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Texas Health Care Reform

Texas Health Care Reform. Coverage Institute September 26, 2007. The Texas Health Care System. Employer-based health insurance (~50%) Non-group (No guaranteed issue, full medical underwriting & pre-existing condition exclusions allowed)

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Texas Health Care Reform

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  1. Texas Health Care Reform Coverage Institute September 26, 2007

  2. The Texas Health Care System • Employer-based health insurance (~50%) • Non-group (No guaranteed issue, full medical underwriting & pre-existing condition exclusions allowed) • Small group (guaranteed issue & renewability, limited medical underwriting & allowed) • Large group (limited rate/underwriting regulation) • Public programs (~25%) • Medicaid (~12%, 2.8M) • Uninsured (~25%)

  3. Primary Challenges • National Challenges • Access • Affordability • Costs • Fragmentation (horizontal) • Texas-specific Challenges • Demographics • Industry structure • Fragmentation (vertical) • Regulation

  4. Framework for Reform • Health Care Delivery • Risk & Cost Distribution • Patient & Consumer Dynamics

  5. Sample of Recent Activities • Health Care Delivery • House Bill 1066 (health information technology) • Risk & Cost Distribution • Senate Bill 10 (Medicaid reform) • Patient & Consumer Dynamics • Senate Bill 1731 (Price & quality transparency)

  6. Considerations for Texas Health System Reform • Health Care Delivery • Regulatory review • Aligned incentives for quality, safety, and efficiency • Risk & Cost Distribution • Health insurance market reform • Health insurance market support • Health insurance market infrastructure • System integration • Eligibility changes • Patient & Consumer Dynamics • Personal responsibility • Consumer empowerment

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