

Download PDFWhat’s New With the No Surprises Act? Final rules for the arbitration process of the No Surprises Act have…

Mon, 12 September 22

Medicaid Monday: Service Coordinators Connect Members to Services

Download PDFby Jessica Lynch Today’s Texas Medicaid is more than health care coverage—it connects Texans to the personalized care and…

Wed, 17 August 22

Enhanced ACA Subsidies Mean More Coverage for Texans

Download PDFThe News 📜🖊 Yesterday, President Biden signed broad ranging legislation that includes several major health care initiatives, including extending the enhanced subsidies…

Mon, 8 August 22

Medicaid Monday: Managed Care Organizations Partnering with HHSC To Address Eligibility Issues After the Public Health Emergency

Download PDFBy Jessica Lynch As the end of the COVID-19 Public Health Emergency approaches, the Texas Health and Human Services…

Mon, 27 June 22

Medicaid Monday: Mental Health Innovations in Managed Care

Download PDFIn 2021, 34.2% of adults in Texas reported symptoms of anxiety and/or depression. Experiencing mental health challenges can have…

Thu, 16 June 22

Value of Coverage: Mental Health

Download PDFBy Alicia Pierce and Jamie Dudensing People with health insurance have better access to care, and importantly that includes…

Tue, 14 June 22

Medicaid Monday: Managed Care Means Innovation

Download PDFBy Jessica Lynch In Texas, the 1115 Medicaid Transformation Waiver allows the state to expand managed care, which allows for…

Thu, 26 May 22

The No Surprises Act is Working, Texas Can Learn from the New Law

Download PDFBy Blake Hutson Today it was announced that since the No Surprises Act went into effect at the beginning…

Mon, 23 May 22

Medicaid Monday: Managed Care Reduces ER Visits

Download PDFBy Jessica Lynch The use of emergency rooms for primary care services is decreasing, thanks to Medicaid managed care….

Tue, 17 May 22

Price Transparency Helps Patients

Download PDFby Jamie Dudensing Can driving just a few miles save a patient thousands of dollars? If they’re in the…

Mon, 9 May 22

Medicaid Monday: Medicaid Managed Care Nurses Make a Difference

Download PDFBy Jessica Lynch Did you know National Nurses Week is now Nurses Month? Extended in 2020 to recognize the…

Mon, 2 May 22

Medicaid Monday: New Moms Still High-Risk for Medicaid Churn

Download PDFBy Jessica Lynch As the public health emergency winds down, millions risk losing Medicaid coverage, not because they no…

Thu, 14 April 22

Fixing the Family Glitch Means Millions Could Qualify for Affordable Coverage

Download PDFby Jamie Dudensing and Alicia Pierce A recently announced change to the administration of the Affordable Care Act will…

Wed, 6 April 22

Texas Medicaid Managed Care is Working to Keep People Covered Even after the PHE

Download PDFBy: Jessica Lynch and Alicia Pierce In an essay in the New York Times, health care expert Elisabeth Rosenthal…

Tue, 29 March 22

Texas Breaking Enrollment Records

New Census Data reports show that Texas still has the highest uninsured rates in the nation at 17.3 percent— a full 3 percentage points higher than the state with the next-highest uninsured rate, Oklahoma. Why does this matter? Because study after study shows that when families have health care coverage, they have better health care outcomes. Texans with insurance are more likely to receive preventative, primary, and specialty care services. 

Thu, 24 February 22

The New Hidden Fee That is Surprising Patients with Excessive Medical Bills

There is a new billing scheme that is misleading Texas patients with  hidden costs—facility fees. These excessive hospital based fees, often in the thousands of dollars for very basic services, have long come under criticism from patients and consumers for creating surprise medical bills that Texans cannot afford. But, it’s not only hospitals that are charging these hidden fees anymore. The out-of-control expansion of these unreasonable fees is driving up the cost of premiums and out-of-pocket costs for Texas families and employers.

Wed, 16 February 22

Texans Continue to Experience COVID-19 Price Gouging

Throughout the COVID-19 pandemic, Texans have been tricked into a new type of health care price gouging – outrageous COVID-19 testing.

Thu, 3 February 22

Groups Push Against Lawsuit to Undermine Surprise Billing Protections

Physician groups are facing far-ranging opposition in their lawsuit to overturn rules implementing new surprise medical billing protections. Opponents to the physician-led attack on the new law now include employer coalitions, unions, patient and consumer groups, health policy experts, and essentially any group that cares about controlling health care costs.

Fri, 28 January 22

Texas’ Individual Insurance Market is More Competitive Than Ever

A record number of Americans signed up for health care coverage through Affordable Care Act marketplaces at the same time a number of new plans joined the market. About 14.5 millions Americans signed up for an ACA plan during the enrollment period that ended January 15. That’s 2 million more than ever before.

