DALLAS — Recent events have left health insurance coverage and healthcare access in flux for millions of Texans.
There's been a flurry of activity the last few weeks in this realm, namely on three separate fronts.
First up, there's the tussle between Baylor Scott and White Health and Blue Cross Blue Shield of Texas, who are engaged in a back-and-forth over terms that could jeopardize those with BCBS plans being able to still receive in-network coverage at Baylor Scott and White Health facilities.
Then there's the situation between the Texas Health and Human Services Commission and the Fort Worth-based nonprofit health insurer Cook Children's Health Plan, which finds the former refusing to award a Medicaid contract to the latter (among others) -- a move that could require millions of Texans to change plans next year if the decision continues to stand.
Lastly, there's the turmoil surrounding the Dallas-based hospital operator Steward Health Care, which said last month that it plans to sell off more than 30 hospitals it operates across the country, possibly leaving many rural Texans -- and others across the country in similar geographic situations -- without access to their local healthcare facilities.
Below, we'll take a deeper dive into each of the above and try to explain exactly what's happening.
Baylor Scott and White Health's negotiations with Blue Cross Blue Shield
Baylor Scott and White Health hospitals and facilities could soon be out of network for those with Blue Cross Blue Shield of Texas insurance if the two entities don’t agree on changes to physician and hospital agreements by July 1.
Patients who have an out-of-state Blue Cross Blue Shield plan may also be impacted.
This has been an ongoing issue for Blue Cross Blue Shield, as contentious contract negotiations between its state-level entities and various regional hospital networks have repeatedly jeopardized coverage for many across the country.
Specifically, the negotiations center around a disparity between the increased, post-pandemic reimbursement rates Baylor Scott and White is requesting and the amount that Blue Cross Blue Shield of Texas is willing to agree upon.
In Texas, the possibility of an agreement not being reached is especially concerning. Baylor Scott and White is the largest nonprofit health system in the state with 51 hospitals. Blue Cross Blue Shield, meanwhile, is the largest insurer in the state with nearly 25% of the market share.
Below is a list of the plans at the center of the negotations:
- ParPlan
- Health Select
- Blue Choice PPO
- Blue Essentials
- Blue Advantage HMO
- Blue Premier/ High Performance Networks (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 wouldn’t award a Medicaid contract to the Fort Worth-based nonprofit health insurer Cook Children’s Health Plan, as reported by the Fort Worth Star-Telegram earlier this month. Other plans affected include the Texas Children’s Health Plan in Harris County and Driscoll Health Plan in South Texas, the Texas Tribune has reported.
The Cook Children’s Health Plan, a subsidiary of the Cook Children’ pediatric health system, is a major provider of Medicaid health insurance to children and pregnant people in Tarrant County.
Instead of awarding a contract to Cook Children's, the state plans to award the contracts to other insurers -- United Healthcare, Molina, Blue Cross Blue Shield and Aetna -- in Tarrant and in five other Texas counties.
In not awarding a Medicaid contract to Cook Children’s and five other managed care organizations across the state, nearly 2 million Texans who currently receive Medicaid coverage through those providers would have to change their plans next year -- unless Texas Health and Human Services reverses its decision to redistribute the contracts.
Immediately after one recent attempt to appeal the decision quickly failed, Cook Children’s Health Plan said earlier this month that it intends to file another appeal of the decision in hopes of retaining coverage for its members.
Steward Health Care plans to sell its hospitals after filing for bankruptcy
The Dallas-based hospital operator Steward Health Care filed for bankruptcy in May and said it plans to sell the more than 30 hospitals it operates around the country.
Steward said at that time of its bankruptcy filings that it doesn’t expect interruptions in the daily operations of its hospitals during the Chapter 11 process. But that hasn't necessarily calmed the concerns of legislators across the country, who have publicly stated their concerns that hospitals operated by Steward could shutter and leave many people -- particularly those in rural areas -- without nearby hospital facilities to serve their needs.
Prior to its bankruptcy filings, Steward -- among the largest private, for-profit health systems in the country -- faced multiple lawsuits from vendors who alleged being owed a combined $50 million in unpaid services provided to the company.
The status of Steward's operations, which are based out of a high-rise looking over Klyde Warren Park in Dallas, has been of particular concern in Massachusetts, where the largest number of Steward's hospitals are based. There, public hearings have been held to discuss options for providing medical services to already-underserved areas across the state should the Steward hospitals in those regions suddenly close.
A group of Congressional representatives led by Sen. Edward Markey of Massachusetts is also seeking reassurances that workers at hospitals owned by Steward -- a reported 33,000 employees in all as of Fall 2023 -- will have their health care and retirement benefits protected in the wake of any potential sale.
Hospital workers and patients in Texas appear very much at risk for the same issues being discussed in Massachusetts, as Steward currently operates hospitals in Port Arthur, Odessa, Big Springs, Houston and Texarkana, according to its website.
A sixth facility that it had previously operated in the state, the Medical Center of Southeast Texas in Beaumont, closed in early February.