Texas House considering allowing employers to provide less health insurance

Yahoo

20-03-2025

In most cases, your health insurance must cover a list of certain services such as cancer screenings even if you get it from your employer. The proposed Texas House Bill 139 could remove that requirement and let a company provide an "Employer Choice of Benefits Plan" that does not provide all those state-mandated services.
The bill was filed by Rep. Jay Dean, R-Longview, who is the chair of the House Committee on Insurance. Dean's office did not respond to questions from the American-Statesman on the bill.
State-mandated services include:
Providing coverage for newborn children, students, adopted children and certain grandchildren. This includes children up to age 26.
Supplies and services for diabetes care
Serious mental illness coverage
Childhood vaccines
Hearing screenings
Covering an out-of-network specialist when an in-network specialist is not available
Cancer screenings, including mammograms, colonoscopy or other colon cancer screenings, pap smears and prostate cancer screenings.
The health benefit plan would have to share with employees this disclaimer: "This Employer Choice of Benefits Plan, either wholly or partly, does not provide state-mandated health benefits normally required in health benefit plans in Texas. This employer health benefit plan may provide a more affordable health benefit plan for you, although, at the same time, it may provide you with fewer health benefits than those normally included as state-mandated health benefits in health benefit plans in Texas. Please consult with your insurance agent to discover which state-mandated health benefits are excluded from this health benefit plan."
The plan then has to give a list of mandated health benefits it is not providing.
If this bill becomes law on Sept. 1, "it would allow insurers to offer plans that fail to meet basic expectations that most Texas patients have," said Katherine McLane, spokesperson of Texas Coalition for Patients. She said the coalition believes this legislation would "throw away" 35 bills of protection from the past five legislative sessions.
The employer choice of benefits plan still would have to follow federal rules set by the Affordable Care Act, which does include preventative cancer screenings, newborn screenings and vaccines, for example.
The coalition worries that as the ACA continues to be attacked at the federal level, Texans can't rely on federal law to continue to uphold health care insurance protections, said the coalition's Talan Tyminski. "Mental health, children's health care, those would all be gone," she said.
Dean has another bill that also has the coalition frustrated. HB 138 would create the Health Impact, Cost and Coverage Analysis Program that would create a report of any added cost that mandated health legislation would have on insurance providers or the state, as well as individuals. That report also would analyze if the legislation would increase or decrease the use of health services.
The Center for Health Care Data at the University of Texas Health Science Center at Houston would create the report, but McLane worries patients and providers would be left out of the decision-making.
"This has the stink of big insurance all over it," she said. "We can't exclude patients and Texans from it and (from) taking a wholistic view of health care."
This article originally appeared on Austin American-Statesman: Employer health insurance bill in Texas could reduce coverage mandates