Thu, 13 January 22

Health Plans Make Sure You’ll Never Walk Alone

Download PDFBy: Madeleine Richter-Atkinson, Jamie Dudensing Social isolation, defined as having few relationships or infrequent social contact, was a common experience in…

Tue, 11 January 22

At-Home COVID Tests Covered by Insurance Starting January 15

Starting January 15, individuals with private health insurance will have coverage for up to eight at-home COVID tests per month, per covered family member.

Mon, 3 January 22

No More Surprises

Looking for some good news to start the year? We’ve got you covered. After a years-long debate, the end of unfair and outrageous surprise medical bills is finally here.

Wed, 8 December 21

Texans Deserve More Than a Health Care Safety Net

For many of the five million uninsured Texans, our state’s health care safety net is their routine source of health care and final life line. Although critically important for these Texans, it’s worth asking, “why is a safety net the first and only option for so many Texans?” Proponents of safety net only policies fail to realize that safety net care should be a last resort, not a plan for a healthy Texas.

Thu, 2 December 21

Look for New Patient Protections in Your Stocking This Holiday Season

As we near the January 1, 2022 start date of the wildly popular new law to end the egregious practice of surprise medical bills, debate over the details has heated up. Following the release of interim final rules in October, the same physicians that initially fought to preserve the practice of sending patients unexpected bills are now complaining over the details of how they’ll be paid.

Fri, 19 November 21

What Drives Healthy Outcomes?

Experts agree that as much as 80% of a person’s health is determined by factors outside of direct medical care, including where they are born, grow, live, and work. To encourage better outcomes, health plans are working in communities to help address social barriers to good health, including the need for access to reliable and affordable transportation.

Tue, 2 November 21

Five Things That May Surprise You About ACA Plans in Texas

This week kicks off the open enrollment period to purchase health insurance through an ACA marketplace or exchange for 2022 coverage. Uninsured Texans may be surprised by the new options and affordable rates available to them. With new plan providers, increased subsidies, and help finding the best plan, this could be the most important open enrollment period in Texas yet.

Wed, 27 October 21

Learn All About It: Education Improves Health Outcomes

Experts agree that as much as 80% of a person’s health is determined by factors outside of direct medical care. Whereas the conditions in which people are born, grow, live, and work — known as social determinants of health (SDOH) — play a much greater role. To encourage better outcomes, health plans are working in communities to help address SDOH, including the need for education.

Thu, 21 October 21

It’s Clear: Freestanding ERs Need Transparency, Accountability

Freestanding ERs made headlines again as a new report of a COVID test more expensive than a Tesla surfaced and another report of COVID test price gouging came out of Houston.

Tue, 19 October 21

Texas Invests Federal Funds in IT for Better Health Care

The third special session of the Texas Legislature wrapped up this morning shortly after midnight. This morning, the Legislature voted for the final passage of SB 8, which came out of conference yesterday and appropriates $16 billion in federal COVID relief funds from the American Rescue Plan Act (ARPA).

Wed, 13 October 21

Get Employed, Get Healthy

Experts estimate that direct medical care affects only 15-20% of a person’s overall wellness, whereas the conditions in which people are born, grow, live, and work — social determinants of health (SDOH) — play a much greater role. To encourage better outcomes, health plans are working in communities to help address SDOH, including the need for gainful employment.

Fri, 24 September 21

Food as Medicine

Experts estimate that direct medical care affects only 15-20% of a person’s overall wellness, whereas the conditions in which people are born, grow, live, and work — social determinants of health (SDOH) — play a much greater role. To encourage better outcomes, health plans are working in communities to help address SDOH, including the need for healthy food.

Thu, 16 September 21

Home Is Where the Health Is

Experts estimate that direct medical care affects only 15-20% of a person’s overall wellness , whereas the conditions in which people are born, grow, live, and work — social determinants of health (SDOH) — play a much greater role. To encourage better outcomes, health plans are working in communities to help address SDOH, including the need for safe, secure housing.

Tue, 14 September 21

SDOH: What’s Keeping You Healthy?

hroughout the day to maintain a healthy lifestyle—nutritious meals, regular physical activity, access to medical care and pharmacies, clean drinking water, and the opportunity to get a good night’s rest.

Fri, 27 August 21

Coming September 1: New Texas Health Care Laws

The 87th Regular Session of the Texas Legislature began in the midst of a pandemic that made health care and health care policy a central part of almost every debate. Not only did we see creation policies responding to the COVID pandemic, but we also saw greater emphasis on all areas of health care policy and what it means for Texans.

Mon, 16 August 21

Medicaid Monday: 56 Years of Medicaid

In the summer of 1965, President and Texan Lyndon Johnson signed the law that would put Medicaid into effect. Fifty-six years later, Medicaid is an essential program for the health of many Americans. In Texas, Medicaid connects more than 4 million Texans with the greatest medical needs to health care and coverage.

Wed, 11 August 21

Texas Covered Conference + Expo Agenda Release

Today, the Texas Association of Health Plans released its agenda for the upcoming Texas Covered Conference + Expo, which will be held November 8-10 in Austin, Texas.

