Texas Covered Kicks Off with CMS, CEO Panel, and Elected Officials

By: TAHP | Tuesday, November 4, 2025

Jamie Dudensing, TAHP CEO, Highlights Health Plan Solutions

• Jamie opens Texas Covered 2025: Jamie introduced the TAHP team and the threat of rising health insurance costs-especially if enhanced premium tax credits expire.
  • Uninsured Cliff Set for Texas
  • Texas Is Hit Hardest with Loss of Tax Credits
  • Millions of Texans Could Lose Coverage Without Congressional Action
• Big moves by health plans: Jamie highlighted efforts by plans to expand care, improve outcomes, and support members.
  • Parkland provided free meals for pregnant members
  • BCBS Texas celebrated 2 years of its maternal and child health initiative
  • UnitedHealthcare launched a prenatal and postpartum care awareness campaign
  • Superior HealthPlan invested $700k in community hygiene
  • Multiple plans explored value-based care, digital tools, and customer service improvements

How Tech is Reshaping Patient Care

• New opportunities in health tech: Dr. Daniel Kraft, Physician-Scientist & Global Health Innovation Leader, led a rapid-fire talk on how emerging tools could impact health care.
  • Patients are moving from Dr. Google to Dr. GPT.
  • Physicians who use AI frequently can see better outcomes, but may be at risk of physician deskilling.
  • AI, selfie analysis, surgical simulations, and apps that help patients visualize lifestyle impacts are just a few of the technologies that Dr. Kraft explored.
• Patients and health information: Dr. Garth Graham, Director & Global Head of Healthcare and Public Health Partnerships at Google/YouTube, highlighted how digital tools changed how people find and trust health information today.
  • 30% of people never fill their prescriptions. The biggest drivers for medication adherence are understanding and trusting their health information.
  • Patients are doing their own research and coming to their own conclusions. They consider feedback from their physician and other patients.
  • Young patients increasingly see themselves as content creators. They prefer two-way dialogue that considers their perspective.

The New Science of Healthcare Quality Measurement - Dr. Will Bruhn

• Talk on data and quality: Dr. Will Bruhn, Founder of Restoring Medicine & Co-Founder of Global Appropriateness Measures, talked about determining what care is appropriate.
  • Discovered that his hospital was unnecessarily keeping patients on life support to falsely reduce 30-day mortality.
  • In Texas, choosing the wrong physician can result in much higher prices and unnecessary operations.
  • 60% of Texas physicians are wasting money on expensive skin substitutes when cheaper, high-quality alternatives exist.
• New approach to quality measurement: Dr. Bruhn talked about identifying metrics for low-value care. His team now has 400 measures that span 50 different specialties.

CMS - What's Next for Medicare and Medicaid

• Clear direction: Dr. Oz's team starts every day with morning meetings and identifying hard issues.
• Focus areas from CMS:
  • Innovation as CMS is the biggest payer in health care.
  • Going after FWA-the agency took down a multi-billion dollar fraud syndicate early on.
  • Developing consumer-facing technology with smart tools.
  • Reducing U.S. drug prices and health care spend, which are much higher than those in other countries.
  • Collaboration with the private sector.
• On Medicare Advantage: Carlton said there is bipartisan consensus that fee-for-service isn't working, but added that frustration with prior authorizations should be addressed by working with MA plans to "self-regulate."

Health Plan Leadership on Texas' Future

• Next on the stage: Four health plan CEOs joined TAHP's CEO, Jamie Dudensing, for a conversation about what's driving health care in Texas.
  • Fred Turner, CEO and Founder, Curative
  • Lisa Wright, President and CEO, Community Health Choice
  • Jim Springfield, President, Blue Cross Blue Shield of Texas
  • Dennis Ellis, CEO for North Texas/ Oklahoma, UHC
• What they're thinking:
  • Affordability is crucial, especially given the potential loss of tax credits.
  • Utilization has increased due to a sicker population, leftover demand from COVID, outpatient surgeries, and pharmaceuticals. Thoughtful benefit design and preventative care are crucial.
  • Telemedicine will be key to addressing rural health care shortages.
  • AI can improve claims, UM, and customer service efficiency without making clinical decisions.
  • $0 copays for medications and care lead to long-term member retention.
  • More open network agreements would increase competition in the market.

Under the Dome - 89th Texas Legislature

• Who was up: Five elected officials joined TAHP's VP of Public Affairs, Blake Hutson, to talk about key takeaways from the 89th Legislative Session.
  • Rep. Jay Dean, District 7-House Insurance Chair
  • Rep. Matt Morgan, District 26
  • Rep. David Spiller, District 68
  • Rep. James Frank, District 69
  • Rep. Dennis Paul, District 129
• What they had to say:
  • Legislators are aware that the public is enraged by rising health care prices, which are "crushing the middle class." Without change, we may be headed for a single-payer system.
  • Texas puts too many mandates on health insurers-beyond Affordable Care Act (ACA) requirements-that only drive up health care premiums.
  • Fiscal notes are set to be available for insurance costs-see HB 138.
  • Texans need more "mandate lite" health coverage options.