Texas Legislature Bill Filing Starts & Health Care Mandates Grow

What’s new: Early bill filing kicked off last Tuesday, and Texas lawmakers have already filed dozens of new health insurance mandates, a concerning trend that’s been growing each legislative session.

Why it matters: Health insurance costs in Texas are too high. This marks the third consecutive year of premium increases, driven largely by out-of-control hospital and drug prices, a flood of new mandates, and a lack of flexibility for health plan innovation.

The numbers show a concerning trend:

• 30+ new mandates filed as of November 18, 2024
• 110+ mandates filed during the entirety of the 88th session (2023)
• 100+ mandates filed during the 87th session (2021)
• 23 new mandates from the prior two sessions became law

Texas is falling behind. Each new mandate comes with hidden costs, adding to the burden for employers and patients. Meanwhile, Texas health insurance premiums have jumped more than 5% annually for three years in a row.

• Employers—not state government—cover 50% of Texans, pay most of the cost of insurance premiums, and make tough choices about what benefits to offer.
• Texas lawmakers owe it to employers to be more careful about adding mandates to their health insurance.

Solutions for mandate transparency and affordability:

• Enact a mandate moratorium: Halt new health insurance mandates until there is a transparent process to evaluate their costs.
• Adopt a mandate fiscal note: At least 29 states (not Texas) have a process to estimate the cost of health care mandates so lawmakers are fully informed before adding costs to businesses and families.
• Expand flexibility: Allow health plans to implement innovative models and cost-saving strategies, free from the constraints of excessive mandates.
• End the special carve outs: Mandates should never be applied to businesses and exempted for state lawmakers and other state employees.
• Increase accountability: Ensure lawmakers consider the true financial impact of mandates on businesses and families before passing new regulations.
• Avoid ERISA mandates: Large self-funded employer health plans have been protected from costly state mandates under the federal ERISA law. Lawmakers should reject attempts to add mandates to these big employer health plans.

The bottom line: Overregulation and excessive mandates are driving up health care costs and limiting affordable coverage options. Texas needs to hit pause on new mandates, build a better process for reviewing proposals, focus on addressing rising health care costs, and allow for innovation and flexibility. The legislative session kicks off on January 14, 2025, and bill filing will continue through March 14. TAHP will be advocating for solutions to the mandate problem.