HB 426 mandates full Medicaid and Children’s Health Insurance Program (CHIP) coverage for cranial remolding orthoses used in the treatment of pediatric cranial conditions such as plagiocephaly, brachycephaly, and craniosynostosis. While the bill’s intent is to assist children with medically recognized cranial deformities, the mechanism it uses—expanding public health entitlements—raises fundamental concerns about fiscal responsibility, the role of government, and long-term policy precedent.
First and foremost, the bill expands the scope of state government by adding a new mandated benefit to two major public health insurance programs. This represents a structural change to Medicaid and CHIP, both of which are already large, complex, and fiscally demanding. Although the bill addresses a narrowly defined medical issue, it nonetheless establishes a new state obligation to finance a specific treatment that private insurers sometimes classify as non-essential. Such expansions, even when well-intended, incrementally broaden the government’s reach into areas that could be managed by families, physicians, or private payers.
The bill also creates a significant, ongoing burden on taxpayers. According to the Legislative Budget Board, the General Revenue impact will exceed $2.2 million annually, starting in fiscal year 2027. These costs are recurring and will increase modestly year over year. While the bill assumes small offsets from insurance premium tax revenue and contributions to the Foundation School Fund, those revenues fall well short of balancing the additional spending. No provisions are included to sunset the program, evaluate cost-effectiveness, or limit its duration, leaving the state with a permanent spending obligation and no clear mechanism to assess its impact.
Moreover, the bill may contribute to “benefit creep”—a policy pattern where new medical or therapeutic interventions are incrementally added to public health plans without comprehensive reform or prioritization. By mandating coverage for a specific treatment through statute, the legislature opens the door to similar future mandates, which could cumulatively erode budgetary discipline and constrain the legislature’s flexibility to focus resources where they are most impactful.
While HB 426 does not impose regulatory burdens on individuals or private businesses, its implications for the private insurance market are not neutral. By requiring public programs to cover services that private insurers often deny, the bill risks undermining insurers’ ability to design plans based on clinical and cost-effectiveness standards. This could encourage families to rely on public programs over private options, increasing pressure on the state and crowding out market-based solutions.
From a policy standpoint rooted in limited government, personal responsibility, and fiscal prudence, the bill raises serious red flags. It moves the state in a direction of greater dependency on taxpayer-funded medical benefits for treatments that were previously discretionary or contested within private markets. While the health needs of affected children are genuine and worthy of compassion, the method by which assistance is provided should reflect restraint, cost-consciousness, and a respect for the role of private solutions. For these reasons, Texas Policy Research recommends that lawmakers vote NO on HB 426.
- Individual Liberty: The bill supports individual liberty to a degree by ensuring access to medical devices (cranial remolding orthoses) that can improve a child’s health outcomes and quality of life. Families who cannot otherwise afford such treatment may gain options they previously lacked. However, this expansion comes not through deregulation or market liberalization, but via government mandates. Thus, while it may increase choices for beneficiaries, it does so by expanding a taxpayer-funded entitlement, not by enhancing personal autonomy or reducing barriers to care.
- Personal Responsibility: By shifting the financial burden of specific pediatric treatments from families and private insurers to the state, the bill undercuts the principle that individuals (and in this case, parents) should bear primary responsibility for their children’s non-emergency health needs. While there is a humanitarian rationale for public coverage in cases of medical necessity, the bill does not include cost-sharing provisions or targeted financial hardship tests—it universally obligates taxpayers. Over time, such expansions erode expectations of self-reliance and contribute to growing entitlement dependency.
- Free Enterprise: The bill interferes with market-based health care decision-making. Private insurers frequently deem cranial orthoses elective or cosmetic and may choose to deny coverage based on clinical standards or plan design. This legislation sends a message that when private markets decline to cover a service, the state will fill the gap with public funds. That undermines the discipline of insurance risk pools and may disincentivize innovation in affordable private care options. In this way, the bill expands the public sector at the expense of market solutions.
- Private Property Rights: The bill does not impact physical property, land use, asset forfeiture, or other areas directly related to private property rights. This principle remains unaffected by the bill’s provisions.
- Limited Government: The bill clearly expands the size and scope of government by creating a new permanent Medicaid and CHIP benefit. It adds new spending without structural reform, sunset provisions, or outcome-based accountability. The bill requires HHSC to implement the policy, administer eligibility, conduct rate hearings, and manage reimbursement systems, adding operational responsibilities and increasing the long-term footprint of state health services. This growth occurs outside of an emergency context and without corresponding reductions elsewhere, which directly contradicts the principle of limited, restrained government.
