Tagged Legislation

Senate Panel Makes Surprisingly Fast Work Of ‘Surprise Medical Bills’ Package

It may seem as if the Senate, or at least certain key senators, have decided on a way forward to fix the nation’s “surprise medical bill” problem. But make no mistake: The door is still open to try another solution.

Members of the Health, Education, Labor and Pensions (HELP) Committee approved a sweeping measure Wednesday that tackles a range of big-ticket health care concerns. The 196-page bill touches nearly every aspect of the health care industry, from lowering the price of prescription drugs and creating a national database of health care costs, to increasing vaccine rates and preventing youth tobacco use.

One thing the bill specifically does not deal with: the insurance market and the Affordable Care Act, which could be why the massive package was voted out of the committee in just over two hours with little debate. The Lower Health Care Costs Act of 2019, sponsored by HELP Committee Chairman Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the top Democrat on the panel, sailed through with a bipartisan 20-3 vote.

“You don’t have to preach the whole Bible in one sermon,” said Alexander as he described his panel’s action. “We picked out one important thing: reducing health care costs.”

Still, just because the first hurdle has been cleared doesn’t mean there’s room for speculation about what could happen between now and when it reaches the Senate floor. Alexander said he’s hoping the bill will be voted on before the Senate leaves Aug. 2 for a monthlong recess.

The smooth hearing capped a busy few weeks, as senators debated the mechanism that would be used to stop surprise medical bills — the unexpected and often costly charges patients face when they get care from a doctor or hospital not in their insurance network.

An earlier draft of the bill outlined three options to solve disputes between payers and providers. There was an in-network guarantee, where all of the health care providers at a hospital — whether the anesthesiologist or lab — must accept in-network insurance rates.

Another option, often referred to as baseball-style arbitration, would have the health plan and the doctor — if they couldn’t reach an agreement on reimbursement — present to an independent arbitrator their best offers for how much a patient’s out-of-network care should cost. The arbitrator would choose between the two.

But another approach — benchmarking — ultimately made it into the formal draft. Here’s how it works: When patients are seen by doctors who aren’t in their network, the insurer would pay the providers the “median in-network rate,” meaning the rate would be similar to what the plan pays other doctors in the area for the same procedure.

At the markup hearing Wednesday, Alexander said he initially preferred one of the other approaches, the in-network guarantee, but changed his mind when the Congressional Budget Office said benchmarking would save more money.

A group of senators on the panel led by Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.) and Lisa Murkowski (R-Alaska) voted for the chairman’s choice, even though they had advocated for arbitration. Cassidy made clear he continues to have reservations.

“This is entirely for the insurance companies,” he said of benchmarking. “I’m surprised that my colleagues on the other side of the aisle running for president are OK with this.”

Neither of the two Democratic senators on the committee running for president, Sens. Elizabeth Warren (Mass.) and Bernie Sanders (Vermont), were present but both voted no by proxy.

But it is also not an entirely settled issue.

Cassidy and Alexander indicated that the door was still open to including independent arbitration before the package gets to the floor.

“We’re going to keep working on that the next three or four weeks. There are clearly opportunities to improve the bill and move in the direction Sen. Cassidy wants to go,” Alexander told reporters after the hearing.

At the markup hearing Wednesday, the committee took a step toward Cassidy’s preferred vision for fixing surprise bills. It passed an amendment from Cassidy that would require insurance companies to post accurate lists of who is in-network, so patients have a better chance of avoiding surprise bills.

“This bill is not as good as it should be,” Cassidy said. “And I thank the chairman because he has offered to work between now and floor consideration on the surprise bills.”

The only other amendment approved by the panel, offered by Sen. Tammy Baldwin (D-Wis.), would require drug companies to report price increases.

And despite Alexander saying early on that he didn’t want to talk about the individual insurance market or the ACA, some Democrats couldn’t let the opportunity pass without mentioning Republican efforts to undermine it.

“Repairing the train can only get you so far if you are pulling up the track at the same time — and that’s unfortunately exactly what this administration is doing,” Murray said in her opening statement. “The biggest threat to families’ health care continues to be sabotage from President Trump.”

Early Abortion Bans: Which States Have Passed Them?

This year has brought an unprecedented wave of new state laws that allow abortions to be performed only early in pregnancy — if at all.

Most of the new laws — known as early abortion bans — explicitly outlaw abortion when performed after a certain point early in the pregnancy. The laws vary, with some forbidding abortion after six weeks of pregnancy, and some after eight weeks. Alabama’s law is the most extreme: It aims to outlaw abortion at any point, except if the woman’s health is at serious risk. So far in 2019, nine U.S. states have passed laws of this type, and more states are considering similar legislation.

None of the laws passed this year are actually in effect, either because they have a future enactment date or because judges have put them on hold in response to lawsuits, or both.

These new bans are a direct challenge to the precedent set by the 1973 U.S. Supreme Court ruling Roe v. Wade, which affirmed that a woman has a right to seek an abortion up until the point that the fetus could be “viable” outside of the uterus. Viability must be determined on an individual basis but is generally between 24 and 28 weeks of pregnancy.

“We want to stop abortion of unborn children. And the only way we can do that is to go back and revisit the Roe decision,” Eric Johnston, the president of the Alabama Pro-Life Coalition, told NPR’s Ari Shapiro. Johnston helped write the Alabama law that outlaws almost all abortions.

“This law is, in effect, a vehicle to do that.”

