Healthcare Policy Crossroads

How Federal and State Regulations Are Reshaping North Texas Healthcare

May 20, 2025

Healthcare Conference | Event Date: May 15, 2025

The North Dallas Chamber's Healthcare Conference featured a panel on "Regulatory Realities," examining how shifts in federal and state policies impact healthcare delivery in North Texas. Moderated by Jessie Quick of Blue Cross Blue Shield of Texas, the discussion brought together provider organizations and employer perspectives on navigating an increasingly complex regulatory environment.

Key Takeaways

Healthcare organizations face a perfect storm of regulatory challenges, including executive orders, program cuts, and potential Medicaid reductions
Political environment targets healthcare providers for budget cuts as they represent large government spending categories
Texas has the leanest Medicaid program nationally yet maintains an 18% uninsured rate and the largest working uninsured population
Employer healthcare costs now reduce pay raises and other benefits, creating difficult business tradeoffs
Regional collaboration among competitors has become essential for effective advocacy

Unprecedented Regulatory Uncertainty

Healthcare organizations in 2025 face what panelists described as "unprecedented" regulatory uncertainty. David Tesmer, Chief Community and Public Policy Officer for Texas Health, highlighted the impact of over 140 executive orders from the Trump administration, combined with a regulatory freeze, leaving many policies in limbo.

"From a macro perspective, we've had a lot of executive orders, program cuts," Tesmer explained. "Under Trump 2.0, he wants regulatory compliance, but simplified, in tandem with restructuring HHS, CMS, CMMI."

The repeal of the Richardson waiver now allows HHS to forego public comment periods for certain administrative rules, effectively shutting off public input on regulatory changes.

Healthcare Providers as Budget Targets

Matt Moore, Chief External Relations Officer for Children's Health, offered a candid assessment of healthcare providers' political position: "If you're a member of Congress or state legislator, and your primary goal is to cut the cost of government, you're looking for big buckets. And healthcare is a big one."

The challenge is that healthcare is "hopelessly complex" in funding and delivery, making it difficult for policymakers to understand the full implications. The polarized political environment has created "anti-big business," "anti-healthcare expert," and "anti-hospital" sentiment.

"As a children's hospital, we sit in all three categories. We're a big business. We have medical professionals providing medical advice, and we're providing healthcare that's expensive," Moore said. "As that ax starts swinging around, we've got a target on our backs."

Texas Medicaid: Lean but Challenged

Medicaid emerged as a central discussion topic. Tesmer noted that Medicaid accounts for 10% of the federal budget, covering approximately 80 million Americans, with about 4.2 million beneficiaries in Texas.

Texas operates uniquely efficiently: "Texas has the most lean Medicaid program through the entire nation. Federal spending per Medicaid enrollee in Texas is about $4,100. Federal spending for those who expanded Medicaid is $6,000."

Despite this efficiency, coverage challenges persist. "Eighteen percent of the Texas population remains uninsured," making it "the largest state with working uninsured." This creates a cycle where healthcare providers deliver more uncompensated care, ultimately impacting premiums and costs system-wide.

For Children's Health, these dynamics have an immediate impact: "Two-thirds of the kids that come to see us in any given year are involved in CHIP and Medicaid. So even a small change to the Medicaid program will have big impacts on organizations like ours."

The Employer Struggle

Ben Isgur, Vice President of Health Thought Leadership at Fidelity Investments, provided the employer perspective on regulatory challenges affecting companies across industries.

Employers struggle with "disability for certainty" while managing ever-increasing healthcare costs. "Our surveys show that over half of benefit leaders say health costs are actually starting to eat into their ability to give pay raises and provide other benefits, like retirement."

This financial pressure leads to different coping strategies. Some employers are "buying up things very rapidly" to get through uncertain periods, while others adopt "the exact opposite strategy" of retrenchment.

A particular concern is what happens when government programs face cuts. "There are some employers taking notice and very concerned about what happens with government-supported programs," Isgur noted, "because they feel that it's going to come back and be pointed back at them."

Marketplace Subsidies and Exchange Dynamics

A significant concern involves potential expiration of enhanced subsidies for Affordable Care Act marketplace plans. Quick noted that Blue Cross Blue Shield of Texas insures significant numbers through the marketplace, and these subsidies have helped reduce Texas' high uninsured rate.

