Medicaid, opioids and abortion: Health care issues to expect this Texas legislative session

Texas is leading the charge in a federal lawsuit seeking to end the Affordable Care Act, known as “Obamacare,” arguing the law is no longer constitutional after Congress ended the individual mandate. The state also has the highest uninsured rate among adults in the country and the largest number of children without health insurance. But amid uncertainty about the federal health law, state legislators will tackle a variety of issues during the session, from abortion to mental health to opioids to funding for Medicaid.

Here are eight things we're watching in the health and human services landscape during the session.

1. A new leader

This is the Health and Human Services Commission's first session being led by its new executive commissioner, Dr. Courtney Phillips, after her arrival in October. The former chief executive officer for the Nebraska Department of Health and Human Services is now overseeing the Texas agency with 60,000 employees and an $80-billion biennial budget. A key difference going into session: She has a background in health care that her predecessor Charles Smith did not. The agency continues to recover from the fallout of mishandling contracts and problems with the Medicaid managed care program. She’s also heading into session after dozens of experienced staff members departed amid low morale in the agency.

2. Medicaid

The joint federal-state health insurance program for the poor and disabled continues to be a point of frustration for Texas legislators, doctors, patients and advocates. The costs for the program continue to grow and will be a point of contention during budget talks as legislators balance other funding priorities like Hurricane Harvey recovery, property taxes and school finance. It will also be important to watch if and how legislators overhaul the state’s Medicaid managed care program. The program has been scrutinized in recent months after The Dallas Morning News reported on how private companies running the program have failed to care for vulnerable Texans, and put that money toward paying lobbyists and executives’ bonuses. In addition, doctors are again pushing for higher reimbursement rates under the program, which they say would likely encourage more physicians to participate. Another issue is if Texas legislators will give Medicaid expansion one more look. The state has previously resisted expanding coverage for low-income Texans but advocates are making the case again citing the potential financial savings and how it would help hospitals who treat uninsured people.

3. Opioids and substance abuse

Texas hasn’t captured the national spotlight in the opioid crisis like Kentucky, Maine, Ohio and West Virginia. But Texas legislators said in a November report the state has an “alarming” problem when it comes to helping Texans with substance abuse problems. Nearly 3,000 Texans died from opioid and other drug overdoses in 2017, according to the report, which said it could cost $931.1 million to tackle the state’s problems. Some of its recommendations include enacting "Good Samaritan" laws to legally protect people who help someone who is overdosing; making more medication-assisted treatment options available for doctors and patients; and investing in helping vulnerable populations like pregnant women and families dealing with Child Protective Services.

4. Adult Protective Services

Legislators approved $12,000 raises for Child Protective Services caseworkers before the 2017 session amid a crisis over children sleeping in state offices and overworked caseworkers being unable to see some endangered children. But now Adult Protective Services, the agency responsible for older adults and disabled people who have been abused or neglected, is also experiencing high caseworker turnover and caseloads. That’s why the agency is hoping legislators will approve its $17.8 million request for caseworker raises. If approved, 517 staffers would receive a $12,000 annual salary increase. But it’s unclear if APS will get the same level of priority as CPS did. Even Kezeli Wold, associate commissioner for APS, admits that the agency doesn’t always “get enough attention” from the Legislature, media or community.

5. Maternal care

Texas’ maternal mortality numbers have made headlines since the 2017 session because they’re lower than originally reported. A study published by several of the state’s top health experts last year found that the number of women who died from childbirth was less than previously stated. The state’s Task Force on Maternal Mortality and Morbidity found in its most recent report that 118 women died in 2012 within a year of giving birth. Among the deaths reviewed, heart and cardiovascular problems, hemorrhaging and infection/sepsis were top culprits. Black mothers were most likely to die from complications. Despite the numbers, health advocates have said legislators are not off the hook when it comes to helping more Texas mothers access prenatal care, postpartum care and other help they may need with substance abuse and mental health. Advocates are particularly hoping legislators will heed the task force’s recommendation to extend full Medicaid benefits for low-income mothers to a year after they deliver instead of only two months.

6. Mental health

Texas legislators made substantial investments during the 2017 session in mental health. That included launching a community grant program for mental health services, addressing how health insurance companies offer mental health benefits and funding to renovate state mental health hospitals. One issue to watch this session is how legislators will focus on vulnerable populations who need access to care including children in grades K-12, people with intellectual and developmental disabilities, pregnant women and incarcerated people. Other key issues are suicide prevention; funding for mental health services; if legislators will further mental health benefit protections for insurance; and whether legislators will give salary increases to state hospital workers.

7. Abortion

In the wake of Supreme Court Justice Brett Kavanaugh replacing Justice Anthony Kennedy — a swing vote at the time — the high court’s conservative majority has fueled speculation about the future of abortion policy, including the potential overturning of Roe v. Wade. Anti-abortion groups have expressed hope that abortion bills passed into law in Texas and elsewhere face lawsuits that may ultimately move up to the Supreme Court and trigger the justices to reexamine Roe v. Wade. One Texas Senate bill would prepare for the demise of Roe v. Wade with a state constitutional amendment prohibiting abortions in the state if the Supreme Court overturns it. The tone was arguably set the day before session started when state attorneys and lawyers representing reproductive rights groups argued in federal court about whether a lawsuit challenging more than 60 Texas abortion regulations would continue.

8. Vaccines

Public health experts are continuing to fight an uphill battle as outbreaks of diseases of the past like measles, mumps and whooping cough have resurfaced nationwide among people who are unvaccinated. Texas is one of 25 states that have experienced a measles outbreak in 2018, according to the federal Centers for Disease Control and Prevention. The public health community has also expressed concern about the growing number of Texas children with conscientious vaccine exemptions. There were 56,738 Texas students from kindergarten to 12th grade with such exemptions, according to the Texas Department of State Health Services. Another issue to watch is whether anti-vaxxer families will pursue legislation that would require child care providers to accept children who haven’t been vaccinated. In addition, while bills related to requirements for vaccines and immunization data will be important to watch, amendments during heated floor debates will also matter.