Implementing National Health Care Reform

TexPIRG

AUSTIN, TX, June 16 – The new federal health care reform law puts state leaders in the driver’s seat, according to a new report by consumer advocacy group Texas Public Interest Research Group (TexPIRG).  Delivering on the Promise shows how state policy makers can implement and improve on the law to ensure it offers the best deal to consumers.

“The new law gives states the tools – and funding – they need to make fundamental improvements to Texas’ health care system,” said Melissa Cubria, Advocate with TexPIRG. “Now, whether Texans actually see lower costs, higher quality, and more stable coverage is up to our state leaders.”

Among the central opportunities is the law’s call for each state to create and run an “exchange” – a health insurance purchasing pool for individuals and small businesses. The report lays out key recommendations to make the exchange a powerful force for consumers:

• It should offer a powerful, easy-to-use set of tools that put consumers in charge of their coverage, including clear comparisons between plans and quality and cost ratings, and that ensure there is a range of clear, distinct choices, rather than an endless array of confusing products. 
• The exchange can improve care quality and lower costs by encouraging insurers to adopt reforms that deliver better care for consumers.  It should also be able to actively negotiate with plans on behalf of consumers and stop excessive premium hikes.
• States must ensure that the exchange’s governance is transparent, accountable, and responsive to consumers’ interests, not those of the insurance industry. 

“The exchange can be a real game-changer, giving individual consumers and small businesses the equivalent of a large employer’s human resources department negotiating rates for them.  And by providing clear information and easy-to-use comparisons on insurance plans, it will promote competition,” said Cubria.  “But if state policymakers miss the boat, it won’t be much more than an Expedia page for health insurance.”

The new law also offers grant funding to help states adopt important reforms to:

• Encourage high-quality, low-cost treatment by investing in primary care, programs to prevent chronic diseases from turning acute, and reforms to improve coordination of care when many doctors treat the same patient.
• Set up programs to review premium increases before they go into effect, protecting consumers from unjustified rate hikes and informing them about where their dollars are going.
• Create temporary purchasing pools for consumers with pre-existing conditions who otherwise could not get coverage.

“There are billions of dollars of grant funds available to support stronger consumer protections and invest in innovative approaches to care that will make affordable, quality health care a reality for Texans.  Texas should take advantage of these federal dollars. State leaders should not leave this money on the table,” continued Cubria.

State leaders also have the chance to improve on the achievements of the federal law.  The report outlines approaches that can save money and improve care, such as streamlining administrative paperwork, limiting abusive pharmaceutical company marketing practices, and investing in ground-breaking health IT systems to give doctors more powerful tools.  And while the federal law ultimately did not include a public health insurance option, states have the ability to create one to serve their own residents.

“The bottom line is that our own policymakers and advocates need to step up and take the lead if Texas is going to see relief from the rising cost of health care,” concluded Cubria.  “Texas has been at the bottom of the barrel for too long with some of the highest premiums and lowest rates of coverage in the nation. Texas has the opportunity to improve its flawed health care system. Congress delivered on its promise. Now it’s up to the leadership in Texas to do the same.”