A few states already have existing laws that outlaw abortion earlier in pregnancy than the standard set by Roe, banning the procedure as early as 18 or 20 weeks. When challenged, bans on abortion at this stage of pregnancy have consistently been struck down in court, according to the Guttmacher Institute. But not all of those laws have been challenged in court, so they remain on the books. There is no state law currently in effect that bans abortion before 20 weeks.

Three states — New York, Vermont and Illinois — have moved in the other direction. All three states passed laws this year that affirm the legal right to an abortion in each state, even if the Supreme Court overturns Roe v. Wade. Illinois is the most recent example, with its governor signing a bill on June 12 that states that “every individual has a fundamental right to make autonomous decisions about one’s own reproductive health.”

These early abortion bans differ from another common type of state regulation known as a TRAP law — for Targeted Regulation of Abortion Providers. TRAP laws place particular restrictions on the doctors or health clinics that provide abortions, and the Supreme Court has allowed some of these laws to go into effect, while striking down others.

Here are some details on the newest bans, by state.

*Important note: Supporters of reproductive rights have filed multiple lawsuits against this type of law. None of these early abortion bans are currently in effect or are being enforced.

Alabama – No abortion at any point in pregnancy. Allows exceptions if the woman’s life is threatened. No exceptions for rape or incest.

Arkansas – No abortion after 18 weeks. Allows exceptions for rape, incest or medical emergencies.

Georgia – No abortion after 6 weeks. Allows exceptions if the woman’s life is endangered, if the pregnancy is deemed “medically futile” and in cases of rape or incest if the woman files a police report.

Kentucky – No abortion after 6 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered.

Louisiana – No abortion after 6 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered or if the pregnancy is deemed “medically futile.”

Mississippi – No abortion after 6 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered.

Missouri – No abortion after 8 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered.

Ohio – No abortion after 6 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered.

Utah – No abortion after 18 weeks. Allows exceptions for rape or incest if the doctor performing the abortion verifies that the incident was reported to law enforcement. Allows exceptions if the woman’s life is endangered.

NPR’s Carrie Feibel, Sarah McCammon and Carmel Wroth contributed to this report.

This story was originally published by KHN’s partner NPR.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! The jury is still out whether we’re all growing horns out of the back of our heads because of how much we use smartphones, but apparently humans on the whole are somewhat decent people when it comes to finding wallets with cash in them. Now buckle up, because our cups have runneth over this week in terms of truly excellent health stories.

We’ll start, though, with what to look out for next week: President Donald Trump is expected to issue an executive order that would compel hospitals, insurers and others in the health industry to reveal closely guarded information about the true cost of procedures, according to The Wall Street Journal. This is the order that certain players in the health field have been dreading. It’s unclear how aggressive the administration will be with the rule, considering the rumblings of discontent already rippling through D.C. But a whopping 88% of people in a recent survey said they support such a policy — so the president is not exactly going out on a limb with voters.

The Wall Street Journal: Trump to Issue Executive Order on Health-Care Price Transparency


Speaking of voters, this executive order comes closely on heels of the official kickoff for Trump’s reelection campaign, which took place on Tuesday in Florida. The president has been searching for ways to win back ground against Democrats on the topic of health care — and promised to issue a plan within the next month or two that would counter the buzzy “Medicare for All.”

Many Republicans, though, kind of wish Trump would channel “Frozen” and let it go. With polls showing voters favor Democrats’ stance on health care, Republicans want the president to focus on issues where they think they have an edge, such as immigration.

The New York Times: Trump Wants to Neutralize Democrats on Health Care. Republicans Say Let It Go.

The New York Times: Trump, At Rally in Florida, Kicks Off His 2020 Re-Election Bid

Adding to the prevailing narrative that health care is a winning issue for the Dems, House Speaker Nancy Pelosi is using the topic to divert attention away from the more volatile talk of impeachment. “When we won the election in November, it was health care, health care, health care,” Pelosi said earlier in the week. She also promised that Democrats would fight relentlessly against Trump’s attempts to chip away at the health law.

In short, you can pretty much guarantee health care is going to play a central role in the 2020 races.

Bloomberg: Impeach Trump? Pelosi’s Dems Prefer Health Care Focus for 2020

Meanwhile, The New York Times interviewed many of the Democratic candidates about their stances on different issues, including health care. While they all agree something needs to be done about the country’s system, what that looks like becomes a dividing line in a crowded field.

The New York Times: 2020 Democrats on Health Care


A federal appeals court handed the Trump administration a win this week when a panel of three Republican-appointed judges ruled that new rules prohibiting federal family-planning grants to health clinics offering on-site abortions or referrals for the procedure can go into effect. The changes — which are largely thought to be targeting Planned Parenthood and are called a “gag rule” by opponents — have provoked fierce backlash among abortion rights groups that say the implementation of such restrictions will be devastating to women who rely on the clinics for health care. Although the decision isn’t the final say on the matter, the judges predicted the administration will prevail in this case.

The Washington Post: Trump Administration’s Abortion ‘Gag Rule’ Can Take Effect, Court Rules

Meanwhile, a look at two abortion clinics 20 minutes apart highlights the great divide evident around the country as state-level laws stand in stark contrast to one another.

The Wall Street Journal: Two Abortion Clinics, 20 Minutes and a Legal Universe Apart


Politico lifts the curtain on the ever-deepening quarrel between White House aides and HHS Secretary Alex Azar. “Alex is outnumbered and keeps losing,” an individual familiar with the simmering tensions told reporters. With Trump’s focus on health issues as he launches his campaign, the discord threatens to derail progress on key administration agenda items like high drug prices.