Isgur explained that exchanges provide a crucial "bridge" for employees nearing retirement who aren't yet Medicare-eligible, allowing retirement rather than continuing work solely for health coverage.

Quick added context about marketplace importance for small businesses: "Small businesses in Texas are the backbone of the economy. Sixty-five percent of small businesses are not offering coverage today, so you can see how heavily reliant they are upon the federal exchange and those corresponding subsidies."

Legislative Developments

Despite initial concerns, the panel expressed cautious optimism about the current Texas legislative session outcomes. "We've ended up in a much better place than we started," Moore said.

Early legislation would have eliminated all facility fees charged by hospitals. The final version only prohibits facility fees for telemedicine provided outside facilities, a much more manageable change.

Moore and Tesmer highlighted the importance of local provider participation funds, allowing hospitals to be taxed to provide the non-federal share of Medicaid funding. These mechanisms exist in Dallas and Tarrant counties, with efforts underway in Denton and Collin counties.

Action Steps for Organizations

The panelists offered practical advice for navigating the regulatory environment:

Foster collaboration despite competition - Moore emphasized North Texas healthcare providers' strong coalitions: "Despite the fact that we compete with each other in the daytime, at night, we lock arms together to advocate on behalf of this region."
Focus on adaptability and innovation - Tesmer advised organizations to "adapt, be nimble" and "invest in your government affairs departments."
Strengthen community connections - Build relationships with policymakers, industry partners, and community organizations.
Control what you can control - Isgur recommended employers focus on direct influence areas: "You have power over plan design, whether you decide to give employees ten mental health visits, the vendors and partners you're working with."
Improve communication - Moore acknowledged that healthcare providers "have not done a good job of explaining" the complexities of healthcare delivery and financing.

The Path Forward: Collaboration as Key

A central theme was the critical importance of regional collaboration. As healthcare organizations face increasing financial pressures and regulatory challenges, working together has become essential.

This collaborative approach extends to supporting safety-net providers. When an attendee from a low-cost clinic asked about specialty care referrals, both Moore and Tesmer immediately offered to explore partnerships.

"We're happy to talk about collaboration, working together to help solve that," Tesmer assured, while Moore added, "Let's figure it out. You've identified a gap."

This cooperation spirit reflects North Dallas Chamber President Ken Malcolmson's principle: "Autonomy is our worst enemy" in addressing healthcare challenges. The willingness of competing organizations to collaborate may determine how effectively North Texas navigates uncertain regulatory waters ahead.

Speaker Information & Links

Jessie Quick (Moderator)
Divisional Senior Vice President, Sales and Client Management, Blue Cross Blue Shield of Texas
LinkedIn Profile

Jessie Quick is a senior executive at Blue Cross Blue Shield of Texas with over 15 years of experience in healthcare insurance. She serves on the board of the North Dallas Chamber of Commerce and brings extensive knowledge of healthcare policy, insurance markets, and employer benefit dynamics to the discussion.

David Tesmer
Chief Community and Public Policy Officer, Texas Health Resources
LinkedIn Profile

David Tesmer has been with Texas Health Resources for 30 years, overseeing public policy, community health improvement, Blue Zones work, and pastoral care. His extensive experience in healthcare policy advocacy at both state and federal levels provides valuable insights into navigating regulatory challenges.

Matt Moore
Chief External Relations Officer, Children's Health
LinkedIn Profile

Matt Moore leads government and community relations, communications, and marketing at Children's Health, where he has worked for 14 years. His background includes experience in the Texas Legislature and patient advocacy at Susan G. Komen, giving him a comprehensive understanding of healthcare policy from multiple perspectives.

Benjamin Isgur, FACHE
Vice President, Health Thought Leadership, Fidelity Investments
LinkedIn Profile

Ben Isgur conducts research on health benefit trends affecting employers across the United States at Fidelity Investments. Previously, he led PwC's Health Research Institute for 20 years and worked in the Texas House of Representatives, bringing a unique employer-focused perspective to healthcare policy discussions.

Thank you to our event sponsors for making this valuable program possible.

Platinum Sponsor Scottish Rite for Children

Silver Sponsors Bank of America | Parker University | UT Southwestern Medical Center | West Coast University Texas

Bronze Sponsors Tenet Health | Dallas-Fort Worth Hospital Council | SMU Cox School of Business