The Daily Signal - Is Texas the Model for Good Health Care Policy?

Episode Date: July 29, 2022

Health care affects every single American. Republicans and Democrats argue over the best way to provide the essential service to the population. But in Texas, a sweeping series of health care reform bills was able to make their way through the state Legislature. And it was done on a bipartisan basis. Dave Balat, director of the Right on Healthcare initiative at the Texas Public Policy Foundation, was instrumental in getting that legislation passed. "When it comes to good health care bills, there really shouldn't be a left and right divide," Balat says. "It should be about what's best for patients." Balat hopes he can spread these bills across the nation. "These [bills] are designed for communities," he says. "They aren't by any means Texas-specific. And I'm working with a number of states already to try to export these ideas and give them the support that they need to implement exactly what has been done." Balat joins "The Daily Signal Podcast" to discuss how his organization helped get these policies passed, and how other states can use Texas as a model. We also cover these stories: The U.S. enters a recession. Sen. Joe Manchin, D-W.V., makes a deal with Senate Majority Leader Chuck Schumer, D-N.Y., on a tax-and-spend bill. Justice Clarence Thomas will not be teaching his constitutional law class at Georgetown Law after student backlash.  Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

This is the Daily Signal podcast for Friday, July 29th. I'm Samantha Rank. And I'm Doug Blair. Healthcare impacts every single American. Republicans and Democrats argue over the best way to provide that essential service to the population. But in Texas, a sweeping series of health care reform bills was able to make its way through the state legislature to the benefit of all Texans and in a bipartisan manner. David Bellot, director of the Right on Health Care Initiative at the Texas Public Policy Foundation, joins the show today to discuss how his organization. helped get these policies passed and how other states can use Texas as a model.

But before we get to Doug's conversation with David Ballott, let's hit today's top news. According to the technical definition, the U.S. is in a recession. The U.S. economy shrank again for a second consecutive quarter at an annual rate of 0.9%. Two subsequent quarters of economic contraction is the definition most economists use to mark a recession. The Bureau of Economic Analysis released that data Thursday amidst record high inflation. In a statement released on Thursday, President Biden said, coming off of last year's historic economic growth and regaining all the private sector jobs lost during the pandemic crisis,

it's no surprise that the economy is slowing down as the Federal Reserve acts to bring down inflation. However, the Biden administration has attempted to redefine what recession means in recent days, as well as trying to tamp down on fears the economy was headed for a recession. West Virginia Senator Joe Manchin, has made a deal with Senate Majority Leader Chuck Schumer, agreeing to a so-called massive tax

and spending bill despite the news Thursday that the U.S. is in a recession. Schumer said that after years of many in Washington, promising but failing to deliver, with the Inflation Reduction Act of 2022, this Senate Democratic majority will take action to finally take on Big Pharma and lower prescription drug prices, tackle the climate crisis with urgency and vigor, ensure the wealthy, corporations and individuals pay their fair share in taxes and reduce the deficit. The Daily Signal reported that the proposed legislation is expected to increase taxes by more than $450 billion over the next decade and would direct $369 billion for decarbonizing

all sectors of the economy. Mansion State of West Virginia is the second largest producer of coal in the nation. Heritage Foundation expert Matt Dickerson said the so-called inflation Reduction Act of 2022 will, in reality, only add to the inflationary pain families are already failing thanks to hundreds of billions in new government spending and job destroying tax hikes. Nearly 12 years ago, Mansion said he didn't think during a time of recession you mess with any of the taxes or increase any taxes. The Senate is expected to vote on the legislation next week. After student pushback, it appears that Supreme Court Justice Clarence Thomas won't be teaching his constitutional law course at George Washington University Law School this fall, after all.

On Wednesday, the university released a statement that said, Justice Thomas informed GW Law that he is unavailable to co-teach a constitutional law seminar this fall. The school was unable or unwilling to provide more comments, and Reuters reported that the Supreme Court itself had not released any comment on Thomas's withdrawal from teaching the class. Following Thomas's decision in the Dobbs case to overturn Roe v. Wade, students and teachers began to disseminate a petition online to try and get Thomas fired from the school. At the time, University Provost Christopher Bracey and Law Dean Dana Bow and Matthew refused to fire him. Judge Gregory Mags, who has taught the class with Thomas since 2011, will now teach the class solo.