Fri, 6 August 21

Don’t Be Surprised: Texas Should Follow the Example of the First No Surprises Act

Act, which was adopted in December to provide patient protections against surprise billing.

Wed, 28 July 21

Uninsured Texans Have Two Weeks to Take Advantage of Special ACA Enrollment

In response to the pandemic, the Biden Administration created a special enrollment period for Americans that started on July 1 and runs through August 15. This gives consumers additional time to shop for coverage and to take advantage of new savings through the American Rescue Plan.

Mon, 19 July 21

Medicaid Monday: STAR Kids Program Beats National Benchmark

A recent external study showed that Texas’ STAR Kids program beats national benchmarks in the majority of areas. These areas include getting needed care (66% compared to 61%), positive customer experience (76% to 68%), specialist rating (82% to 74%) and access to prescription medications (75% to 69%).

Thu, 15 July 21

State of Employer-Sponsored Health Coverage in Texas

Last month, AHIP, the national organization for health plans, released state-by-state data breaking down employer-sponsored health coverage in each state. In Texas, almost 13.5 million Texans were covered by an employer-sponsored plan, the way the majority of Texans (52%) have health insurance coverage.

Tue, 22 June 21

TAHP’s End of Session Guide

Like every session, the 87th Texas Legislature was full of action and surprises. Throughout the 140 days of the regular session, Texas Association of Health Plans was monitoring and actively participating every step of the way, all with the goal of helping our members as they endeavor to make Texas a healthier place.

Fri, 11 June 21

SB 2038: Opportunity for Governor Abbott to Address FSER Price Gouging

Throughout the COVID-19 crisis, Texas has seen a dangerous trend of outrageous bills for COVID-19 testing, including numerous bills over $10,000. Most of these excessive bills are often tied to freestanding emergency rooms. Not only do these facilities overcharge for the test, they often pile on thousands of dollars in physician, facility, and observation fees. In many of these cases, Texas patients received drive-thru testing, where no medical care was delivered other than a simple COVID test.

Wed, 9 June 21

Apply To Speak! – Texas Covered 2021

Covered Conference + Expo that will take place in person in Austin (COVID permitting) from November 8-10. The conference is the largest event of its kind in Texas and brings together decision-makers from across the health care spectrum—from major health plans, providers, and regulators, to legislators, journalists, academics, and more.

Mon, 7 June 21

Medicaid Monday: Legislative Update

Download PDFJune 7, 2021 One week ago today, the 87th Texas Legislature completed the regular session. This Medicaid Monday we’re…

Tue, 1 June 21

Prescription Drug Benefits Are A Big Problem for Small Businesses

A recent survey of small business owners provides a warning for policy makers. Nearly one in three small business owners that provide health coverage to employees has considered dropping it—the vast majority because costs are too high.

Mon, 24 May 21

Medicaid Monday: Improving Client Communication

Download PDFMay 24, 2021 The managed care model has transformed Texas Medicaid from a disjointed, ineffective system to a more…

Thu, 13 May 21

Overutilization by Hospitals Puts Texas Patients at Risk

When people visit a hospital, they are often in the most vulnerable position of their lives. They need to be able to trust that tests and treatments ordered for them are both safe and medically necessary.

Mon, 10 May 21

Medicaid Monday: Managed Care Plans Deliver During COVID-19

In the last decade, Medicaid managed care transformed Texas Medicaid into a more efficient and effective system that helps Texans live healthy and full lives. The COVID-19 crisis has highlighted how managed care can respond to patient and community needs beyond what is available through a fee-for-service model.

Tue, 4 May 21

“Insurance-Like” Products Erode Protections for Pre-Existing Conditions

heduled to hear two bills that would allow “insurance-like” products that would create instability in the market, drive up premiums, and expose Texans, particularly those with pre-existing conditions, to significant liabilities.

Mon, 3 May 21

Medicaid Monday: Celebrating Managed Care Nurses

Thursday kicks off Nurses Week, which runs from May 6 through 12 this year. While all nurses deserve to be celebrated, TAHP would like to highlight a special group of nurses in Medicaid managed care. Texans with complex medical needs in Medicaid have access to health plan nurses who provide one-on-one support and walk families through every step of the complicated and overwhelming health care system.

Thu, 29 April 21

Legislators Need to Know the Cost of Health Care Mandates

When members of the Texas Legislature consider a bill, they often consider the fiscal note (an estimate of what new legislation would cost the state) to weigh the costs and benefits of the legislation and make a decision. But when it comes to health care, legislators also need to understand the financial impact new health insurance mandates have on Texas employers and families.

Thu, 22 April 21

Prioritize Addressing Abuse in the Texas Commercial Market

While the Texas Legislature has devoted considerable resources to combating fraud, waste and abuse in the state’s Medicaid program, little has been done to combat the same issues in the commercial insurance market where abuse is 50% more prevalent and costs $75 billion more than in Medicaid.