Politico: ‘They’re All Fighting Him’: Trump Aides Spar With Health Secretary


Major stakeholders have been anxiously watching congressional action on surprise medical bills — an issue most lawmakers agree needs to be addressed but for which there are several approaches. Industry players each have a preferred strategy (such as independent arbitration), but powerful HELP Committee leaders Sens. Alexander Lamar and Patty Murray hadn’t yet settled on theirs. That changed this week when they announced they back a “benchmark” plan, meaning insurers would pay a provider a rate similar to what the plan pays other doctors in the area for the same procedure. Alexander had “intrinsically” supported a different plan previously but changed his mind after the Congressional Budget Office ruled that this one would garner the most federal savings.

Hospitals were not pleased with the direction this is taking, calling the tactic “unworkable.”

Politico: HELP Committee Leaders Back Benchmark for ‘Surprise’ Billing


One of my favorite stories of the week looks at how those much-hated robocalls, which are mostly just a huge nuisance for most of us, become a life-and-death situation for hospitals. While the rest of us can either block or ignore the calls, hospitals don’t have that option. And when the calls come in waves of thousands, they can jam up emergency lines.

The Washington Post: Robocalls Are Overwhelming Hospitals and Patients, Threatening a New Kind of Health Crisis

I know a lot of people are creeped out by the privacy issues of having digital ears listening in on your every move, but there could be a flipside. Researchers want to train Alexa et al. to listen for gasping that could signal someone is experiencing cardiac arrest.

Stat: ‘Alexa, Are You Listening?’ A Research Tool Warns of Cardiac Arrest


Arkansas’ implementation of a Medicaid work requirement was closely watched by other conservative states eager to follow its lead. Advocates were appalled by the tens of thousands of people dropped from coverage, while state leaders and the Trump administration insisted that an improving economy was the reason behind the declining enrollment.

But a new study adds another layer to the debate: The work mandate has done nothing to affect the number of people who are unemployed in the state. So, after all of that, fewer people have insurance and fewer people have jobs.

Modern Healthcare: More Arkansans Uninsured, Unemployed Post-Medicaid Work Requirement


In news that surprised zero people, but should be noted anyway: Drugmakers made official their opposition to the new rules requiring them to include prices in TV ads. They say the requirements violate their freedom of speech rights and will be confusing to patients, since the prices aren’t what most people end up paying for the drugs.

Reuters: U.S. Drugmakers File Lawsuit Against Requiring Drug Prices in TV Ads


In the miscellaneous file this week:

• It often seems as if the anti-vaccination movement is this grassroots thing that has bubbled up through social media. But the tried-and-true “follow the money” method paints a more interesting picture, starting with a wealthy Manhattan couple who pumped millions into the cause over the past several years.

The Washington Post: Meet the New York Couple Donating Millions to the Anti-Vax Movement

• Immigrant children in U.S. custody give bleak accounts to lawyers of their experiences — including reports of toddlers without diapers being cared for by 10-year-old girls. The lawyers involved say that during their interviews the “little kids are so tired they have been falling asleep on chairs and at the conference table.”

The Associated Press: Migrant Children Describe Neglect at Texas Border Facility

• The youth suicide rate appears to have reached the highest since the government began collecting such statistics in 1960 — driven, in part, by a sharp increase among older teenage boys.

Los Angeles Times: Suicide Rates for U.S. Teens and Young Adults Are the Highest on Record

• Firefighters who die of cancer outnumber firefighters who die responding to an emergency “at least ten, 20, 30 to one.” Yet the very cities they risk their lives protecting are turning their backs on them once they become sick. “My city’s workers’ comp carrier initially flat-out said, ‘We don’t cover cancer,’” one firefighter recalled.

CBS News: Firefighters Battle Occupational Cancer: Many Sickened First Responders Are Being Denied Workers’ Comp Benefits


That was a fairly grim file to end The Friday Breeze with, so make sure to check out Stat’s list of 23 of the best health and science books to read this summer to give yourself a little boost to finish off your week. And have a great weekend!

Sen. Alexander Details His Plan To Fix Surprise Medical Bills

Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), who are pushing a major legislative package to lower health costs, announced their favored solution to handle disputes about surprise medical bills.

Those unexpected and often high charges patients face when they get care from a doctor or hospital that isn’t in their insurance network are a perpetual complaint from consumers.

Alexander and Murray formally introduced their wide-ranging bill Wednesday, but they had offered a broad outline before without taking a stand on how to mediate between health care providers and patients on the surprise bills.

When a patient is seen by a doctor who isn’t in their network, the Alexander-Murray bill says insurance would pay them the “median in-network rate,” meaning the rate would be similar to what the plan charges other doctors in the area for the same procedure. If there aren’t enough other doctors covered by the plan to compute a median in-network, the plan would use a database of local charges that is “free of conflicts of interest.”

Alexander said in a written statement that his decision was swayed by an assessment by the Congressional Budget Office, which “indicated that the benchmark solution is the most effective at lowering health care costs.”

According to early numbers from a CBO report, benchmarking could save $25 billion over the next 10 years. Loren Adler, associate director of USC-Brookings Schaeffer Initiative for Health Policy, said that means commercial insurance premiums would be reduced by about a half-percent.

“That’s pretty significant for federal policy,” Adler said.

