Commentary: Advocate for patient choice

This is a time for advocacy. We are concerned that a recent decision by the Texas Health and Human Services Commission, if implemented as announced, will cause substantial changes to how STAR and Children’s Health Insurance Program services are administered. The Rio Grande Valley will lose two vital health plans, Driscoll Health Plan and Superior HealthPlan, which serve more than 260,000 lives in the area, along with the investments they have made in our community through patient programs, grants and provider relations.

For nearly 25 years, I’ve been the executive director of the South Texas Physician Alliance, an organization that helps providers more effectively meet the needs of their patients. Through our commitment to improving the health of all patient populations, we’ve seen the struggles of some of the most vulnerable individuals in our community, many of whom are pregnant women and children who depend on Medicaid and CHIP to stay healthy. Access to quality health care should never be a struggle, but if HHSC’s proposed contract awards remain as announced, we are concerned a significant number of our patients could lose their STAR and CHIP coverage due to administrative issues.

First, our concern is access to care. The unwinding associated with the end of the COVID-19 public health emergency caused about a third of our patients to lose coverage due only to administrative issues with getting their paperwork completed. If a third of our patients have issues with the unwinding, we are concerned there will be a significant disruption in changing health plans for more than 260,000 patients, of which the majority have voluntarily chosen either Superior or Driscoll. This procurement has the potential to further impair access to care due to administrative hurdles.

Second, both health plans have made substantial investments in the community through programs and grants. Superior has contributed community and provider grants totaling $680,000 to the Rio Grande Valley over the past 10 years. Driscoll reports investing more than $300,000 in various community support programs, and has invested $160 million in maternal fetal medicine since 2008. Additionally, both health plans have nearly 20 years of experience in the Rio Grande Valley with established working relationships that will be sacrificed if this procurement decision stands.

Third, both Superior and Driscoll are highly rated health plans. According to HHSC’s own quality report cards, Superior has achieved an overall 4-star rating for both STAR Adult and STAR Children. Driscoll has earned an overall 3.5-star rating for STAR Adult members and a 4-star rating for STAR Children. These quality ratings are important measures that HHSC should absolutely consider in evaluating the health plans that will be servicing our members.

We strongly encourage Rio Grande Valley residents to help protect the right to remain with the quality health plans of their choice and tell their state representatives to allow the Superior and Driscoll health plans to remain in the Rio Grande Valley.

Sheila Magoon, M.D., of Harlingen, is executive director of the South Texas Physician Alliance.