Could health care plans with fewer mandates help more Texans get insurance? Marshall lawmaker believes so

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State Rep. Jay Dean said he’ll propose a bill in the next legislative session that could help more Texans get health insurance by letting small businesses purchase lower-cost healthcare plans.

House Bill 139 would allow private health insurance companies to offer health plans that cover services outlined by the Affordable Care Act but bypass the dozens of insurance coverage mandates the state of Texas has imposed.

State mandates, Dean said, drive up the cost of health insurance and ultimately make health insurance unaffordable for small businesses, which are classified as those with 50 or fewer employees. Large employers in Texas generally do not have to abide by the state’s mandates because their health insurance plans are governed by federal law.

Gov. Greg Abbott calls the proposed legislation the “Essential Benefits Health Insurance Plan" and announced his support for it in July. Dean’s bill does not create a government-run health insurance program.

“We got a lot of these small businesses that make up a lot of the employees in the state of Texas," said Dean, a Longview Republican who represents Gregg, Harrison and Marion counties. “We want them to have the opportunity to be able to offer affordable healthcare, but without all this extra stuff that they don’t need."

More than 16% of Texans are uninsured, meaning the state has the highest rate of uninsured people of any state, according to the Texas Association of Businesses.

Small employers struggle to afford group health insurance plans for their employees, in part, because of the state’s mandates, according to the Texas Association of Health Plans. Those mandates require health plans to pay for more services, which drives up their cost.

But if small businesses can buy health plans without those mandates, their plans could be more affordable. The governor’s office estimates that premiums under a proposed essential benefits plan would be roughly 20% lower than premiums for other policies.

“It’s very common sense," Dean said.

The Texas Association of Health Plans estimates that 80% of all Texas employees have coverage that bypasses the state’s mandates, so the proposed plan would allow small employers to do the same.

“House Bill 139 just does away with all these crazy mandates," Dean said. “As long as they follow the (Affordable Care Act), which is the federal program, which covers most everything, then (businesses and insurers) write their own program."

The Affordable Care Act requires certain health plans to cover essential health benefits, according to healthcare.gov. Those services are: ambulatory patient services (outpatient care people get without being admitted to a hospital, such as routine doctor’s visits); emergency services; hospitalization, including surgery and overnight stays; pregnancy, maternity, and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

Those benefits cover several core facets of healthcare, but they do not include various services such as adult dental and vision care, cosmetic surgery and hearing aids.

Under Dean’s proposed legislation, small businesses could choose to have their health plans cover state mandates, but they wouldn’t be required to.

“They can write programs that benefit their particular employees rather than having to have all of these mandates," Dean said. “So, it’s mandate-lite."

Texas has the highest number of health plan mandates of any state, Dean said. Those mandates have been added gradually over time by previous legislators. But whether they have accomplished their initial purposes is something that lawmakers should examine, Dean said.

Just how many Texans could the bill help get insurance? He said he estimates that figure to be roughly 1.6 million people.

Dean based that estimate on data regarding uninsured people from the Texas Hospital Association, the Texas Department of Insurance and the state’s overall workforce numbers, which show that roughly 5 million Texans work at small businesses.

Dean compared the health plan proposal to purchasing a car. Some healthcare plans are top-of-the-line models that are too expensive for small businesses; those proposed under his plan are more affordable cars that still get people where they need to go.

So far, Dean’s bill has the backing of the Texas Association of Businesses, and the Texas Association of Health Plans has called for similar legislation.

The Texas Legislature will convene Jan. 12.