Unique coalition drives balance billing legislation

The fact there is legislation to limit balance billing in Texas is not a surprise after hearing people in the Texas health care community talk about their priority issues. The fact there is such a broad coalition on the issue is more interesting.

Insurers are vocal advocates on the score, not surprisingly given the constant challenge of out-of-network providers leading to surprise out-of-pocket costs for consumers. The Texas Association of Health Plans was among the first declared supporters of Senator Kelly Hancock’s SB 507, calling out in particular the issue of free-standing ERs:

“Home to the majority of the nation’s freestanding ERs, Texas has become ground zero for the explosive growth of emergency care costs and rates of surprise medical billing,” said Jamie Dudensing, TAHP CEO and a former practicing nurse. “TAHP applauds Sen. Hancock’s efforts to better protect consumers against this growing trend, to require greater protections for consumers against surprise billing by freestanding ERs and other emergency care providers, and to ensure consumers have more options to challenge exorbitant, surprise medical bills often waiting for them in the mailbox after they’ve been treated in an emergency situation.”

While the issue of freestanding ERs is somewhat unique to Texas, which has about 50% of such facilities in the country. Yet, the overall issue of out-of-network ER providers, whether in a freestanding facility or not, is equally significant. This recent media report explains further, building off of a recent Center for Public Policy Priorities report on the issue, including this video:

This related datapoint from TAHP’s press release on SB 507, also referenced in the CPPP report, amplifies the point: “Up to 56 percent of hospitals in Texas that are in-network with the three largest insurers in the state have no in-network emergency physicians.”

With underlying data like that, it’s no surprise consumers are running into problems with unexpected bills, something that is bound to drive constituents to talk to their legislators, and not so surprisingly legislators to act. Senator Hancock cited that very feedback loop in a Q&A with State of Reform on the issue as a motivator for his multi-year work on the balance billing issue.

A diverse array of other interest group have weighed in as well, including Consumers Union as well as the Texas Association of Business in an Austin American-Statesman op-ed:

Higher medical costs are a serious drag on Texas businesses. The majority of Texas companies self-fund their medical benefits, which means the company pays the full cost of employees’ medical bills. As a result, the higher costs charged by freestanding emergency rooms come directly out of their bottom lines, siphoning money that could otherwise expand the business or create new jobs.

Freestanding ERs and their skyrocketing medical costs are pinching not only their patients but also Texas businesses and the state’s economic growth. Texas businesses, health care consumers, insurers, policymakers and regulators should unite now to address this urgent concern.

That reference to stakeholder interest fairly captures an atypical assemblage of supporters, including health insurers, the state’s leading business organization, consumer organizations, and a left-of-center policy think tank. Between that broad coalition and Senator Hackock’s past success on the balance billing issue the likely path to passage for this legislation seems rather clear and decisive.