WNBA player Brittany Greiner may return home sooner than expected thanks to a deal offered to the Russians, Anthony Blinken announced Wednesday. The deal also sought the release of Paul. Whelan, another jailed American, and would reportedly trade convicted Russian arms dealer Victor Bout for the two Americans, ESPN reported. Secretary Blinken said, our governments have communicated repeatedly and directly on that proposal, and I'll use the conversation to follow up personally, and I hope to move us toward a resolution. Griner was jailed back in February for drug possession and faces up to 10 years in prison if convicted. Weillen was sentenced to 16 years in prison

on espionized charges back in 2020, which the U.S. have said are false, according to NPR. That's all for headlines. Now stay tuned for my conversation with David Ballot, as we discuss how Texas attempted to make health care accessible for its citizens. If you're tired of high taxes, fewer health care choices, and bigger and bigger government, it's time to partner with the most impactful conservative organization in America. We're the Heritage Foundation, and we're committed to solving the issues America faces. Together, we'll fight back against the rising tide of homegrown socialism and we'll fight for conservative solutions that are making families more free and more prosperous.

But we can't do it without you. Please join us at heritage.org. My guest today is David Ballott, director of the Right on Health Care Initiative at the Texas Public Policy Foundation. David, welcome to the show. Good morning. Well, it's great to have you with us, And we're going to talk about health care today. So you have an instrumental in getting some really solid health care legislation passed at the state level in Texas. And this legislation sort of focuses on increasing Texans access to health care, improving those health care outcomes, and then making care more accessible and more affordable. So how does the legislation that you guys worked on do this? Well, we did a number of things.

And a lot of credit goes to the membership in the legislature and the Senate and the House and as well as the governor. Probably the price transparency bill was the most consequential. We saw what happened under President Trump with the executive order that had hospitals disclosed their pricing. We saw the fight, we expected the fight, we ended up winning in court, but we still didn't see any compliance because the penalties were not significant enough. So we knew at that point that we needed to do more at the state level, and we certainly did that.

In a session that was so defided where we even saw Democrats get in a plane and end up in D.C. We saw incredible unity when it came to these efforts and these bills that came across on health care. Price transparency, for instance, we had 100% unanimous votes in support of those bills in every committee and in every chamber. So it sounds like this was something that just they needed to get the process through. It almost wasn't even a right-left divide. It was just nobody had proposed it.

You know, honestly, when it comes to good health care bills, there really shouldn't be a left-and-right divide. It should be about what's best for patients. And that's a lot of what we talk about in right-on-health care is what's best for patients. How do we make health care more affordable, more accessible, and how do we fix the safety net? A lot of this effort that came about to improve health care. And the initiative that came out of the house was the Healthy Families, Healthy Texas Package. Those were bills of things that we could be for.

Because historically, as you know, conservatives and Republicans have been great about shutting things down and being opposed to things. But we needed to be in favor of things. Why? Because we were pushing back on Medicaid expansion. And many people on the right were getting weary of being opposed to it and not having a solution. So that's what we gave them. We gave them a solution. But one of the categories of solutions had to be, how do we fix the existing Medicaid program

so that it works for those for whom the program was intended? One of those bills that you're talking about here is House Bill 290, which streamlined the eligibility process for children to get coverage under Medicaid and then allowed them to continue receiving coverage for up to a year after their eligibility expires. sort of playing devil's advocate here, is our children one of those groups that Medicaid was designed for? Because as you mentioned, conservatives are sort of wary of like expanding Medicaid as opposed to just eliminating it. Correct. Yeah.

No, it's absolutely. Pregnant moms, the disabled, the elderly, and of course children. That's what Medicaid was designed for. Okay. So it's a positive then that we were able to expand Medicaid into this category. Correct. Because many of those populations don't have. Texas is a big state.

