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Texas This Week: Bill to end 'surprise medical billing' moves forward

This week, a bill to take the patient out of payment disputes between insurance companies and healthcare providers moved one step closer to becoming law.

AUSTIN, Texas —

Three things to know in Texas politics

Members of the Texas House of Representatives say they have accomplished "transformative change" with impacts that will "last for decades" in House Bill 3, coined The Texas Plan.

It's their school finance bill that injects a total of $9 billion into the public school system. School districts would get $6.3 billion of that. There's also $2.7 billion of property tax relief built into the bill because it decreases school district tax rates.

Representative Chris Turner (D-Grand Prairie) added an amendment requiring districts use at least 25 percent of the basic allotment increases they'll get to give raises to all full-time school district employees, except administrators. That's an average raise of $1,850 a year. And that may be a sticking point for the Senate, which voted to give teachers and counselors a $5,000 raise.

The Senate passed Senate Bill 17 by Senator Charles Perry (R-Lubbock). It creates a defense for state-licensed professionals who deny service based on their religious beliefs, unless there's a medical emergency. Senator Perry said counselors have lost their state-issued licenses for refusing to work with same-sex couples, so his bill would give them and others a defense to use when they go before licensing boards.

But other lawmakers call the bill a "license to discriminate," noting people have used religion to justify discrimination and racism. This bill now heads to the House. 

And if you thought this legislative session was truly going to focus on nothing but "bread and butter" issues, think again. There are some divisive bills and resolutions filed, and this week some of them advanced. Senators passed Senate Bill  22 by New Braunfels Republican Donna Campbell. It bans cities and counties from giving taxpayer dollars to abortion clinics or any of their affiliates. This could impact Austin because the city partners with a Planned Parenthood clinic, which does not perform abortions but offers women's healthcare services.

The bill pitted the Republicans and Democrats against each other, and so did a surprise resolution brought forward by GOP senators to declare the situation at the Texas-Mexico border an "emergency," support the President's efforts to address it and call on Congress to fully fund border security (Senate Resolution 535). The Democrats had never seen the resolution. It was passed out to them on the Senate floor as Lieutenant-Governor Dan Patrick called it up for a vote, so the senators who actually represent Texas border communities had no say in it.

In the grand scheme of things, a resolution doesn't carry much legislative weight. It's the equivalent of sending a letter to Congress. So the Democrats plan to send their own letter letting Congress know they oppose the resolution passed by their colleagues.

Legislation to end 'surprise medical billing' moves forward

This week, the Senate Committee on Business and Commerce voted out Senate Bill 1264, legislation to make sure Texans on state-regulated insurance plans never get hit with surprise medical bills again. Instead, it would force insurance companies and providers into arbitration. The author of the bill, Senator Kelly Hancock (R-North Richland Hills), talked with Ashley Goudeau about his bill.

Ashley Goudeau: Senator, you have been working on surprise medical bill legislation for a decade now. How did you first get interested, first find out about this?

State Sen. Kelly Hancock: "Well actually I was running for office and I had a constituent, a friend of mine at church had an operation, had gotten surgery, met his co-pay, paid his deductible, thought he was done and then all of a sudden he had a $2,500 bill that showed up in the mail. And he was not happy, obviously. And so he asked me to do something about it. And so I got elected, came down, and almost immediately was told, 'You'll never do that. People have been trying to fix that for years.' And of course that was exactly all I needed to say, 'Well alright, watch me!' And so yeah, it's been 10 years. We passed our first bill 10 years ago to deal with it and it was a little bit smaller and we had to get used to it. And then we kept growing and adding and adding. And finally this last week we passed out of the committee in the Senate, the Business and Commerce Committee in the Senate, we passed out a much more comprehensive that will essentially eliminate surprise medical bills, balance billing, for those with state-regulated plans. So we're almost there."

Goudeau: For people who are not familiar with the bill, what exactly does it do?

Hancock:  "Well number one you have to understand we use the concept balance billing, surprise medical bills, and what it is is when you think that your insurance company has covered everything, that you've paid your deductible, you know, you've paid your co-pay and then the provider or that physician, a bill shows up in the mail. And it's a surprise to you. And what happens is the insurance company has paid the provider or the physician but apparently not sufficient. And so then they come to the patient to pay the balance. And what this bill does is essentially say you don't get to use the patient as a pawn in this game. If you don't think you were paid enough by the insurance company, then we established first a phone call that takes the patient out of it. And initially the patient had to initiate this. And with patient initiation we saved $30 million for patients across the state of Texas. This doesn't require the patient to be involved at all. And so if the provider doesn't feel they were compensated fairly then they can simply request arbitration; it starts with a phone call. Historically, 95 percent of this has been worked out with a simple phone call between the insurance company and the provider. If that doesn't work, then it goes into, what we call, a baseball-style arbitration, which is you look at what was paid, the reimbursement by the insurance company, and then what was billed by the doctor or by the provider and then the arbitrator will sit there and determine which one is closer to the right number, and which one is actually closer actually wins the arbitration."

Goudeau: When we look at how the bill is moving through the process, you mentioned that it got voted out of committee. Congratulations, that's a very big deal for the bills.

Hancock: "It's a big deal."

Goudeau: However, a Republican senator from actually our area, Senator Donna Campbell, she's an ER doctor. And she voted against the bill. She feels like this helps insurance companies opposed to helping providers, doctors. So what do you say to line of thought, that reasoning?

Hancock: "Well I think the baseball-style arbitration, what it does is it forces both parties to the middle. And so, let's take for example, if the insurance company low-balls the reimbursement, then that's actually going to work against them in this baseball-style arbitration where the arbitrator says, 'Well, here's what we believe is appropriate. Whoever's closest to that appropriate number actually wins the arbitration. So if you're going to low-ball or if you're going to bill egregious charges that way out of the norm, then the chances of you winning in arbitration are pretty limited. And so the baseball-style arbitration is intended to bring both parties together to resolve the issue because the farther away you are from what is a reasonable reimbursement, a reasonable bill charge, the less likely you are to win in arbitration. And so I think we've addressed it where both of the bad actors, both those who are billing egregious charges to patients and both insurance companies that may low-ball a reimbursement, are going to be penalized through this baseball style arbitration and that's why we drew it up that way...

"You know, one of the things that you see in legislation is that the lobbying, the government affairs individuals that work down there, can apply a lot of pressure. But what we did in this bill is we just got the members in the room. So there was no lobby in the room, there were simply members in the room and members who have worked on this for a long time. We had Doctor Oliverson (R-Cypress), a physician who was well versed in it. Senator John Whitmire (D-Houston) was in the room, and then Trey Martinez Fischer (D-San Antonio) who initially was a joint author with me in the House when we passed the first balance bill. And so what we did is we took the lobby out and we brought in legislators and literally sat at a table with our staff around us and took pieces of this one and pieces of that one and we built this legislation across party lines, Senate and the House. And when you walk out of that room and you have that type of support, a broad range of support, and you have a physician carrying the same bill in the House, it's really hard to oppose that piece of legislation, just because of the way it was put together. It was members doing their job, looking out for their constituents, both Republicans and Democrats. You know, the way legislation should be crafted."

Sen. Hancock tells KVUE News he expects his bill to come to the full Senate for a vote "soon."

The Last Word

In this week's The Last Word Ashley Goudeau discusses what helps coax her through long days of covering the Texas Legislature and the expert-level shade from lawmakers.