Abbott seeks leaner, cheaper health plans

Gov. Greg Abbott this week is laying out plans to lower health insurance costs and drug prices as the Republican governor continues to focus his reelection campaign on affordability ahead of a midterm likely to be dominated by cost-of-living concerns.

The focus on health care could work to blunt a longstanding attack line for Democrats in the state: Texas' sky-high uninsured rates. The state is the highest in the nation, with some 5 million Texans lacking health insurance.

Abbott says his plan would create affordable coverage for more than a million of them by making it cheaper for small businesses to offer insurance for their employees. The governor on Wednesday said state mandates have made it too expensive for many small businesses to offer insurance. He called for legislation that would allow those businesses to provide plans that don't meet all state mandates beyond what is required by the federal government.

"Small businesses want to provide their employees with health care insurance. It's just good policy, it's a good strategy, but also it's essential for them to be able to compete with other employers," Abbott said at a campaign event in Fort Worth. He said his plan will "allow Texans to get health insurance covering all of the essentials without paying for expensive additional mandates imposed by the state."

Critics, however, say the plan would clear the way for businesses to offer "junk" insurance plans and could actually lead to higher costs for consumers.

The plan "leaves Texans vulnerable to expensive medical conditions and surprise medical events by removing protections that Texans have fought to secure for decades," said Lynn Cowles, a health policy expert at the Austin nonprofit Every Texan. "This plan will lead many Texans who have or develop high-cost health care needs into medical debt and worse health overall."

Every Texan, an Austin think tank, argued a similar proposal pushed last session by Rep. Jay Dean would "realistically increase health care expenditures for individuals and families when they must take on costs of health care services they assumed were covered by their employer health insurance plan but actually would not be covered."

Dean, the Republican chairman of the House Committee on Insurance, said he is working with the governor on the proposal, the details of which are still being worked out.

Dean's bill last session would have allowed insurance companies to offer plans that do not comply with state mandates, as long as they carried clear disclosures. Insurers would also have had to provide a fully compliant plan in order to offer the lighter options.

The bill was opposed by a slew of medical groups, including the Texas Medical Association, which argued it would undermine longstanding protections and expose Texans to "hidden costs and harmful coverage gaps."

The state only regulates plans for a portion of the insurance market that cover about 3.2 million Texans, most of them employed by small businesses. The mandates dictate everything from how big the plans' networks must be and when they can use generic drugs to the benefits they must offer, including diabetes treatment and coverage of gender "detransition" services, which lawmakers passed last year.

Dean argued Texas's many mandates are effectively forcing Texans onto plans that go well beyond what they might need.

"Right now, it's an 'all or nothing' ... You can either get a Mercedes or nothing," Dean said. "I'd buy a good used vehicle, just so I could get to and from work and school. Right now with these mandates, it's, 'No, you're either going to take the Mercedes or you can keep walking.'"

Healthcare experts say Texas' refusal to expand Medicaid to cover low-income adults also contributes to the high uninsured rate. Abbott and other state Republicans have consistently opposed that plan citing cost concerns. The federal government heavily subsidizes the safety net insurance, but states must cover a portion of the costs.

Abbott is also calling for legislation that would cap monthly co-pays at $25 for inhalers and epinephrine for those same state-regulated insurance plans. He previously signed legislation capping insulin costs in the same way.

"This will save millions of Texans hundreds of dollars a year on their health care costs," Abbott said during a campaign stop in Mission Thursday.

The health care proposals build on the governor's growing focus on affordability as he campaigns for a record fourth term in office.

Abbott earlier this month called for a $400 million grant fund to help homeowners fortify their roofs, which could help drive down home insurance costs. He has also called for legislation allowing all auto insurers to factor in driving records when setting rates so safer drivers pay less. (Current law only allows county mutual insurers to do so.)

The governor is also pushing a major property tax overhaul that would cap appraisals and use the state surplus funds to eliminate school taxes for homeowners.

State Rep. Gina Hinojosa, an Austin Democrat running against Abbott, called the governor's pitch an "election year stunt."

"If Greg Abbott wanted to lower healthcare costs for Texans, he would've done it in the twelve years he's been Governor," Hinojosa said. "Texas has the highest number of uninsured people and the most rural hospital closures in the country. Abbott has no credibility here as health insurance premiums continue to skyrocket."