There are a lot of rural communities and they don't have the ability always to keep up. And so for them to come on and then come off those roles because they missed an email or a text or a call is easy to do. So having that continuous eligibility up to a year and I think it's actually six months is what we did. It keeps them on the roles so that we're able to check their eligibility once that time period has ended. I think prior to that it was every three months and now it's every six. Speaking of those sort of vulnerable populations, there was another bill, House Bill 18,

that reduces the cost of prescription medications for uninsured Texans. Now, I guess to start out, how does that work? Is that more of that price transparency thing? Or how did the process work that more uninsured Texans were able to? That's actually a really innovative bill who's proposed and championed by Dr. Tom Oliverson, who's the head of the insurance committee in the House. And the way that works is it relied on some of the ARPA funds that was coming from the federal government and having a fund there available so that when patients, and these are only for, this benefit was only for uninsured patients in Texas. So, you know, we talked about how everybody was looking to expand Medicaid to help the uninsured, which it doesn't because the supply of physicians and providers was not going to increase, which meant it was effectively going to crowd out the people who, were vulnerable. So this was a drug program for people who were uninsured. And so they could go in

and buy a medication for the after-rebate cost, which insulin would be $35, something to that effect. The state would make up the difference. And then the PBM for the state would that refund the rebate right back into the state of Texas fund. Is this the more effective way of reducing the cost of health care than to get these people insured? You know, I think we need to look at as many options as possible. That's absolutely a great way of helping uninsured folks be able to afford and purchase the drugs that they need, whether they're chronic or acute in nature. But yes, insurance, one of the things that was a big part of our messaging was coverage isn't care. having an insurance card does not mean that you have health care,

and we've got to stop conflating those two terms. It's important that we recognize having that shiny, pretty card in our wallet does not mean that we have access. And that's especially true, as we've seen, for Medicaid patients, because it's so difficult to get in to go see the doctor. It's so difficult to get in to get the care that you need, that where do they end up? They go to the ER.

Okay. One of the other bills that we are looking at here as sort of the slate of packages is House Bill 133, which focused on maternal health and mortality. You mentioned that pregnant moms are a at-risk group. So given the aftermath of the decision to overturn Roe v. Wade, we're going to expect probably more mothers to give birth here. What other programs should we be looking at at the state levels to improve maternal health? Well, I think that that's something to focus on. I think we need to look at prenatal care. and improve upon, again, access to doctors because so few physicians take new Medicaid patients.

I think the numbers in Texas, and I don't know how this tracks in other states, but we have about 60 or just under 60 percent of physicians that are enrolled as Medicaid providers, but only 30 to 35 percent except new Medicaid patients. Why do so many people enroll but don't take Medicaid patients? because they probably see Medicare patients that have a Medicaid supplement. So it's really there for their Medicare patients. But they don't take new Medicaid patients. So we have a third of physicians that take new Medicaid patients.

And a fraction of them are primary care. And a fraction of them are OB-Gen. So we need to be able to provide additional avenues for these women to get prenatal care so that they can have the healthiest pregnancy. that they possibly can with an outcome of a healthy child. It seems like this bill or the slate of bill sort of expanded access to Texans every which way. One of them also expanded access for telemedicine. Telemedicine obviously kind of came into full force during the pandemic when it was very difficult to go and see somebody in person.

How did the bill address those barriers to telemedicine? And what were some of those barriers in the first place? Well, there was a lot of opposition by a number of groups that there was a couple of concern about telemedicine, whether the physician or medical professional on the other end of the line was meeting the same standards as the physicians in Texas, were the requirements substantively equivalent? That was one of the concerns. Another was really there was a concern about turf.

You know, a lot of physicians here didn't want to see their patients, go see someone else, and it's much easier and much more efficient to do that. So, you know, COVID eliminated a lot of those oppositions. And it's a good thing. Now, are there concerns still moving forward about how best to use telemedicine? Absolutely. But I think overall, it's become more a part of the fabric of how we can consume health care. And that'll continue to be refined.

We've talked a lot about bills that made sense in Texas. And as you mentioned, Texas is a big state. it's got considerations that maybe other states don't have. Are these proposals something that you think would transfer well to, say, a Louisiana or a Minnesota, something like that? Yeah, these are designed for communities. It's not, they aren't by any means, Texas specific. And I'm working with a number of states already to try to export these ideas and give them the support that they need to implement exactly what has been done. Are we seeing any states in particular that are really taking to that, whether we might.

