TAFP’s loan repayment reform bill filed

Rep. Warren Chisum, R-Pampa, and Rep. Richard Raymond, D-Laredo, filed a bill aimed at increasing the number of primary care physicians practicing in rural and underserved areas. House Bill 1876 would consolidate the state’s various loan repayment programs under one umbrella and significantly increase the funding available so that physicians and other health care providers agreeing to practice in underserved communities could receive up to $160,000 in loan repayments over four years of service.

The bill would reorganize the state’s loan repayment programs so they more closely resemble the successful National Health Service Corps program. TAFP member Adrian Billings, M.D., Ph.D., practices in what he calls the “frontier” location of Alpine because he’s fulfilling his obligation for loan repayment through the NHSC program. Billings says the program paid all of his medical school costs, allowing him to graduate free of debt. He plans to stay and keep practicing in Alpine even after he’s completed his obligatory four years.

“Because our patient population out here is significantly underinsured or not insured, I am able to afford to practice out here because I do not have to worry about making payments on any medical school loans.”

Despite the success of NHSC, the national program lacks the scope to ensure that Texas has an adequate and properly distributed primary care workforce, which is why TAFP believes an enhanced state loan repayment program would make a measureable difference. Today, more than half of Texas’ counties need additional primary care physicians. 114 counties do not meet the national standard of one physician for every 3,500 people. By 2015, Texas will need more than 4,500 additional primary care physicians and other providers to care for the state’s underserved population, predicted to be 5.3 million people.

On average, medical students graduate with more than $130,000 in debt, which leads many to eschew careers in primary care in favor of more lucrative specialties. The number of U.S. medical students entering family medicine residency positions has dropped by more than half over the last 10 years.

Without the weight of medical school debt, Billings says he’s able to see any patient who comes to his office, whether he or she is insured or not.

“It is very fulfilling and I feel I am meeting a significant need for the community and the Big Bend area as a result of the National Health Service Corps scholarship.”

The bill would pay for the additional loan repayment funding by changing the way some tobacco products are taxed. Currently, the tax on smokeless tobacco products is based on price, not unit. The excise tax on these products is not applied consistently, which creates a tax loophole that promotes the use of cheap smokeless tobacco and deprives the state of excise tax revenue.

Most excise taxes are applied on a per-unit basis rather than on a product’s retail value, including cigarettes and cigars. This means all products are taxed equally, regardless of their price, ensuring these products fully compensate society for their negative impacts.

TAFP argues that closing this smokeless tobacco loophole would simultaneously bring a measure of tax fairness to the market, reduce smokeless tobacco consumption thereby improving the health of Texans, and raise a significant amount of new revenue that could be used to increase access to primary care in underserved areas.

For more information, check out TAFP’s issue brief on loan repayment.

Instant verification of benefits could become a reality in Texas

As the cost of health insurance continues to climb and Texans find themselves paying more of their health costs out of their own pockets, doctors and patients need access to the details of their coverage while they are in the exam room. But today that’s not the case. Patients often don’t know what services are covered under their plans, what their co-pay is or how much of their annual deductible they’ve already spent.

H.B. 1342 by Rep. Jose Menendez, D-San Antonio, and its companion, S.B. 863 by Sen. Chris Harris, R-Arlington, would require health insurers to provide instant verification of coverage to physicians at the point of service. That would include what services are covered and what the patient’s out-of-pocket costs will be so patients and their doctors can have meaningful discussions about treatment options.

Without the requirement that all health plans offer instant verification of coverage, physicians are often put in the awkward position of trying to help patients understand the limits of their insurance coverage with no way to know for certain what services are covered while the patient is in the office. Today, there’s no mechanism for discerning how much the policy will pay, what the patient’s financial responsibility is and if the patient has met his or her deductible.

This lack of information prevents physicians and their patients from having meaningful conversations about different treatment options and what the out-of-pocket costs of those options might be.

“How can a patient be expected to spend appropriately on health services when he or she doesn’t have access to exactly what services are covered and what those services are going to cost?” says TAFP CEO Tom Banning.

The bill has been filed in both the House and the Senate, but neither has been referred to a committee yet.

TAFP member testifies before House Appropriations Subcommittee on Health and Human Services

Family physician Todd Thames, M.D., director of the CHRISTUS Santa Rosa Family Medicine Residency Program in San Antonio, told members of the House Appropriations Subcommittee on Health and Human Services on Thursday that Medicaid rates are still too low for many physicians to participate in the program. The subcommittee has been meeting each day this week hearing testimony about state funding for health services.

“As the Texas economy slows, we know that more and more Texas families will turn to Medicaid, the Children’s Health Insurance Program and other publicly financed health care programs to receive their medical care,” Thames told the subcommittee. He encouraged lawmakers to use federal fiscal stimulus dollars to make sure public programs can handle the expected increase in needs during the recession and strengthen the infrastructure of those programs so they work better for patients and physicians alike.

Thames also told the subcommittee that as they consider funding levels for health services in the next biennium, the organizations he represents recommend reducing the number of uninsured children by expanding coverage to 12 months for children in Medicaid, boosting efforts to get eligible children enrolled in CHIP and supporting private and public initiatives to make affordable, accessible insurance options available to families.

He also recommended that Medicaid payment rates be increased to the level of payment in the Medicare program. Even after increases in Medicaid reimbursement rates enacted last session, Medicaid pays about 70 percent of what Medicare pays.

In his downtown San Antonio practice, Thames said he maintains a 51-percent Medicaid payer mix. He told the members that when he provides care for his adult Medicaid patients, he loses money. The payment received does not cover the costs of providing those services.

“If I’m going to continue to provide that level of Medicaid service, then it means that other services that I’d like to provide my patients just aren’t possible. I simply can’t keep the doors open and keep staff employed with 50 percent Medicaid,” Thames said.

Read Thames’ written testimony.

Physician of the Day

TAFP extends a special thanks to the physicians of the Texas Osteopathic Medical Association who volunteered as Physicians of the Day during TOMA Week.

Don’t miss your chance to volunteer as a Physician of the Day during the 81st Texas Legislative Session. One day remains in March that needs to be filled: Tuesday, March 24. There are limited spots available in April and May.

As a Physician of the Day, you’ll care for lawmakers and the staff and anyone else on the Capitol grounds in the Capitol Health Services clinic, and you’ll have the honor of being announced in both the Senate and the House. TAFP has been providing this service in the Capitol for legislative sessions since 1971. For more information including an online calendar of available dates, and to sign up, click here.