We look at how three complex ongoing situations could affect Texans’ access to health care and health insurance in the near future.
DALLAS — Recent events have left health insurance coverage and access to medical services in limbo for millions of Texans.
There has been a flurry of activity in this area in recent weeks on three separate fronts.
First, there’s the battle between Baylor Scott & White Health and Blue Cross Blue Shield of Texas, as the two sides continue to spar over the terms under which BCBS plan enrollees can get in-network coverage at Baylor Scott & White Health facilities.
Additionally, a dispute between the Texas Health and Human Services Commission and Fort Worth-based nonprofit health insurer Cook Children’s Health Plan, in which the former has refused to award Medicaid contracts to the latter (and other insurers), could force millions of Texans to change their plans next year if the decision stands.
Finally, there’s the turmoil surrounding Dallas-based hospital operator Steward Health Care, which last month announced plans to sell more than 30 hospitals it operates across the country, potentially leaving many rural Texans, and others in similar geographies across the country, without access to local medical facilities.
Below I’ll explore each of the above in more detail and try to explain exactly what’s going on.
Baylor Scott and White Health Negotiations with Blue Cross Blue Shield
If the two groups don’t agree on changes to doctor and hospital contracts by July 1, Baylor Scott Hospital and White Health hospitals and facilities could soon be out of network for Blue Cross Blue Shield of Texas insureds.
Patients with out-of-state Blue Cross Blue Shield plans may also be affected.
It’s an ongoing issue for Blue Cross Blue Shield, with contentious contract negotiations ongoing between the state-level organization and various local hospital networks. It has been in danger many times It covers a lot of people across the country.
Specifically, the negotiations have revolved around a discrepancy between the increased post-pandemic reimbursement rates that Baylor Scott & White is demanding and the amount that Blue Cross Blue Shield of Texas is willing to agree to.
The possibility of no deal being reached is of particular concern in Texas, where Baylor Scott & White is the state’s largest nonprofit health system with 51 hospitals, while Blue Cross Blue Shield is the state’s largest insurer with about 25% of the market share.
Below is a list of the core plans for the negotiations.
- Par Plan
- Health Select
- Blue Choice PPO
- Blue Essential
- Blue Advantage HMO
- Blue Premier/High Performance Network (HPN)
- Blue Cross Medicare Advantage (PPO)
- Blue Cross Medicare Advantage (HMO)
- Managed Medicaid STAR Kids
Texas denies Cook Children’s Health Plan Medicaid contract
The Texas Health and Human Services Commission announced in March that it would not award a Medicaid contract to Cook Children’s Health Plan, a Fort Worth-based nonprofit health insurer. Fort Worth Star-Telegram Other affected plans include Texas Children’s Health Plan of Harris County and Driscoll Health Plan of South Texas; Texas Tribune I reported it.
Cook Children’s Health Plan, a subsidiary of Cook Children’s Pediatric Health System, is a leading provider of Medicaid health insurance to children and pregnant women in Tarrant County.
Instead of awarding the contract to Cook Children’s Hospital, the state will award the contract to other insurance companies in Tarrant County and five other Texas counties: UnitedHealthcare, Molina, Blue Cross Blue Shield and Aetna.
By not awarding Medicaid contracts to Cook Children’s Hospital and five other managed care organizations in the state, roughly 2 million Texans who currently receive Medicaid coverage through those providers will have to change their plans next year unless the Texas Department of Health and Human Services reverses its decision to reallocate contracts.
Cook Children’s Health Plan announced earlier this month that it plans to appeal the decision again in an effort to preserve coverage for its members, shortly after its most recent attempt to appeal the decision quickly failed.
Steward Healthcare plans to sell hospitals after filing for bankruptcy
Dallas-based hospital operator Steward Healthcare filed for bankruptcy in May and announced plans to sell more than 30 hospitals it operates across the United States.
At the time of its bankruptcy filing, Steward said the hospital’s day-to-day operations would not be disrupted during the Chapter 11 proceedings. But that hasn’t necessarily assuaged concerns from lawmakers across the country who have expressed concern that Steward-run hospitals could close and leave many people, especially those in rural areas, without a nearby hospital facility.
Before filing for bankruptcy, Steward The company, the nation’s largest private, for-profit health care system, faced multiple lawsuits from vendors. The company was allegedly owed $50 million in total for services it provided..
Steward’s business, based in a high-rise overlooking Dallas’ Klyde Warren Park, has been of particular concern in Massachusetts, home to the largest number of Steward hospitals, where public hearings are being held to discuss options for providing medical services to already underserved areas of the state if Steward hospitals suddenly close.
A congressional delegation led by Senator Edward Markey of Massachusetts has filed suit against workers at Steward-owned hospitals, according to reports. As of fall 2023, the company will have 33,000 employees. — Health care and retirement benefits will be protected in the event of a potential sale.
Hospital staff and patients in Texas appear to be highly at risk from the same issues being debated in Massachusetts. Steward currently operates hospitals in Port Arthur, Odessa, Big Springs, Houston and Texarkana. Website.
A sixth facility the company previously operated in the state, Southeast Texas Medical Center in Beaumont, closed in early February.
