Texas House Bill 3891 was sponsored by the well-respected, venerable Texas State Congressman Garnet F. Coleman. Representative Coleman has served in the Texas House of Representatives since 1991 and is a champion of bills impacting mental health issues in the State of Texas. As he has done in past sessions, he filed a bill addressing eating disorders, House Bill 3891. This bill was designed to address and correct deficiencies in the insurance industry and the manner in which eating disorders are handled by insurance companies.
The Bill was dead before it was even filed.
The two main components of HB 3891 were: (1). In conducting a utilization review of treatment for eating disorders, the insurer, in addition to taking into account other factors, was required to consider the practice guidelines set forth by the American Psychiatric Association, and; (2). The insurer, once it approves a claim under its policy, could only conduct a "utilization" review not more than once every six months unless the treating health professional agreed that a more frequent review was necessary.
In layperson's terminology, HB 3891 mandated inclusion of language in insurance companies' group policies that the insurance companies fought against tooth and nail, and limited their ability to "step down" or terminate coverage to once every six months. This necessarily would have resulted in conceivably, hundreds of millions of dollars in additional exposure and expense to the insurance industry. With this financial atomic bomb hovering over its head, the insurance industry marshaled its lobbyists, organizations and influential politicians and although the industry "allowed" the bill to get out of the Public Health Committee, the bill died at the stroke of midnight, Thursday, May 11, 2017 without the House of Representatives debating the bill or voting on it.
The groups who publicly opposed the bill were; The National Federation of Independent Business, Texas Association of Business and, the Texas Association of Health Plans ("TAHP"). The TAHP has been in existence since 1987 and is the statewide trade association representing private health insurers, health maintenance organizations and other related health care entities operating in Texas. With regard to HB 3891, the TAHP's position was, "This bill violates our free market and limited government principles by mandating private insurers offer certain coverage. It is not a role of government to regulate an agreed upon contract between any private entity and a consumer. For these reasons, we oppose HB 3891." With this strong, united opposition, the eating disorder industry and community were facing an overwhelming mountain to climb.
The groups who publicly supported the bill were ... The National Alliance of Mental Illness (NAMI) Texas and ... [insert crickets chirping here] The Eating Disorder Coalition did not. (albeit, they focus their attention at the federal level.) The National Eating Disorder Association did not. The National Association of Anorexia Nervosa did not. No eating disorder recovery hospital, residential program, doctors' association, or counseling association stepped to the plate to be heard. The Texas Medical Association did not lend their considerable influence. No family based foundation attempted to rally other foundations to become involved. No influential corporate leader testified on the bill's behalf. A bill that would have revolutionized the eating disorder industry, a bill that would have brought so much hope to those victims suffering from eating disorders was left floundering, to go down to certain defeat.
HB 3891 was filed on March 10, 2017. This date is significant because this was the last possible date that a bill could be filed and still be considered during this legislative session. This late filing indicates the bill was more of an afterthought instead of a ground breaking piece of legislation that had a likelihood of success. In fact, the bill could have been filed as early as November 14, 2016. Approximately 400 other bills were filed on that date. Former speaker of the Texas House, Representative Tom Craddick stated that the early filing of bills helps because it increases the likelihood of obtaining an early hearing date on the bill while increases awareness and support of the bill. Even Representative Coleman stated that early filing of bills can give advocates something to organize around. So, why was this crucially important bill filed on the last possible day?
That fault lies with us ... the eating disorder community and the eating disorder industry. I had previously opined that the eating disorder industry and community is beset by parochialism, that it is a fractured and fragmented community whose "silo mentality" is merely making noise and no unified, powerful voice is speaking clearly and passionately articulating a vision that will result in saving lives. Is there any better proof than Tx HB 3891? The eating disorder industry continues to look inward, seemingly more concerned about protecting its "proprietary secrets" and desire for personal glory than in collaborating on a much needed broad-based initiative designed to bring assistance to all persons suffering from this disease. So, what can the eating disorder community do to insure that bills like Tx HB 3891 do not become status quo?
First, successful passage of a future bill (after the current session adjourns at the end of May 2017, the next session does not start until January 2019) begins today. It is comparable to winning a championship in football. Championships are not won in January when the game is played. They are won when the hot, hard work is done the previous July and August when no one is looking. Today, the eating disorder industry and community must rally, collaborate and find a common cause to support.
Language of a realistic bill that has a chance of being passed into law must be generated now. A Republican co-sponsor of that bill, a person with vision and wisdom must be identified and approached. (Why Republican? Because they control the Texas senate, house and all powerful positions in Texas government). The groups who opposed Tx HB 3891 must be approached and in-depth discussions must be had about the new bill. Instead of being approached in an adversarial basis, those groups are approached in the spirit of cooperation, educating them about the statistics that we, in the eating disorder community know so well. We retain political activists and a lobbyist who has a history of success in pushing through the agendas of his/her clients. The eating disorder community MUST reach out to African-American and Hispanic schools, groups and communities to help educate and inform and include them in this cause against eating disorders. The family foundations who are hoping to find their mighty voice must be found and approached. So too must we include the Gay, Lesbian, Bi-Sexual and Transgender groups and communities in this fight. Eating disorders know no racial, ethnic or sexual identity discrimination. It kills without remorse across the spectrum. The medical industry which would benefit so much, financially and otherwise, by mandatory improvements in the manner by which the insurance industry reviews treatment decisions must be rallied to this cause. A financial analyst must be retained to give a realistic, accurate report on the financial impact on citizens of the State of Texas that this bill would have. A "white paper" must be generated immediately outlining where the eating disorder industry is and what critical changes need to be implemented.
If these steps are successfully implemented, then we will have the eating disorder community, the eating disorder industry, the medical community, the African-American community, the Hispanic community, the LGBT community, the Democratic party, a champion in the Republican party and the family foundations rallied behind one cause, with one purpose in mind... and the powerful insurance industry will be left isolated, alone facing the combined mighty voices of a people acting as one, a people who are single minded in their purpose and now who have power and influence. Now, the playing field is even. Now, we can go to powerful politicians in Austin with thousands of voices supporting us. We have our Army of Warrior Angels inspiring but now, they too will feel hope and strength knowing that their message is being heard.
IF we undertake these tasks. IF we are willing to do the hard work. IF we listen to our Army. Only then, can we implement real change. IF we commit ourselves. Our cause is righteous. Our cause is just. The only question remaining is, do we have the courage of our convictions?
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