The formula is similar to what a different group of bipartisan senators, led by Sen. Bill Cassidy (R-La.), proposed earlier this year. The critical difference is that in the Cassidy bill if the insurer and doctor can’t agree on a median-in-network rate, they can take their case to an independent arbitrator.

The provider community has pushed back on any attempt to set a “benchmark” for physician pay, like the one in Alexander and Murray’s bill.

At a hearing Tuesday before the Health, Education, Labor and Pensions Committee — of which Alexander and Murray are the chairman and ranking member, respectively — Tom Nickels, executive vice president of the American Hospital Association, said benchmarking would hurt efforts to set up broad insurance networks because providers and insurers would already know what they would be paid for surprise bills and it would be hard to recruit physicians to adequately staff hospitals.

“Health plans and hospitals have a long-standing history of resolving out-of-network emergency service claims, and this process should not be disrupted,” he said in written testimony.

Alexander also pointed out that Rep. Frank Pallone (D-N.J.), chairman of the House Energy and Commerce Committee, and Rep. Greg Walden (R-Ore.), the ranking member of that committee, have also recommended this proposal.

Although it isn’t the most aggressive solution the committee could have picked, according to Adler, it’s still a positive step, and he said it was promising that an influential health committee in the Senate and an influential health committee in the House are on the same page.

“There’s some logic to moving trains in the same direction,” Adler said.

The Alexander-Murray legislation says that any care the patient receives would count toward their in-network cost sharing, like their deductible, coinsurance or copay.

Once they are stable and lucid after an emergency, patients must be given written notice that they are going to be seen by an out-of-network doctor, an estimate of how much that could cost, and a list of in-network doctors or facilities where they could seek care.

The bill specifies that the notice must be short, easy to read and that consent to see an out-of-network doctor is clearly optional. If the patient doesn’t get this document, they can only be billed at an in-network rate.

Senators Agree Surprise Medical Bills Must Go. But How?

Two years, 16 hearings and one massive bipartisan package of legislation later, a key Senate committee says it is ready to start marking up a bill next week designed to contain health care costs. But it might not be easy since lawmakers and stakeholders at a final hearing Tuesday showed they are still far apart on one simple aspect of the proposal.

That sticking point: a formula for paying for surprise medical bills, those unexpected and often high charges patients face when they get care from a doctor or hospital that isn’t in their insurance network.

“People get health insurance precisely so they won’t be surprised by health care bills,” said Sen. Maggie Hassan (D-N.H.), the co-author of a separate proposal to tamp down surprise bills. “So it is completely unacceptable that people do everything that they’re supposed to do to ensure that their care is in their insurance network and then still end up with large, unexpected bills from an out-of-network provider.”

It’s a cause that has been taken up by President Donald Trump and various bipartisan groups of lawmakers on Capitol Hill.

The wide-ranging legislative package on curbing health care costs is sponsored by Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the chairman and ranking member of the Health, Education, Labor and Pensions (HELP) Committee. Given the committee’s influence, and because this legislation has bipartisan support in the Senate where not many bills are moving, industry observers are taking the HELP panel’s proposal very seriously.

Alexander and Murray’s bill lays out three options for paying surprise medical bills but does not specify which path the final legislation should take. Advocates for each of the choices were among the five witnesses Tuesday.

Their positions fell along familiar fault lines. Everyone acknowledged that patients who stumble into a surprise bill because their emergency care was handled at a facility not in their insurance network or because a doctor at their in-network hospital doesn’t take the patient’s plan should not have to pay more than they would for an in-patient service. But they differ on how much doctors, hospitals and other providers should be compensated and how the disputes should be resolved.

Tom Nickels, an executive vice president of the American Hospital Association, cautioned against using benchmarks to set pay levels, such as local customary averages or a price set in relation to Medicare. He said such a plan might underpay providers and hospitals could lose their leverage to negotiate with insurers.

Elizabeth Mitchell, president and CEO of the Pacific Business Group on Health — a group that represents employers, including some who are self-insured who pay their workers’ health costs— said doctors should be paid 125% of what Medicare pays. She told senators that an independent arbitration process like the one Nickels advocates would add unnecessary costs to the system.

Benedic Ippolito, a researcher with the American Enterprise Institute, said requiring all providers in a hospital to be in-network was the cleanest solution.

“On surprise billing, all three approaches are equal in that first and foremost they protect the consumer,” said Sean Cavanaugh, chief administrative officer for Aledade, a company that matches primary care physicians with accountable care organizations.

There was also broad support among the witnesses for some of the legislation’s transparency measures, especially the creation of a nongovernmental nonprofit organization to collect claims data from private health plans, Medicare and some states to create what’s called an all-payer claims database. That could help policymakers better understand the true cost of care, these experts told the committee.

Sen. Susan Collins (R-Maine) expressed trepidation about the all-payer claims database, noting that increased transparency could hurt rural hospitals, which typically charge higher prices than those in cities because their patient base is small and they need to bring in enough revenue to cover fixed costs.

The witnesses also offered support for eliminating “gag clauses” between doctors and health plans. These stipulations often prevent providers from telling patients the cost of a procedure or service.

“Patients and families absolutely have skin in the game … but they are in a completely untenable and unfair situation. They have no information,” said Mitchell, from the Pacific Business Group on Health. “We’re talking about providers not being allowed to share information. … Transparency is necessary so people can have active involvement.”

