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AUSTIN, Texas – For the first time in a decade, the number of uninsured children in the United States has gone up.

According to a new Georgetown University report, the number of uninsured kids rose by more than 275,000 in 2017, and nearly 4 million children in the U.S. now lack coverage.

Texas has the largest share of children without coverage: More than one in five uninsured kids lives in the Lone Star State.

Adriana Kohler, senior health policy associate with the group Texans Care for Children, says the report should be a wake-up call for state officials.

“This is a disturbing report for families that want kids to get eyeglasses they need to read the chalkboard at school, or mental-health care to stay healthy. This is disturbing for families who want the best for Texas kids.”

Kohler pointed to the state’s decision not to expand Medicaid as the primary reason the uninsured rate jumped a full percentage point last year, representing some 83,000 children. She said states that expanded Medicaid saw more families enroll, and added that children are far more likely to be insured if their parents can access coverage.

State officials have argued that taxpayers could be on the hook for Medicaid costs if the Affordable Care Act implodes.

Joan Alker, study co-author and executive director of the Georgetown University Center for Children and Families, noted the increase in uninsured kids came during a year when the Trump administration cut the budget for publicizing affordable coverage and hiring “navigators” to help explain the enrollment process.

Alker said people also were watching a steady stream of congressional efforts to shrink programs designed to help working families, which she believes created an “unwelcome mat” effect.

“Congress was trying to repeal the Affordable Care Act for much of the year; Congress was trying to cut Medicaid,” Alker recalled. “And then, Congress let funding for the Children’s Health Insurance Program expire Sept. 30 of that year, and it took them many months to actually get the CHIP program extended.”

Alker believes it is in the nation’s best interest long-term to build upon years of bipartisan progress in reducing the number of uninsured children.

She said when children’s health needs are met, their parents miss fewer days of work, kids are better able to learn in school and are better equipped to make positive contributions as adults.

The full report is online.

Author: Eric Galatas -Public News Service (TX)

AUSTIN, Texas — It can be a major setback for Texas health care consumers: a surprise bill for thousands of dollars from a doctor who isn’t in your insurance company’s network. Texas lawmakers approved a mediation plan in 2015 to allow patients to negotiate those bills, but health care advocates say it’s so complex that too few consumers are using it.

According to Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities, under the current payment system, a medical procedure can become a Catch-22 for the patient.

“Say, a colonoscopy – they often find out if their doctor is in-network and the facility is in-network,” Pogue said. “But they don’t know to ask – or they can’t get good information on – whether the anesthesiologist is going to be in-network; if they have a biopsy and it goes to a lab, if that pathologist in network.”

Pogue said patients, particularly during emergencies, are rarely informed that they may be treated by an out-of-network provider, and those bills must be paid in addition to any deductibles or co-pays. She said Texas legislators are looking at several ways to address the problem, simplify the process and make it easier to arbitrate the bill.

Surprise bills have become a hot potato the health care system doesn’t want to deal with, Pogue said.

“Insurance companies, as you can imagine, and doctors don’t agree on who should pick up the tab. Today, they just push it off on patients because they can,” she said. “And so, if the Legislature says ‘No, you can’t push that cost off on a patient,’ what these other agencies care about is who has to pick up that cost. And that’s the complicating factor.”

Since 2015, about 250,000 Texans who received out-of-network bills were eligible for mediation, Pogue said, but fewer than 4,000 have taken advantage of it.

“Hopefully, it’ll also help consumers know about the program, because that’s one of the biggest barriers is that they created this program to help consumers, but they don’t know about it,” she said. “It does require that there’s a notice that’s put on your medical bill that you have a right to mediation.”

Pogue said she’s confident that the Legislature will act on surprise medical bills this session. She said the issue has bipartisan support in both the House and Senate.

A report, written by Pogue, on the issue of surprise out-of-network medical bills is available here.

Author: Mark Richardson, Public News Service (TX)

On April 15, 2015, Ed Hagan spent a sleepless night trying to cope with a sharp pain in his back.

When morning came, Hagan, then a teacher at a Dallas middle school, was too sick to work. He headed to the emergency room at Texas Health Presbyterian Hospital, which he knew was in-network for his health insurance company, Aetna.

Medical tests revealed Hagan had kidney stones. But the news quickly got worse: Doctors suspected Hagan had a rare form of leukemia, and told him he needed to be hospitalized immediately to get tested.

It was the beginning of more than a year of intensive cancer treatment for Hagan, now 66 and in remission. But the very first day of that ordeal left a lasting — and costly — impression: thousands of dollars in surprise medical bills.

Despite choosing an in-network hospital, the emergency room doctor who treated Hagan wasn’t in-network. Neither was the anesthesiologist who worked on Hagan’s bone marrow sampling. Combined, their bills totaled $2,000.

“Most people don’t know to fight this stuff, or how to write a letter, or how to kick it back at them, saying, ‘You guys got a scam going,’” Hagan said.

State lawmakers have long sought a solution to surprise medical bills — also known as balance bills — as doctors, insurance companies and patients argue over who is responsible for the phenomenon.