Mon, 19 April 21

Medicaid Monday: Texas Medicaid MCOs Work Beyond the Walls of a Doctor’s Office

Today’s Texas Medicaid health plans provide more than health care coverage—they connect Texans to the personalized care and support they need to stay healthy and live their lives to the fullest. Texas Medicaid health plans also provide services that go beyond the walls of a doctor’s office, including helping with transportation, coordinating meals, helping with housing and navigating challenges at school and work.

Tue, 13 April 21

Texas Should Ban Efforts by Big Pharma to Manipulate Drug Costs

As the old joke goes, drug dealers always offer you the first hit for free because once they get you hooked, you’ll be back for more and willing to pay. When similar incentives are offered by Big Pharma for high-priced prescription drugs, the joke’s on patients and employers who pay for health coverage.

Mon, 12 April 21

Medicaid Monday: Care Coordination Creates Better Outcomes and Savings

Today’s Texas Medicaid is more than health care coverage—it connects Texans to the personalized care and support they need to stay healthy and live the fullest lives possible while creating efficiencies that benefit everyone.‍

Tue, 6 April 21

Medicaid Monday: Medicaid Managed Care Works

Over the past 20 years, Texas has transformed an outdated Medicaid system that provided fragmented care into a modern, patient-centered health insurance program providing more than 4 million Texans with the coverage and care they need.

Mon, 5 April 21

Medicaid Monday: Texas Medicaid MCOs Save Money on Prescription Drugs for Taxpayers

Texas taxpayers and patients. Drug costs had almost doubled from 2001 to 2011, and patients received fragmented care that didn’t produce the most efficient or effective results.

Thu, 1 April 21

Electronic Filing of Prior Authorization Benefits Patients and Providers

Every Texan deserves the best health care possible—that means ensuring their care is safe, effective, and clinically appropriate. Prior authorization (PA) is the most important tool health insurance providers have to get patients that care. It reduces inappropriate care by catching unsafe or low-value care and targeting care that is not consistent with the latest medical recommendations—both of which contribute to potential harm and unnecessary costs for patients.

Tue, 30 March 21

New Partnership with Texas Medicare Advantage Plans to Help “Save our Seniors”

The COVID-19 crisis poses unprecedented challenges to Texas and our nation, touching every facet of American life. In the face of these challenges, Texas health insurance providers, Medicaid managed care plans, and Medicare Advantage plans are taking decisive actions to help patients and curb the spread of the virus,

Mon, 29 March 21

Medicaid Monday: Texas Medicaid MCOs Increase Access to Care

Access to care is an essential part of any health care delivery system, and the Texas Medicaid program is no exception. Like private health insurance, Texas Medicaid managed care organizations (MCOs) establish a network of providers to connect Texans to the personalized care and support they need to stay healthy and live the fullest lives possible. As a result, Medicaid managed care allows Texans on Medicaid to access and choose from a variety of doctors and hospitals in their area.

Thu, 25 March 21

Press Release: TAHP Supports HB 2029 to Improve Health Care Access

AUSTIN – The Texas Association of Health Plans supports House Bill 2029, which was heard yesterday in the House Public Health Committee. The bill, by Chair Stephanie Klick, will remove unnecessary and outdated mandates that are preventing Advanced Practice Registered Nurses (APRNs) from providing more health care access and options to Texas Patients.

Wed, 24 March 21

HB 4 and SB 412 Provide Smart Telehealth Expansion

throughout the COVID-19 crisis, Texas health plans and Medicaid health plans have expanded access to care by encouraging and expanding telehealth services and waiving cost sharing, helping Texans receive the care they need from the safety of their homes. The crisis brought with it an explosion in the use of telehealth across Texas—regardless of patient age and type of health insurance. So far, telehealth appears to be fulfilling its promise as a significant part of the health care system.

Tue, 16 March 21

TAHP Opposes HB 907: Don’t Eliminate Protections of Prior Authorization

The Texas Association of Health Plans opposes House Bill 907, which creates a new, unfunded health insurance mandate that prohibits preauthorization requirements for all drugs prescribed to treat a chronic or autoimmune disease. This would eliminate most prior authorizations for prescription drugs. HB 907 is scheduled to be heard in the House Insurance Committee on Tuesday, March 16.

Mon, 15 March 21

Health Plans Helping to Bridge the Vaccine Gap

Throughout the COVID-19 Crisis, health plans have done their part to help Americans get and stay healthy. Now, they are helping to increase vaccinations, especially for the most vulnerable populations who may have the toughest time getting to vaccine sites.

Mon, 15 March 21

TAHP Opposes Insulin Copay Cap Mandates: A Hidden Tax on Employers

insulin has been around for decades, but no generic alternatives exist. That is because the pharmaceutical companies that control the market make small tweaks to extend the patents—gaming the system, artificially inflating prices, and keeping generics off the market. Even though the original patent for insulin was bought for only $1 a hundred years ago and the average cost to produce insulin is only about $6 a vial, the average price of insulin has grown by more than $300 a vial in the last 20 years.