If one thing is clear, it’s that Alexander doesn’t want this summer to be a rehash of last year, when it appeared he had a bipartisan deal to address problems in the federal health law’s marketplaces before the effort fell apart.

“For the last decade, Congress had been locked in an argument about the individual health care market,” said Alexander at Tuesday’s hearing. “That is not this discussion. This is a different discussion. We’ll never lower the cost of health insurance until we lower the cost of health care.”

Texas Is Latest State To Attack Surprise Medical Bills

Texas is now among more than a dozen states that have cracked down on the practice of surprise medical billing.

Texas Gov. Greg Abbott, a Republican, signed legislation Friday shielding patients from getting a huge bill when their insurance company and medical provider can’t agree on payment.

The bipartisan legislation removes patients from the middle of price disputes between a health insurance company and a hospital or other medical provider.

“We wanted to try to take the patients — get them out of the middle of it, because really it’s not their fight,” said Republican state Sen. Kelly Hancock, the bill’s author.

Under the new law, insurance companies and medical providers can enter into arbitration to negotiate a payment — and state officials would oversee that process.

Surprise medical billing typically happens when someone with health insurance goes to a hospital during an emergency and that hospital is out-of-network. It also occurs if a patient goes to an in-network hospital and their doctors or medical providers are not in-network. Sometimes insurance companies and medical providers won’t agree on what’s a fair price for that care and patients end up with a hefty medical bill.

Consumer advocates in the state have urged lawmakers to do more to help Texans saddled with surprise medical bills.

Drew Calver is among the many Texans who have dealt with a surprise bill in the past few years. Calver, a high school history teacher in Austin, had a heart attack in 2017. He was rushed to the closest hospital by a friend that day, and doctors implanted stents to save his life.

Even though he had health insurance that paid the hospital more than $55,000 for his care, Calver ended up with a $109,000 bill. Calver and his wife, Erin, fought with the hospital and the insurance company for months with little success.

The Calvers eventually turned to the press. Last summer, he told his story to the “Bill of the Month” investigation from NPR and Kaiser Health News. “CBS This Morning” also covered the story. Shortly afterward, his bill was slashed to just $332. Erin Calver said she has seen her family’s story strike a chord.

“For whatever reason, people could relate to us — and be scared that maybe it could happen to them,” she said.

Drew Calver said he encounters many people who worry about the issue.

“The doctor that put my stents in — he either just had a baby or is about to have a baby — and he was saying that, ‘Yeah that could happen to me, too!’” Calver said.

In fact, getting a steep hospital bill is something many Americans call their biggest financial fear.

“Polling shows us that the top household pocketbook concern for consumers is a surprise medical bill,” said Stacey Pogue with the Center for Public Policy Priorities, a think tank that analyzes health and economic issues in Texas. “And that’s actually pretty shocking that consumers will say they are more worried about their ability to afford a surprise medical bill than their health insurance premiums [and] their really high deductibles.”

Last year, a Kaiser Family Foundation poll found that 67% of people worry about unexpected medical bills — a larger share than those who say they worry about prescription drug costs or basic necessities such as rent, food and gas. (KHN is an editorially independent program of the foundation.)

Pogue said that’s a big reason why lawmakers in the state took the issue seriously and passed legislation that she said is now one of the strongest state protections she has seen.

“It is as strong or stronger than any of the protections in the country,” Pogue said.

In addition to Texas, neighboring states Colorado and New Mexico also passed legislation in 2019 to address the problem of surprise out-of-network bills. The Commonwealth Fund’s most recent report on the issue found about half of states offer some legal protections from surprise bills, but only six states had laws that provide “comprehensive” consumer protections similar to those just passed in Texas.

Texas’ new surprise bill law officially takes effect Sept. 1, 2020.

Hancock said the fight over who pays disputed bills will be back where it belongs: with insurance companies, leaving the hospitals, doctors and labs to focus on providing medical care.

“It was just time to get the patient out” of the middle of disputed bills, Hancock said.

Instead, when a hospital and insurer can’t agree on a price, the two parties will have to work it out — without ever billing the patient.

“There is still the ability to negotiate,” Hancock said. “You didn’t have government determining what the price was or determining what the settlement was.”

But not all Texans will be protected by the new law. The Texas law does not apply to people who work for large employers whose plans are regulated by the federal government. In Texas, federally regulated plans account for roughly 40% of the state’s health insurance market.

In fact, Drew Calver would have been exempt from the state’s protections because until recently he had a self-funded health plan regulated by the federal government. However, Drew is now part of wife Erin’s health plan, which will be subject to these new protections.

Pogue said people who have federally regulated health plans will be protected only if Congress acts. She predicted the state’s action will spur federal lawmakers.

“Texas passing a bill will really help on that front,” she said. “There were five states, I think, in 2019 that passed bills that fully protected consumers — and every nudge like that is going to help Congress move.”

Texas lawmakers passed separate legislation that could help Texans with federally regulated plans. Senate Bill 1037 prevents a surprise medical bill from affecting someone’s credit, regardless of what health insurance plan they have.

Congressional leaders have said they are working on coming up with a fix for people across the country with federally regulated plans. President Donald Trump also recently held an event at the White House, with Drew and Erin Calver standing by his side, announcing his administration’s support for banning surprise medical billing in the country.

During a U.S. House Ways and Means Health subcommittee meeting in May, members discussed ways to ban the practice of surprise medical billing.