start to see these types of policies evolve? Well, Montana did a lot with direct primary care. They're looking at transparency for their next coming session. Wisconsin is looking at hospital price transparency and also looking at prior authorization reform that we had in Texas and that is actually just been adopted by Dr. Michael Burgess at the federal level as well. He's introduced a gold card program for prior authorization. So Texas has really taken the lead on that issue and we're seeing a number of

of efforts following the wake. So we'll have probably people who are going to disagree that the state is the best way to do this. They'll say things like Medicare for all or the federal government should be in charge. What is the counter to that? You know, again, it goes back to what I was saying earlier about Medicare is insurance. The one thing that I always tell people is that when you hear your politician say anything about health care and predominantly at the federal level, when they're taught, when they say the word health care, I want that to trick. trigger something in your mind. I want that to cause you to think and ask and question, are they talking about health care

or are they talking about health insurance? Nine times out of ten, they're talking about health insurance and we have to make that distinction. You know, we talk about, you know, we hear all the time that health care is a fundamental right. You know, rights are, it's, when you have a right, you can, you can't. can't compel the work of another for you to have a right. And that's exactly what Medicare for all and people who are saying that health care is a fundamental right are saying. They're saying, they have to provide me services. They have to give me medical care. And that's just not the

way that it works. They'll often say, well, look at Canada. Well, yeah, let's look at Canada. I would love to have that discussion because, you know what, they have extraordinary wait time. Some things they do well, but a lot of things they don't. Because if you need surgery, It could be a very long time. If you're in the UK and you need hip surgery and you're 75, you may not be approved for it. And in fact, they just recently said, if you're elderly and you have cataracts, you might get one repaired. Because they just don't have the bandwidth for everything else. There are invariably going to be procedures and policies that ration care in a government-run health care system.

Does that mean that the federal government has no role in the health care debate? Preferably. Fair enough. I guess, yeah, because the question then becomes is the state, the sort of excellent way, the best way to provide that care, or do we even go even lower? Do we go to sort of localities for providing this type of service? Health care is personal, not partisan. It's not something it's done by governments. It's done.

What is health care? most basic level. It's the relationship between doctor and patient. Right. Right. That's as local as it gets. So it's important that we recognize where it happens, where it occurs, and how do we amplify or strengthen that relationship rather than drive wedges between it, which is exactly what's happened. It used to be your doctor used to look at you and put their hands on you rather than face a corner tapping on a computer. I have many physician, friends. And I've told them, unfortunately, the policies of both government and insurance have made you overpaid glorified date entry clubs. And it's unfortunate. I'm sure they responded

positively to that. It's usually a nod and say, yeah. Interesting. Do doctors have any particular, I guess that raises this question. Do doctors have any particular insights on, like, what would be the most effective way to start caring for their patients more intimately? Well, let's look at what's working. We're seeing a lot of surge in direct primary care and other forms of direct care. Direct primary care is a subscription-based relationship with the patient and the doctor. It's both clinical in its direct relationship, but it's also financial. The payment is coming from the patient.

I utilize it myself. And there are oftentimes when I say, you know, doc, we've, you know, this exam has been about an hour long, I got to go. Right. As opposed to, you know, we've been here for four minutes and I've got to go see my next patient. Yeah. The nice thing about that model is that physicians get to practice medicine. And right now in this insurance-centric model that we have, it's, and I hesitate to even call what we have today health care. It's a sick care model.

It's reactive in nature. The coding, how everything is functioning. It's all based on a chief complaint and a diagnosis. Whereas a direct care model is focused on preventative and proactive care. Most of the client's hell for that model happens to be chronic disease patients because they get the time to ask the questions and think about how they can best control and approve upon what it is that they deal with. live on a day-to-day basis. Maybe focus more on that ounce of prevention than the pound of cure. Yeah, it's real health care.

Interesting. That was David Ballott, director of the Right on Healthcare Initiative at the Texas Public Policy Foundation. David, thank you so much for your time. It's been great. Thank you. And that'll do it for today's episode. Thanks so much for listening to The Daily Signal podcast.

If you have not done so already, be sure to subscribe to the Daily Signal podcast on Google Play, Apple Podcast, Spotify, IHeartRadio, or wherever you guys. your podcast. And please leave us a review and a five-star rating on Apple Podcasts and encourage others to subscribe. Thanks again for listening and we'll be back with you all on Monday. The Daily Signal podcast is brought to you by more than half a million members of the Heritage Foundation. The executive producers are Rob Bluey and Kate Trinko. Producers are Virginia Allen and Doug Blair. Sound designed by Lauren Evans, Mark Geinney, and John Pop. For more information, please visit DailySignal.com.

Thank you.