Thu, 11 March 21

The Power of Prior Authorization

There are opportunities for Texas lawmakers to help lower the cost of health insurance for Texas families and employers, but broadly eliminating prior authorizations is not one of them. Unfunded government mandates that eliminate prior authorizations undermine important patient protections and drive up the cost of health coverage for Texas employers.

Fri, 26 February 21

Containing Out-of-Control Costs – Suggestions from Bill Hammond

In a recent op-ed published by the Dallas Morning News, Bill Hammond, chief executive of Texas Employers for Insurance Reform, outlined one of the biggest problems faced by employers today: the rapidly increasing cost of health care.

Thu, 4 February 21

TAHP Files Complaint Against FSER Abuses

As Texas Legislators meet to consider changes to Texas law, many are understandably upset about the practices of free-standing emergency rooms (FSERs). News stories of $10,000 COVID tests from FSERs have populated the headlines for months, and many want to take action.

Thu, 28 January 21

TAHP Announces Medicaid Priorities for the 2021 Legislative Session

The COVID-19 crisis reminds us of the value of affordable health insurance coverage and the peace of mind it brings to Texans and their families. Medicaid managed care has played a key role in helping provide coverage during this economic and health care crisis. Texas Medicaid managed care plans cover medical expenses, coordinate complex medical care, and help Texans stay as healthy and active as possible—all while providing caring, compassionate one-on-one support. The focus on prevention, wellness, and care coordination—getting Texans the care they need to get healthy, stay healthy, and live in their communities—has translated into better care and lower costs. As a result, millions of Texans—including children and pregnant moms—have seen improved outcomes and Texas taxpayers have saved over $5 billion.

Thu, 21 January 21

Texas Health Insurance Providers and PBMs Fight Out-of-Control Drug Prices

While Big Pharma is posting record profits, too many hardworking Americans have to choose between paying their bills and accessing life-saving medicines. Today, more than 21.5 cents of every health care dollar still go to pay for prescription drug costs—more than any other health care expense. That’s why TAHP is prioritizing health insurance provider and PBM efforts to lower drug prices this legislative session.

Thu, 14 January 21

TAHP Joins THCA’s Call to Increase Affordable Access to Care

The COVID-19 crisis has underscored just how important it is for Texas to address our systemic health care provider shortage. Before COVID-19, over 7 million Texans were already experiencing shortages of primary care and over 15 million Texans were already experiencing a shortage of behavioral health care. During the 87th Session, the Texas Association of Health Plans will be advocating to increase affordable access to high-quality health care through more options, better quality, and lower costs.

Fri, 4 December 20

Press Release – TAHP Applauds New TDI Rule That Will Expand Access to Association Health Plans

AUSTIN—Texas Association of Health Plans (TAHP) CEO Jamie Dudensing issued this statement following the Texas Department of Insurance’s adoption of a rule establishing a process for an employer group or association to sponsor an employee health benefit plan:

Thu, 3 December 20

A Telehealth Explosion in Texas

The COVID-19 crisis poses unprecedented challenges to Texas and our nation, touching every facet of American life. In the face of these challenges, Texas health insurance providers are committed to curbing the virus and helping Texans receive the care they need from the safety of their homes — including waiving out-of-pocket costs for telehealth and expanding telehealth programs.

Mon, 16 November 20

COVID-19 And the Growth of Telehealth in Texas

The COVID-19 crisis poses unprecedented challenges to Texas and our nation, touching every facet of American life. In the face of these challenges, Texas health insurance providers are committed to curbing the virus and helping Texans receive the care they need from the safety of their homes — including waiving out-of-pocket costs for telehealth and expanding telehealth programs.

Mon, 16 November 20

Putting Texas Patients First: Texas Health Plans Are Standing With You

The COVID-19 pandemic has posed unprecedented challenges for Texans and our nation, touching every facet of American life. In face of these challenges, TAHP and our members are doing all we can to keep Texans safe while providing continued support to and reducing burdens on patients and health care workers alike. Listed below are some ways health plans are proactively working to care for Texans and help them get access to the services and resources they need to stay healthy during the pandemic.

Mon, 16 November 20

Connecting Texans: Texas Medicaid Managed Care Plans Support Texans During COVID-19

The COVID-19 pandemic poses unprecedented challenges for Texas and our nation, touching every facet of American life. During this crisis and into the future, Medicaid Managed Care Plans are connecting Texans to the personalized care and support they need to stay healthy and live their lives to the fullest. Learn more about how Texas Medicaid Managed Care Plans are responding to COVID-19.

Wed, 11 November 20

Texas Medicaid Serves Texas Veterans

oday on Veteran’s Day, we honor all those who served our country. We celebrate and honor America’s veterans for their patriotism, love for our country, and willingness to serve and sacrifice for the common good. 

