Legislative Mandates: A Hidden Healthcare Tax
Every legislative session, Texas lawmakers file dozens of bills aimed at expanding healthcare coverage. Their intentions are good—helping more people afford the care they need—but the reality is that many of these mandates come with staggering costs that make health insurance more expensive for everyone.
House Bill 2412, filed by Rep. John Bucy, is a prime example of this problem. The bill would require all insurance plans in Texas to cover GLP-1 medications like Zepbound and Ozempic. These drugs can be life-changing for people struggling with obesity or diabetes, but they are also one of the most expensive prescription drug classes in the country, and they are frequently used for elective weight loss.
This is exactly the type of policy that sounds compassionate but would have a crushing impact on Texas families—even those who will never use these drugs.
How Much Would This Cost Texans?
Let’s break it down. Texas has about 10.5 million obese adults, roughly 34% of the population. A monthly supply of a GLP-1 drug like Zepbound costs around $1,000—or $12,000 per year per patient. If insurance plans were required to cover these prescriptions at list price for everyone eligible, the total cost would be $126 billion per year.
For context, that’s nearly half of the entire state of Texas’ biennial budget.
Now, obviously, not every eligible Texan would take these medications. But the question remains: Who is going to pay for even a fraction of this cost? The answer is simple: all of us—through higher premiums and higher taxes.
The Bigger Problem: Mandates Make Healthcare More Expensive for Everyone
This isn’t just about GLP-1 drugs. Every session, lawmakers propose new health insurance mandates that sound great on paper but come with massive price tags. In 2023 alone, over 100 new healthcare mandates were filed—many of them forcing insurers to cover new treatments, procedures, or services without considering how much those mandates would cost Texas families and businesses.
When these mandates pass, the cost doesn’t magically disappear. Insurance companies pass it along in the form of higher premiums, employers are forced to raise costs or cut benefits, and Texans end up paying more out of pocket. Meanwhile, those who can’t afford rising insurance costs are priced out of coverage altogether.
The Truth About GLP-1 Mandates
Let’s be clear—GLP-1 drugs are a medical breakthrough for certain patients. But the reality is that they are also being widely used for lifestyle weight loss rather than strictly for medical necessity.
HB 2412 doesn’t distinguish between the two. Instead, it would force every Texan with insurance to subsidize a drug class that many people will never need or use. That’s not fairness—that’s bad policy.
The Smarter Approach: Transparency and Accountability
Instead of continuing the cycle of costly, feel-good mandates, Texas lawmakers should focus on policies that:
✔️ Improve transparency — so Texans understand how mandates impact their premiums.
✔️ Limit mandates to truly necessary care — rather than elective or lifestyle-based treatments.
✔️ Encourage affordability — through competition, negotiated pricing, and targeted programs.
We need to stop treating health insurance like a blank check for every new treatment that hits the market and start holding lawmakers accountable for the cost of their policies.
Conclusion: A Hard Look at the Cost of Good Intentions
HB 2412 is a perfect example of a well-intentioned but unsustainable healthcare mandate. Texas families are already struggling with rising insurance costs—adding another expensive mandate will only make it worse.
If lawmakers truly want to help Texans afford healthcare, they should reject unaffordable mandates and focus on reforms that lower costs, increase transparency, and keep premiums from spiraling out of control. Anything less is just another burden on Texas families.