Health insurance companies and doctors often fail to go into business together because they can’t agree to what a fair payment for service is. Insurers say doctors want to charge unnecessarily high prices. Doctors, meanwhile, say insurers strong-arm them into taking less than their services are worth.

• READ MORE At Hearing, Advocates Warn of Unexpected Medical Bills

“They’re trying to pay us so minimal to where I can’t keep my office open,” said Ray Callas, a Beaumont anesthesiologist and member of the Texas Medical Association, which lobbies for physicians. “I can’t maintain even employment of other physicians or nurses to maintain access for patients.”

The takeaway is that patients sometimes end up paying the difference.

If doctors and insurers agree on anything, it’s that patients should read the fine print when they go to a hospital so they know what services they will be billed for and what they won’t. But patients who have been stuck with balance bills say the practice is far from transparent.

As lawmakers prepare to take up the issue again in 2017, some are setting their sights on one of the doctors’ key arguments: that health insurers don’t have robust enough networks of doctors to prevent patients from getting stuck with out-of-network costs. The state requires health insurers to contract with a minimum number of physicians in a geographic area.

Health insurers call this “network adequacy” claim a red herring. Jamie Dudensing, chief executive of the Texas Association of Health Plans, said the state’s requirements for physician access are “among some of the most stringent in the nation” and that surprise medical bills are “rarely tied to issues with network adequacy.”

But lawmakers with key posts on the legislative committees that shape health care laws have raised concerns about how well the Texas Department of Insurance polices state rules on network adequacy.

At a May public hearing, Charles Schwertner, a physician and Republican state senator from Georgetown, said in 2014, only 25 of 140 health plans turned in required network adequacy reports in to the insurance department on time.

“How are y’all dedicating your staff to making sure the plans fulfill their requirements regarding the laws in Texas about network adequacy?” he asked department officials. “I’ve been told y’all are deficient.”

Doug Danzeiser, a director at the department, said he thought the agency had done a good job enforcing Texas’ rules. He explained the late submissions by saying the rules were still new as of 2014.

At a subsequent hearing, state Rep. Greg Bonnen, a physician and Republican from Friendswood, questioned whether state officials were appropriately going after health plans with narrow networks.

Debra Diaz-Lara, an insurance department official, said “a lot of work goes into” reviewing insurers’ network adequacy claims and that the agency’s enforcement efforts could be ramped up “with resources.”

Stacey Pogue, a senior policy analyst at the liberal Center for Public Policy Priorities, agreed that the insurance department could do a better job enforcing adequate networks if the agency had more staff devoted to the issue.

But Pogue said going after health insurers alone was insufficient to protect patients from surprise medical bills. She said lawmakers should pass blanket protections for consumers that require doctors, insurers and hospitals to provide up-front information about whether they’ll be covered, and at what cost.

The health insurance lobby says it shares that priority for the 2017 legislative session.

“The keys to curbing balance billing are to remove the consumer from the dispute, expand consumer access to mediation to challenge surprise bills, and to enhance transparency,” Dudensing said in a statement.

Disclosure: The Texas Medical Association, the Texas Association of Health Plans and the Center for Public Policy Priorities have been financial supporters of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.

Author: Edgar Walters – The Texas Tribune

More children in Texas and the nation have health coverage, according to a new report from the Georgetown University Center for Children and Families, but Texas leads the nation in the number of kids still without insurance.

The report found the rate of uninsured children nationally dropped to a historic low of six percent in 2014, the year the Affordable Care Act (ACA) went into effect. Anne Dunkelberg with the Center for Public Policy Priorities cites the expansion of Medicaid eligibility for adults under the ACA – a move Texas has yet to make – as a significant factor for the increased coverage of kids.

“Folks usually refer to that as the so-called ‘welcome mat’ effect,” says Dunkelberg. “When you put out the welcome mat and say, ‘We have coverage for everybody,’ then you end up getting whole families enrolled, and that gets more children covered as well.”

The report found that from 2013 to 2014, the uninsured rate for Texas children declined from 12.6 percent to 11 percent, down from an estimated 888,000 uninsured children to just under 784,000. Dunkelberg says with that many kids in Texas still without coverage, there’s clearly more work to do. According to the study, nearly 4.4 million children in the U.S. still don’t have health insurance.

The report also found that after the rollout of the ACA, 25 states recorded declines in the number of uninsured children, and no state showed significant increases.

Study co-author Joan Alker, executive director at Georgetown’s Center for Children and Families, says the study confirms that years of work by policymakers and other stakeholders to reform health care in the U.S. is beginning to pay off.

“The Affordable Care Act, which is a significant domestic policy initiative, was really building on a decade of success for kids with Medicaid and CHIP,” she says, “But we did see a significant decline from 7.1 percent to six percent in the rate of uninsured kids.”

The report also found that Hispanic and school-aged children were disproportionately uninsured, as well as children living in rural areas or low-income families. Alker says if more states decide to expand adult eligibility for Medicaid coverage, uninsured rates for children could drop even further.

Author: Eric Galatas – Texas News Service