Thu, 15 October 20

1332 Waivers: A New Opportunity to Reduce Costs and Increase Access of Comprehensive Health Coverage

COVID-19 crisis remind us of the value of affordable health insurance coverage and the peace of mind it brings to Texans and their families. The COVID-19 crisis has also provided many examples of problems with health care costs that plague Texas, such as questionable billing practices and price gouging. The New York Times, ProPublica, Politico, and other media outlets repeatedly turn to Texas when reporting on the worst examples of these problems.

Sun, 4 October 20

100 Days Until the Texas Legislative Session

Today marks 100 days until the beginning of Texas’ 87th Legislative Session. Last year, we had great success advocating for and passing several pieces of legislation that protect Texans from the high costs of surprise billing, expensive drug prices, and price gouging at freestanding emergency rooms, but our fight for more affordable, comprehensive health care isn’t over.

Thu, 1 October 20

Texas Health Insurance Providers Encourage Flu Vaccines During the COVID-19 Crisis

The seasonal flu is a serious illness that results in half a million hospitalizations and 30,000-50,000 deaths every year. With the ongoing threat of COVID-19, this flu season is expected to be more severe than usual. Texas health insurance providers are covering the vaccine with no patient cost-sharing and encouraging everyone — particularly older Texans, communities of color, and others who are more vulnerable to the flu’s worst outcomes — to get their flu vaccine.

Fri, 25 September 20

Health Insurance Providers to Continue Payment Parity for Telehealth

The COVID-19 pandemic poses unprecedented challenges to Texas and our nation, touching every facet of American life. Since the beginning of the COVID-19 pandemic, Texas health insurance providers have been fully committed to helping solve this crisis, including waiving out-of-pocket costs for telehealth and expanding telehealth programs, so that Texans can access the care they need from the safety of their own homes.

Tue, 8 September 20

Freestanding ER Doctor Resigns in Protest After $11,000 COVID Test Bill from His Own Employer

On Saturday, the national investigative journalism organization ProPublica published its second article in the past month highlighting how freestanding emergency rooms are price gouging Texas patients for COVID-19 tests. This time, Physicians Premier ER in Austin charged one of its own doctors nearly $11,0000 for a test.

Thu, 3 September 20

TAHP Speaks Against Price Gouging

Last month Chron.com reporter Alison Medley wrote an article about Laurie Delgatto-Whitten, a woman who received a $3,000 medical bill after visiting a drive-thru COVID-19 test site in Spring operated by United Memorial Medical Center.

Wed, 19 August 20

Texas Medicaid Managed Care Plans Bring out the Best of the Texas Medicaid Program

touching every facet of American life. During this crisis, Managed Care Plans are connecting Texans to the personalized care and support they need to stay safe and healthy and to live their lives to the fullest.

Tue, 18 August 20

Texas Health Plans Respond to COVID-19

touching every facet of American life. Texas health plans are heavily invested in the health of the Texas communities in which we live and serve, and we are doing all we can to keep Texans safe and support our provider partners. Learn more about how Texas health plans are taking action to help Texans get access to the prevention, testing, and treatment they need to stay healthy.

Mon, 17 August 20

Texas Health Plans Are Committed to Curbing the COVID-19 Virus

The COVID-19 pandemic poses unprecedented challenges to Texas and our nation, touching every facet of American life. In the face of these challenges, Texas health plans are committed to curbing the virus and helping Texans receive the testing and care they need to stay healthy—including eliminating out-of-pocket costs for Texans by covering COVID treatment and testing at no cost and expanding access to telemedicine. The health and well-being of millions of Texans is our highest priority.

Fri, 7 August 20

TAHP Urges State Leaders to Address COVID Test Price Gouging

AHP sent a letter to state officials opposing the Texas Association of Freestanding Emergency Centers’ (TAFEC) recent request for a waiver or rule change that would allow them to provide non-emergent care, including COVID-19 testing. Under their current licensure, freestanding emergency rooms (FSERs) may only provide medical care in emergency situations.

Mon, 3 August 20

ProPublica Investigates Freestanding ER Price Gouging in Texas

Over the weekend, national investigative journalism organization ProPublica published an article demonstrating how freestanding emergency rooms are price gouging Texas patients. In this case—as in hundreds of others around the state—a freestanding ER billed a Houston woman $2,500 for her son’s drive-thru COVID-19 test. The test itself was only $175, but the facility tacked on $2,300 in unnecessarily high facility and physician fees.

Thu, 30 July 20

TAHP Notes Test Price Gouging is a Dangerous New Trend

HOUSTON — Some consumers who thought they were getting a simple COVID-19 test instead got a surprise bill charging their insurance company thousands of dollars. The Texas Association of Health Plans called it a dangerous new trend from a small number of providers.

