capitol-building-in-austinThe healthcare landscape in Texas has been plagued by rising costs and limited access to affordable care. This dire situation not only affects businesses but also the well-being of Texans across the state. House Bill 711 (HB 711) emerges as a beacon of hope, offering a viable solution to address these pressing issues. In this post, we’ll delve into the employer’s perspective on this crucial legislation and how it aims to make Texas’ healthcare market healthy.

Empowering Employers with Affordable Care
HB 711 is a significant step forward in empowering employers to contain healthcare costs while providing their employees with better access to affordable care. While some healthcare issues require federal intervention, tackling anti-competitive behavior is the most critical action Texas can take to help businesses reduce healthcare expenses for their workforce. This is not merely a state-level concern; it resonates as a nationwide issue, with many other states considering similar changes.

The Alarming State of Healthcare in Texas
The overall health of the healthcare market in Texas is far from robust. Skyrocketing healthcare prices have made affordable care a distant dream for many Texans. Shockingly, over half of the insured population in Texas has had to skip or delay necessary medical care in the past year due to cost concerns. This paints a grim picture of the challenges faced by both employers and employees in the state.

Informed Consumers and Price Transparency
Healthy markets thrive on informed consumers who can shop for care, compare providers based on price and quality, and make choices aligned with their needs and budgets. However, achieving this requires access to comprehensive information regarding both the cost and quality of services. Although progress has been made in promoting price transparency, there’s still room for improvement.

Fiduciary Duty to Protect Patients
One of the pivotal elements of HB 711 is the imposition of a fiduciary duty on insurance companies. This duty ensures insurers, when utilizing Steering or Tiering mechanisms; do so solely in the best interest of the patient. A fiduciary duty is among the most robust legal obligations, aimed at preventing insurers from engaging in self-serving actions with the potential to harm patients’ well-being.

Prohibiting Harmful Clauses

HB 711 takes a firm stance by prohibiting four types of harmful clauses in contracts between medical providers and employers or insurers:

1. Anti-Tiering: The removal of these clauses empowers employers to implement tiered network designs in their health benefit plans. This allows employers to offer incentives like lower co-pays when employees choose high-value providers.

2. Anti-Steering: These clauses’ elimination enables employers to incentivize employees to select high-value providers through various means, not limited to tiered networks. For example, employers could offer enticing benefits to those choosing high-value hospitals.

3. Gag Clauses: While already illegal under federal law, these clauses may persist in contracts. Their removal ensures that decision-makers at all levels of healthcare purchasing have access to crucial information to make informed choices.

4. Most-Favored-Nation Clauses: Eliminating these clauses empowers medical providers to offer care at prices lower than those negotiated with dominant insurers. This opens doors to discounted rates for uninsured individuals and employers seeking direct contracts with providers, fostering healthy competition among insurers.

House Bill 711 is a beacon of hope for Texas’ ailing healthcare market. By addressing anti-competitive behavior and imposing fiduciary duties on insurers, this legislation offers a path towards healthier, more affordable healthcare. It empowers employers to provide better care options to their employees, ultimately benefiting all Texans. As discussions continue nationwide, Texas stands at the forefront of change, setting an example for others to follow in the pursuit of a healthier healthcare market.