Texas Health care policy
Texas is regarded as a very competitive state when it comes to economy as a result of which many businessmen and other people consider this state as a land of opportunities. With economic growth and prosperity, the state faces several public policy related challenges. The major challenges relating to the public policies include water policy, healthcare policies, educational policies, immigration policies, electricity policies and more. One of the most significant public policy issues is related to the health care policy of Texas (Morrisey and Michael).
Historical perspective of the healthcare policy
During the mid 20th century, the Federal government played a significant role in establishing the National Institutes of Health, the Department of Health and Human Services and Centres for Disease Control. It played an important role in regulating the healthcare industry. The Federal Government enacted various legislations such as the Health Maintenance Organisations Act, 1973, Health Insurance Portability and Accountability Act, 1996; Patient Protection and Affordable Care Act, 2010. Today, the healthcare industry forms a major part of the nation’s economy and the policies are complex. These policies are implemented by the Federal, local and state governments and even by the private organizations. In 2010, the ‘Obamacare’ or the Affordable Care Act (ACA) was passed and implemented in the US which purported to those people who were not covered by any health insurance through their work as the law of the country required all its citizens to be covered by a health insurance or any health care plan.
Health policy in Texas
Health care plans include three forms of plans, namely, HMOs, exclusive provider benefit plans (EPOs) and the preferred provider benefit plans (PPOs). An HMO shall pay for the health care only if a person sees a doctor or uses a hospital within the HMO network. PPO health care plan is offered by an insurance company but if one sees a doctor out of its network, he or she has to pay out of their pockets (Swartz et al.). EPOs is regarded as negotiable agreements with the hospitals and the doctors to provide health care to its members with a discount. However, in order to enjoy this health care coverage one is required to pay some costs for the health care themselves and the amount of cost shall depend on the type of healthcare plan adopted by an individual (Barr and Donald). The state laws in the US require Texas to provide certain benefits along with the health care plans or policies and these benefits are termed as ‘state-mandated benefits’. These benefits include emergency services, maternity and newborn care, prescription drugs, hospitalisation including surgery and more.
However, regarding the ACA, if an individual has a health insurance or Medicare, there is no need a health care coverage under the ACA, only when one does not have a health insurance one may need a healthcare insurance under the ACA. Moreover, it is only important to have a health care plan; it does not have to be through the ACA.
Pros and Cons of the policies
Texas is on the states in the United States that depends on the Federal health exchange (the Marketplace) for the purpose of its health care coverage (Morrisey, Michael and Radcliff). Although the ACA and the other state health care policies have a significant impact and are indeed changing the way, the doctors and the hospitals are delivering care (Polsky, Daniel and Janet). However, taking into consideration the healthcare policy under the ACA, these health care policies have their own pros and cons which are discussed below:
Efficiency- the healthcare policies have made the hospitals improve the infrastructure in order to provide better and improved facilities to the patients and exercise standard of care towards them.
Improved care model- Earlier, the hospitals charged more money for performing more services. Now, the treatment result is compared with the expenses charged and hospitals complying with the requisites become entitled to a raise in federal payments.
Healthcare Expenses- both the private and the public payers are gradually experiencing an increase in the health care costs. One of the important factors responsible for such an increase is that the purchasers and the consumers in a health care market are hardly the same entity (Friedberg et al.).
Administrative expenses- the hospitals attend bulk of new patients everyday as a result of which there is an increase in the paper work, care management and extra time is devoted while dealing with Medicare with billions of patients who have become newly insured (Dafny et al.).
Coverage- the act of providing coverage to more people shall increase the level of challenges. The Medicare patients are already facing problems relating to the unavailability of the medical practitioners.
Decrease in payments- in order to enable the hospitals to meet their expenses, the government shall apply various methods one of which may include a steep downfall in the Medicare reimbursements.
Texas is regarded as one of the biggest single payer of the health care services and has a major impact on the health care service related provisions (Jacobs, Lawrence and Theda Skocpol). Therefore, it is highly recommended that Texas should enable the Texans to have an easy access to the expense and quality related information regarding the health care services. However, taking into consideration that it is difficult to provide the Texans with such information, therefore, the state should maintain an internet portal which may act as a one-stop access point of all the information related to the price and quality of the health care goods and services provided by the hospitals of the Federal, national and state organisations. The Texas Health Care Information Collection Centre (THCIC) must be authorised in a manner which enables the patients to have access to the hospital data review process in order to avert any kind of unnecessary delays.
Further, the government officials are required to take into consideration the several factors that are fundamental while developing sound and healthy policies. The policymakers must consider the public health interest; the efficacy of the policies must be evaluated. Thereafter, the policy makers must ensure that the policy focuses on the health related issues and whether it is capable of achieving the objective. Finally, the policy must be implemented effectively for providing health care benefits to the people.
Barr, Donald A. Introduction to US Health Policy: the organization, financing, and delivery of health care in America. JHU Press, 2016.
Dafny, Leemore, Igal Hendel, and Nathan Wilson. "Narrow networks on the health insurance exchanges: What do they look like and how do they affect pricing? a case study of texas." The American Economic Review 105.5 (2015): 110-114.
Friedberg, Mark W., et al. "Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy." RAND Health Quarterly 3.4 (2014).
Jacobs, Lawrence, and Theda Skocpol. Health care reform and American politics: what everyone needs to know. Oxford University Press, 2015.
Morrisey, Michael A., and Tiffany A. Radcliff. "A STUDY OF AFFORDABLE CARE ACT COMPETITIVENESS IN TEXAS." (2017).
Morrisey, Michael. "Price Searching in the Health Insurance Exchanges." 6th Biennial Conference of the American Society of Health Economists. Ashecon, 2016.
Polsky, Daniel, and Janet Weiner. "State Variation in Narrow Networks on the ACA Marketplaces." (2015).
Swartz, Katherine, Mark A. Hall, and Timothy S. Jost. "Realizing Health Reform’s Potential." (2015).