Wed, 1 July 20

Finding Health Coverage When You Lose Your Job: COBRA Is Not Your Only Option

The COVID-19 pandemic is highlighting the importance of health coverage when it comes to financially protecting Texas families from our state’s high health care costs. Texas already had the highest percent of uninsured residents  and some of the highest health care prices in the country—now, both of those problems have been exacerbated by the coronavirus.

Tue, 10 March 20

Statement from TAHP CEO on Coronavirus Preparedness Among Texas Health Plans

TAHP, its member companies, and our employees are heavily invested in the health of the Texas communities in which we live and serve, and we are fully committed to meeting this challenge. Texas health plans are working to help contain the virus, ensure people have coverage for and access to needed testing, and help patients who are infected receive the care and treatment they need.

Tue, 10 March 20

TAHP Statement on Commitment to Work with Gov. Abbott and State Leaders on Coronavirus Response

TAHP Statement on Commitment to Work with Gov. Abbott and State Leaders on Coronavirus Response

Tue, 10 March 20

Complete Coverage: Texas Health Insurance Providers Respond to Coronavirus

The Texas Association of Health Plans, its member companies, and our employees are heavily invested in the health of the Texas communities in which we live and serve, and we are fully committed to meeting this challenge. Texas health plans are working to help contain the virus, ensure people have coverage for and access to needed testing, and help patients who are infected receive the care and treatment they need.

Fri, 1 November 19

TAHP Joins New Learning Collaborative

A group of health sector stakeholders has launched a new learning collaborative designed to help Texas Medicaid health insurance plans develop and implement strategies to address the non-medical, root causes of poor health for patients across the state. The 12-month project will focus on access to healthy food, housing conditions, transportation, and other social factors that often have a direct impact on a person’s health.

Wed, 30 October 19

Texas Health Plans Urge State Congressional Delegation to Delay Health Insurance Tax

The Texas Association of Health Plans recently delivered the below letter to each member of the Texas Congressional delegation urging them to act swiftly to delay the Health Insurance Tax

Fri, 18 October 19

Episcopal Health Foundation, Health Plans, and MCOs Launch Effort to Address SDOH

AUSTIN—The Episcopal Health Foundation, Texas Association of Health Plans, and Texas Association of Community Health Plans jointly launched the Texas MCO Social Determinants of Health Learning Collaborative this week to develop and implement new ways to address social determinants of health (SDOH) in Texas.

Fri, 4 October 19

TAHP CEO Publishes New Op-ed in the Austin American-Statesman

State and national legislators recently turned their attention to an issue that truly needs it: surprise medical billing. Insurers, physicians, and politicians agree we must protect patients from surprise billing in situations where they receive care from a provider they did not specifically choose, such as when they are treated by an out-of-network ER doctor during an emergency.

Fri, 13 September 19

TAHP CEO Publishes New Op-Ed in Houston Chronicle

Surprise medical bills are a major problem nationally, and almost everyone agrees patients must be protected from receiving them. Surprise billing typically occurs in situations where patients receive care from a provider they did not specifically choose, such as when they are treated by an out-of-network ER doctor during an emergency. After treatment, the provider sends a bill to the patient’s insurer, which pays what it determines is appropriate based on market rates. Once the provider receives payment from the insurer, they may send a bill for the remaining balance to the patient. This final bill is called a surprise bill and can saddle patients with unexpected medical bills for thousands or tens of thousands of dollars.

Tue, 4 June 19

New Law Protects Texas Consumers from Having Credit Damaged by Surprise Medical Bills

AUSTIN – Consumer credit reporting agencies are now prohibited from including medical debt collection accounts in consumer reports thanks to Senate Bill 1037 by Sen. Larry Taylor, R-Friendswood, and Rep. Eddie Lucio III, D-Brownsville, which was signed Friday by Gov. Greg Abbott. The law takes effect immediately and represents a major step in protecting consumers from the long-lasting damage that can result from surprise billing in Texas, where patients are at an uncommonly high risk of receiving expensive surprise bills.

Fri, 24 May 19

Texas Legislature Passes Prescription Drug Price Transparency Bill

AUSTIN—The Texas Legislature acted today to keep prescription drug costs down by passing HB 2536 by Rep. Tom Oliverson, R-Cypress, which requires drug pricing transparency by drug manufacturers, health plans and pharmacy benefit managers (PBMs).

Wed, 21 March 18

TribTalk: Medicaid Managed Care is Still the Right Choice for Texas

Too often, government programs make headlines due to inefficiencies and cost overruns. But what if the state could adopt a program with a decades-long track record of containing health care cost growth to rates four times lower than national averages, while improving clients’ quality of care? While that may sound too good to be true, Texas was one of the first states to embrace this initiative, known as Medicaid managed care.

Fri, 2 March 18

Valley Central: Insurance Company Works with McAllen School to Accommodate Student

Jordan is now a senior at McAllen High School, but has come across some challenges getting to class, as he is also a member of his school’s band.