The committee’s chairman, Austin Democrat Lloyd Doggett, said that “federal action is essential” to addressing the issue for many Americans with federally regulated plans. He said he plans to continue to push for legislation that will “finally offer some relief to patients.” However, no legislation has been passed, yet.

During his opening statements, Doggett said there is a bipartisan desire to shield patients from surprise bills, but “conflict remains over how to resolve insurer-provider disputes.”

This story is part of a partnership that includes KUT, NPR and Kaiser Health News.

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Have drug prices gotten so bad that patients are now turning to robbing banks to afford them? It sounds like something out of a movie script, but it’s what a Utah man told police when he was accused of just that. While it’s unverified whether he, in fact, had any prescriptions, it doesn’t seem like much of a stretch for anyone paying attention to the state of drug prices in this country.

On to what you may have missed this week (including one of the wilder health stories I can recall reading in a while).

Lawmakers were busy, busy bees this week with hearings on health care issues.

The moment that drew perhaps the biggest spotlight was almost cinematic: A furious Jon Stewart took members to task in an almost nine-minute display of pointed, nonpartisan outrage over their feet-dragging on health care funding for 9/11 first responders and victims. Why is this “so damn hard?” the comedian asked. Firefighters, police and other first responders “did their jobs with courage, grace, tenacity and humility,” Stewart said. “Eighteen years later, do yours.” A bill allocating money to the fund for 70 years passed the House panel following the hearing.

The Associated Press: Jon Stewart Lashes Out at Congress Over 9/11 Victims Fund

The New York Times: How Jon Stewart Became a Fierce Advocate for 9/11 Responders

Reuters: House Panel Approves Permanent Sept. 11 Victims’ Compensation

But it wasn’t just made-for-TV drama on Capitol Hill this week. There was a flurry of activity related to health care. Here are some of the highlights, including a hearing on universal health coverage, which was heavy on fiery political rhetoric and light on substance:

The Hill: House Democrats Vote to Overturn Trump Ban on Fetal Tissue Research

CNN: Medicare for All Hearing Turns Into a Defense of Obamacare

Modern Healthcare: Arbitration for Surprise Medical Bills Splits House Panel

The Hill: Pelosi to Change Drug-Pricing Plan After Progressive Complaints

The Hill: Democrats Scuttle Attempt to Strike Hyde Amendment From Spending Bill

The Hill: House Panel Launches Investigation Into Juul


Even if “Medicare for All” were to overcome the daunting political hurdles lying in its path, it’s likely it would face so many legal challenges it could be bled out before it’s ever implemented. “There could be a death by a thousand-lawsuits approach,” Georgetown law professor Katie Keith told Politico. Other experts note, though, that there’s a difference between forcing someone to buy a product and banning something, which makes Medicare for All less vulnerable legally than the health law.

Politico: ‘Death by a Thousand Lawsuits’: The Legal Battles That Could Dog ‘Medicare for All’

Over in Chicago at the American Medical Association’s annual meeting, a medical student-led push to get the organization to reverse its decades-long opposition to single-payer health care failed. But, there’s more to it than that! A fabulous thread on Twitter from Bob Doherty of the American College of Physicians explains how the fact that the vote percentages were so close is remarkable in and of itself. The outcome would have been “unimaginable” in years past, he says.

The Hill: Major Doctors Group Votes to Oppose Single-Payer Health Care

And read Doherty’s thread here.


When premiums shot up over the past several years, more and more people turned to health care sharing ministries — which essentially connect people of similar faiths and set up a cost-sharing arrangement among the members. Because these models are not technically insurance, they’re allowed to skirt health law regulations and aren’t regulated by state commissioners. All of that was seen as a point in their favor from supporters at the time they joined them. But now it means that when bills aren’t paid on time, or at all, consumers have little recourse and officials’ hands are tied in holding the organizations responsible for their promises.

The Wall Street Journal: As Sharing Health-Care Costs Takes Off, States Warn: It Isn’t Insurance

Meanwhile, the Trump administration continues to chip away at the health law with its latest rule on health reimbursement arrangements, which will allow small firms to use tax-free accounts to help workers pay for insurance.

The Hill: Trump Officials Issue New Rule Aimed at Expanding Health Choices for Small Businesses


If you took anything away from last week’s drama over former Vice President Joe Biden’s stance on the Hyde Amendment it was probably that it seems the parties are dead set on their positions on abortion. But a look at how the public feels about the issue reveals blurred lines and nuance that doesn’t always fit into pat sound bites and political declarations. Many Americans struggle with the moral complexities surrounding abortion and their opinions can change from one question to the next, depending on the wording.

The New York Times: Politicians Draw Clear Lines on Abortion. Their Parties Are Not So Unified.

A new poll does show, however, that despite the ever-increasing threat to Roe v. Wade a strong majority of Americans don’t want to see it overturned.

NPR: Abortion Poll: Majority Wants to Keep Abortion Legal, but With Restrictions


Actress Jessica Biel ignited a firestorm of criticism after speaking out about a controversial California bill that would give a state official the final say on medical exemptions from vaccines. Once the blaze was lit, Biel tried to clarify that her issue was not with the vaccines themselves, but rather with the legislation introducing bureaucrats into the process. California’s governor has even hinted at similar concerns. The blowback, though, highlights how inherently inflammatory the topic has become as measles cases continue to climb across the country.

The New York Times: Here Is What Jessica Biel Opposes in California’s Vaccine Bill

In New York — the state at the heart of the record-busting measles outbreak — lawmakers passed a bill banning religious exemptions to vaccines. The governor signed it minutes later.

