Dear AAPS Members and Friends:
Should Texas be enacting legislation inspired by unconstitutional California price controls that limit the ability of patients to obtain out-of-network care from independent doctors? Absolutely not.
With almost no notice, a bill that will implement this dangerous plan, SB 1264, has been scheduled for a hearing before the Senate Committee on Business and Commerce this Thursday morning at 8am.
In fact, SB 1264 would narrow Texas patients’ options even further than California has. It would hand insurance company bureaucrats near unilateral power to decide what out-of-network care is worth paying for and what isn’t.
Under the bill, insurers "shall pay for [out-of-network] health care ... in an amount that the insurer determines is reasonable" and "the insured does not have financial responsibility for, an amount greater than the insured's ... copayment, coinsurance, or deductible."
It is critical that as many doctors and patients as possible show up Thursday morning to give short 2 minute statements in opposition to this bill. We understand it will not be possible for most of you to reschedule patient care with such little notice. But if you are able to be there please reply to this email to let us know ASAP.
If you are not able to be there in person, you can still help:
1) Please send the Committee members an email message asking them to oppose SB 1264.
For many email apps, clicking here will open a new email with a template message, and the committee members' email addresses, filled in for you. Simply add your name and city at the bottom of the note, modify the message to your liking, and send.
If the link doesn't work for you, here is a template message you can copy and paste (be sure to add your name and city at the bottom):
Dear Chair Hancock and Members of the Senate Committee on Business & Commerce:
I ask you to oppose SB 1264, a bill even more dangerous than the unconstitutional California bill on which it is based. The intentions of the sponsors are to help patients, but unfortunately the bill will end up hurting them. If this legislation passes, patients will be at great risk of losing access to trusted independent physicians. Patient choice is already often severely limited by insurance company narrow networks and this bill will restrict patient access to care even further. Handing insurers near unilateral power to decide the value of medical care, while limiting patient options, is not good for Texas patients. There are better paths forward and we urge legislators to seek true solutions that respect the freedom and entrepreneurial spirit that is the American way and the Texas way.
Sincerely,
And here are the email addresses you can copy and paste into the TO line of your message:
kelly.hancock@senate.texas.gov,robert.nichols@senate.texas.gov,donna.campbell@senate.texas.gov,brandon.creighton@senate.texas.gov,jose.menendez@senate.texas.gov,angela.paxton@senate.texas.gov,Charles.Schwertner@senate.texas.gov,john.whitmire@senate.texas.gov,judith.zaffirini@senate.texas.gov
2) CALLING the committee members is also very helpful. We have a list of the phone numbers here.
For a flier you can download and print to educate patients and others, click here for a Word File and here for a PDF file.
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Here are some other points you can consider making in testimony or in your emails and phone calls to the committee.
Remember that politicians won’t read papers, only a few bullet points. If you testify in person, don’t read your testimony. Speak from the heart, only 2 minutes, and answer questions. Make major points over and over in a series of witnesses.
1. Physicians can’t just call our patients, cancel their surgery, and say “Sorry Mrs. Smith, just let that breast cancer grow in your body another week while I go to Austin to fight a bad bill.” This needs to be a point made in testimony. Physicians can’t show up to stand against this bad bill that harms patients, the private practice of medicine, and all private business other than the insurance companies who support the bill.
2. The bill is being heard in the Business and Commerce Committee. Make relevant points like "this bill will end up forcing small independent physicians out of business." Imagine if this is applied to every other business. Will Texas pass a law allowing a private company to force others to do their work and dictate what they’re going to pay them?
3. Texas is trying to enact legislation inspired by unconstitutional California price controls that limit the ability of patients to obtain out-of-network care from independent doctors. We must protect patient access to independent physicians.
4. SB 1264 would narrow Texas patients’ options even further than California has.
5. The cost of medical care does not have to be high; it is high because of decades of failed policies from Washington DC, and adding more top down mandates that benefit insurance companies, while limiting patient options is not good for Texas. It further tilts the uneven playing field government created, and monopolies are resulting. Choice and access are vanishing. Restoring choice. access, and competition will lower costs.
6. Texans deserve true solutions that respect the.freedom and entrepreneurial spirit that is the American and the Texas way.
7. Promoted as a means to end surprise medical billing, SB 1264 will actually enrich insurance companies while creating shortages of care for patients.
10. Price controls lead to shortages, always and everywhere, as every economist knows. SB 1264 sets prices in an arbitrary way, effectively authorizing insurance companies to set the prices and impose them even on doctors outside their networks with whom they have no contract.
8. This is bad policy and unconstitutional. There is no precedent. Private companies cannot be lawfully authorized to impose price controls on workers who have no contract with them.
9. Patients are increasingly forced into narrow networks in order to cut costs for insurers. Their needed care is often not available in the network.
10. Physicians stay out of networks because of the extremely low fees that are below the cost of providing the care and because they do not agree with decisions insurance companies make with regard to delaying and denying patient care.
11. If in-network care is not available, THE INSURANCE COMPANY should be obligated to reimburse its subscribers for the out-of-network charges they incur.
12. Insurers have no right to tell their subscribers they are not allowed to spend their own money to buy care their “Plan” denies them.
13. Insurance companies and their highly paid executives profit more if they can impose low prices on the entire market whether physicians contract with them or not.
15. Insurance companies profit even more if they don’t have to pay at all when patients receive no care because of narrow networks that ration care or because out-of-network physicians cannot be paid for the care they provide at a rate that allows them to stay in business.
16. SB 1264 will harm the uninsured as doctors will be forced to cut back on the medical care they provide to the uninsured and to charities. Insurance payment rates are already so low that in-network providers cannot afford to provide much charity care as it is.
20. This bill will hurt everyone but insurance companies. Texas should reject it.
Another point to think about: Insurance companies created “networks” for their own benefit. They can strategically keep “in-network” panels thin, consisting of the few who will accept the lowest pay and comply with the most 3rd party control. Patients will be standing in long lines to see these few physicians. All the while, the insurance company keeps collecting their clients' premiums and government subsidies to boot, making bank deposits, earning interest, and delaying and denying care to keep their bank accounts full and earn more interest. IF patients have “out-of -network” “benefits”, they can see independent doctors - but, they will have to meet a second and higher deductible and pay a bigger cost-share. For example, a patient may meet the $2000.00 deductible and be eligible to see an in-network physician for 80% coverage, but there are so few in-network physicians, the patient cannot wait perhaps 6 weeks for the next available appointment. Patients who have the resources may see an out-of network doctor but a new, bigger deductible, perhaps $5000, will have to be met, and the co-insurance will only be 50%. The insurer wins. The patient could end up paying an extra $5000 and the 50% coinsurance on top of that. This is money the insurance company will not have to pay.
On the other hand, physicians who may try to get “in-network” are denied. But, when their services are needed they are compelled by federal law (EMTALA) to treat and accept what the insurance companies (that refused to work with them) decide to pay, generally a very low price. It’s a no-lose situation for big insurance. The patients and physicians pay while the insurance companies collect, keep, and profit from all the cash.
What really needs to happen is to make networks irrelevant through solutions like transparent reference-based pricing. Insurance companies should be transparent about what they are going to pay for services so patients can evaluate the quality of coverage they are purchasing before they sign up for it. Insurers should not dictate fees that are mutually agreed upon by physicians and patients.
Additional Resource: "Surprise Medical Bills Are Not the Problem — The Network Is," by Twila Brase: https://www.cchfreedom.org/cchf.php/1512
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