Mon, 12 February 18

Dallas Morning News Special Report – State of Emergency: An Examination of Freestanding ERs in Texas

The facilities aim to add convenience by allowing patients to be seen faster than in full-service hospitals’ ERs — where overcrowding has been an issue — and by making emergency care more accessible in areas without a hospital nearby.

Wed, 7 February 18

CBS Denver: “Bill Would Clarify Costs of Visits to Free-standing ERs for Patients”

LAKEWOOD, Colo. (CBS4) – Coloradans who need medical treatment often walk into free-standing emergency rooms thinking they are simply urgent care facilities or clinic and they don’t realize what the visit will cost them. When the bill arrives, they owe thousands of dollars.

Mon, 4 December 17

Interim Hearings on TAHP Priority Issues!

House Insurance has scheduled a hearing next week on Wednesday December 6th to hear all of its health care-related charges. These includes charges on stabilizing the health insurance market in Texas, balance billing, prescription drug coverage and PBM transparency. The posting can be found here.

Sat, 2 December 17

Houston Chronicle Special Investigation into ER Cost Crisis in Texas

It had happened so fast, a moment of play turned to blood and panic. Just before lunch 7-year-old Ava was on the floor with the family’s German shepherd. Pettit held out a pizza roll, but the dog lunged just as his daughter popped it in her mouth. Two holes opened in the little girl’s face where the dog’s teeth had been and she started to scream.

Thu, 23 February 17

HHSC Releases 2017 Fact Book

HHSC has released the Fact Book for 2017, which provides overview of Medicaid programs and caseloads and the 11th Edition of Medicaid/CHIP in Perspective (aka The Pink Book). You can view the Pink Book here.

Thu, 23 February 17

Legislators File Bill Extending Sunset Date of State-Run Medicaid Formulary

HB 1917 (attached) was filed this week by Raymond, Zerwas, and Four Price. The bill extends the sunset date of the state run VDP Medicaid formulary to 2030. Current statute gives MCOs full control of the formulary in 2018. TAHP is strongly opposed to this bill and has begun making visits to share reasons for opposition. See our one-page legislative guide on the benefits and savings that will be achieved by transitioning the formulary to MCO management here.

Thu, 23 February 17

Texas Association of Freestanding Emergency Centers Makes False Claims About Underpayments by Insura

The Texas Association of Freestanding Emergency Centers (TAFEC) issued a press release this week claiming 3,400 requests for mediations in Texas are complaints and have resulted in $750,000 in payments to providers as a result of underpayment by insurance companies. Here is a link to the report requested by Rep. Workman from TDI. TAFEC failed to mention that these 3,400 mediation requests to challenge surprise bills from providers totaled more than $6 million in billing and the ultimate result is that consumers were protected against more than $5 million in over-billing by providers. It is also important to note that as it stands, consumer mediation protections do not apply to FSERs. TAHP pointed out these discrepancies to the Dallas Morning News this week; stay tuned for a piece running later this week.

Thu, 23 February 17

Trump Administration Releases Proposed Rule Addressing Market Stabilization Issues

his week HHS released a proposed rule that takes steps aimed at stabilizing the individual and small group health insurance markets. The proposed rule “would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline.” Read more from AHIP here.

Thu, 23 February 17

HAC Begins Meeting

.HAC started meeting this week with presentations by the Legislative Budget Board. On Wednesday the LBB provided an overview of Medicaid. Total Medicaid funding in the 2016-17 adjusted base is $26.3 billion GR and $64.6 billion in AF. This includes an estimated $1.2 billion in GR funds above the 2016-17 Budget to complete fiscal year 2017 expenditures, which includes revenue adjustments, transfers, and assumed supplemental funding. House Bill 1, as introduced includes $27.0 billion in GR funds and $65.5 billion AF for Medicaid in 2018-19, which is an increase of $0.7 billion in General Revenue-Related Funds and $1.0 billion AFs. The committee had many questions about Medicaid managed care, capitation rate setting and savings, and STAR Kids. TAHP staff immediately started meeting with offices to educate them on the value of managed care and will continue meetings over the next several weeks.  LBB Recommendations for HB 1 can be found here.

Thu, 23 February 17

TAHP, TAB, & Others Launch Coalition to Tell the Truth About Freestanding ERs

This week, TAHP, TAB, TALHI, TAHU, and TORCH launched a coalition to raise awareness about freestanding ERs, their exorbitant pricing and misleading advertising that are confusing consumers and contributing to a serious emergency care cost crisis in Texas. Texans For Affordable Healthcare (TAHC), a healthcare advocacy coalition, seeks to educate the Legislature and Texas consumers about the non-transparent, anti-consumer tactics frequently used by freestanding emergency rooms, as Texas is home to more than half the nation’s FSERs. TAHC will be reaching out to Texans who have experienced surprise bills and confusions at FSERs and are willing to share their stories with others and the Legislature. Our coalition is seeking the following solutions to better protect consumers:

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