The Associated Press: New York Set to Cut Religious Exemption to Vaccine Mandates


I have kept you on tenterhooks long enough! One of the wilder health stories I’ve read in a long time comes from gruesomely fascinating Arizona Republic reporting. It’s a look into the thriving for-profit world of whole-body donations following death. Critics deem the practice as no better than “back alley grave robbing.” “There’s a price list for everything from a head to a shoulder, like they are a side of beef. They make money, absolutely, because there’s no cost in getting the bodies,” lawyer Michael Burg told The Arizona Republic. Supporters, however, see it as an affordable way to dispose of the remains of loved ones (which can actually be very expensive for low-income families).

Either way, it garnered my favorite quote of the week, asked by one potential donor: “Will I have a head in heaven?”

The Arizona Republic: Arizona Is a Hotbed for the Cadaver Industry, and Potential Donors Have Plenty of Options

The Arizona Republic: Despite 2-Year-Old State Law, Arizona’s Body Donation Industry Still Unregulated


In a move that left Flint, Mich., residents stunned and frustrated, prosecutors dropped all criminal charges against officials over the city’s water contamination crisis. Although prosecutors said the old investigation was bungled and there will be new charges, the announcement came like a fist to the jaw to people who already have had their faith in the government shattered.

Detroit Free Press: All Flint Water Crisis Criminal Charges Dismissed by AG’s Office


In the miscellaneous file this week:

• If you ever think you’re having a bad day at work, read this story about how an employee’s small photocopier mishap triggered a series of events that undermined a pair of late-stage clinical trials and ultimately scrapped a development deal between pharma companies.

Stat: How a Mishap at a Photocopier Derailed Clinical Trials and a Development Deal

• I am fascinated by the anatomy of pandemics, and this is a great tick-tock of the start of the last one. They don’t play out as they would in Hollywood, but, to me, the reality is even more interesting (I can’t be the only one, right?!).

Stat: The Last Pandemic Was a ‘Quiet Killer.’ Ten Years After Swine Flu, No One Can Predict the Next One

• World health officials have been begging farmers to stop using antibiotics on healthy farm animals in an effort to combat the ever-looming threat of resistance (which, as you know, terrifies yours truly). The farmer,s though, also have drugmakers whispering in their ears — despite a public facade from pharma of wanting to help combat the problem.

The New York Times: Warning of ‘Pig Zero’: One Drugmaker’s Push to Sell More Antibiotics

• Are you a sufferer of “white coat hypertension”? You might think it’s just because you get stressed out when you visit the doctor (join the club!), but a study shows that those anxiety-induced numbers are linked to an increased risk of a cardiac event.

Stat: Those With ‘White Coat Hypertension’ More Likely to Die From Cardiac Events


That’s it from me! Have a great and restful weekend. (Truly, insomnia can kill!)

A Proposal To Make It Harder For Kids To Skip Vaccines Gives Powerful Voices Pause

As California lawmakers attempt to tighten the rules on childhood vaccinations, they’re getting pushback from unexpected quarters: high-profile officials who support vaccines.

In the past few weeks, Democratic Gov. Gavin Newsom and the members of the Medical Board of California have questioned a bill that would give the California Department of Public Health authority to decide whether a child can skip routine vaccinations.

Anti-vaccine activists have capitalized on these moments, plastering Facebook pages and social media with praise for the officials’ statements.

But those officials are not against vaccinations. In fact, they have made clear they’re committed to vaccines, and to dealing with the problem the bill is supposed to fix — doctors providing kids with medical exemptions for reasons that don’t meet federal standards.

“Having been in public health for a long time, I am a huge supporter of vaccines,” said Dr. Michelle Bholat, a family medicine physician in Santa Monica and until recently a member of the medical board, which has oversight over physicians and their licenses.

What concerns her, she said at a late-May meeting of the board, was the measure’s potential effect on doctor-patient relationships and the particulars of who would qualify for a medical exemption.

Pediatrician and state Sen. Richard Pan (D-Sacramento) introduced the bill to address a spike in the number of children who have been granted what he calls “fake” medical exemptions from vaccinations; more than five times as many kids have medical exemptions this past school year than in 2015-16.

SB 276 would give the final say on medical exemption applications to the state public health department, which would be required to follow guidelines established by the Centers for Disease Control and Prevention. Any exemptions provided by doctors would be subject to approval — or denial — by the department.

The only other state that gives control of vaccine exemptions to a public health agency is West Virginia.

The measure passed the state Senate in May and is awaiting consideration in the state Assembly.

The debate over the measure comes as new state data shows that the percentage of kindergartners who had all their recommended shots fell for the second straight year, largely due to an increase in medical exemptions written by doctors.

During the past school year, the share of fully vaccinated kindergartners dropped to 94.8%, down from 95.6% in 2016-17, putting the state in potentially dangerous territory — officials recommend 90-95% coverage for community immunity.

And as vaccination rates dip, measles is spreading nationwide. In the largest outbreak since 1992, more than 1,000 people have been infected across the country this year through June 5, including 51 in California.

Nearly three years ago, California enacted a law by Pan that bars parents from citing personal or religious beliefs to avoid vaccinating their children. Children could be exempted only on medical grounds if the shots were harmful to their health.

That ban improved vaccination rates, though progress has been slipping.

Today, many of the schools that had the highest rates of unvaccinated students before the law took effect still do. Doctors have broad authority to grant medical exemptions from vaccination; some wield that power liberally and sometimes for cash, signing dozens or hundreds of exemptions for children, sometimes in far-off communities.

Pan’s bill would crack down on this practice and has the strong support of the medical establishment. It was co-sponsored by two powerful doctor associations, the American Academy of Pediatrics, California, and the California Medical Association.

“We want to make sure unscrupulous physicians aren’t making medical exemptions for money,” said Dr. David Aizuss, the president of the California Medical Association. “The idea of the bill is to protect a real personal medical exemption, where kids are on chemotherapy or have an immunological response.” 

But it has its critics — and this time, they extend beyond the small but fervent group of people who continue to question the extensive scientific evidence that shows vaccines are safe. And although raising concerns is typical in the legislative process, their criticisms take on outsize importance with a subject as explosive as vaccines.

The biggest name among the new critics is Newsom, who said he’s worried about interfering with the doctor-patient relationship. “I like doctor-patient relationships. Bureaucratic relationships are more challenging for me,” he said at the state Democratic Party convention in early June.

“I’m a parent; I don’t want someone that the governor of California appointed to make a decision for my family.”

State Sen. Ben Allen (D-Santa Monica), a co-sponsor of Pan’s previous legislation, abstained from voting on the new measure last month, saying he’d made commitments during the previous fight to leave medical exemptions to the discretion of doctors.

Last month, the Medical Board of California offered just lukewarm support, and only to portions of the bill, after listening to 200 members of the public speak against it for more than two hours.

The board members called on Pan to address a variety of concerns, from the potential oversight role the state public health department might play, to the proposed guidelines for medical exemptions.

They agreed on one thing: It should be easier for the board to investigate complaints of questionable medical exemptions. To look into complaints, the board needs to see medical records. To get those records, it generally needs permission from patients or their guardians, something parents who have sought medical exemptions are often unwilling to provide. The bill would give the board access to these records.

One physician, Dr. Bob Sears in Orange County, a well-known opponent to vaccine mandates, was put on probation in 2018 for writing an exemption for a 2-year-old without taking any medical history. Since 2016, at least 173 complaints against physicians for inappropriate exemptions have been filed with the state medical board, with more than 100 currently under investigation, the board said.

Medical exemptions for California kids are clustered in certain communities and schools. In Humboldt County, 5.8% of kindergartners have medical exemptions from shots, according to the new state data. In Nevada County, the rate is 10.6%. All told, nearly one-third of the state’s counties have fallen below 95% immunity from measles. 

Aizuss of the California Medical Association said the organization is working with Newsom’s office and the medical board, among others, to update the bill so that it will be “workable, effective and supported by the governor.”

“I think that our goal is the same,” he said. “The idea of the bill is to protect … the sanctity of the true physician-patient relationship, as opposed to a relationship where physicians were granting the medical exemption for a fee, which is not a true physician-patient relationship.”

California Healthline reporter Ana B. Ibarra contributed to this report.


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

KHN’s ‘What The Health’: Who Will Pay To Fix Problem Of Surprise Medical Bills?


Can’t see the audio player? Click here to listen on SoundCloud.


Congress is finally getting down to real work on legislation to end “surprise” medical bills, which patients get if they inadvertently receive care from an out-of-network health providers or use one in an emergency. But doctors, hospitals, insurers and other health care payers can’t seem to agree on who should pay more so patients can pay less.

Meanwhile, the fight over women’s reproductive rights continues in both Washington, D.C., and the states. This week, governors in three states — Vermont, Illinois and Maine — signed bills to make abortions easier to obtain. At the same time, the Democratic-led U.S. House of Representatives took up a spending bill for the Department of Health and Human Services that still includes the “Hyde Amendment,” which bans most federal abortion funding — despite the fact that most House Democrats oppose the restriction. House Democratic leaders fear that the fight to eliminate the restriction would jeopardize the rest of the spending bill in the GOP-controlled Senate and at the White House.

This week’s panelists are Julie Rovner from Kaiser Health News, Stephanie Armour of The Wall Street Journal, Alice Miranda Ollstein of Politico and Kimberly Leonard of the Washington Examiner.

Among the takeaways from this week’s podcast:

  • Republicans on Capitol Hill and at the White House are just as eager as Democrats are to settle on legislation that would keep consumers from getting surprise medical bills. It would provide a nice counterpoint during the upcoming campaign to Democrats’ charges that the GOP has been undermining health care with its opposition to the Affordable Care Act.
  • A federal judge in Texas has struck down the ACA’s provision that health plans must cover contraception. That is at odds with another judge in Pennsylvania who earlier this year blocked the Trump administration’s plans to loosen the birth control mandate.
  • State insurance regulators are raising concerns about health care sharing ministries, which offer plans that provide coverage for some medical expenses. But consumers often don’t realize that the plans may not cover many health costs, including those from preexisting conditions.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: The Washington Post’s “In Alabama — Where Lawmakers Banned Abortion for Rape Victims — Rapists’ Parental Rights Are Protected,” by Emily Wax-Thibodeaux

Alice Miranda Ollstein: The New York Times’ “Planned Parenthood to Host Women’s Health Forum for 2020 Democrats,” by Lisa Lerer

Stephanie Armour: NPR’s “You May Be Stressing Out Your Dog,” by Rebecca Hersher

Kimberly Leonard: Politico’s “Lost in Translation: Epic Goes to Denmark,” by Arthur Allen

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