Patient advocates in Texas celebrated this spring, when they finally hit a major milestone in the decade-long fight against surprise medical bills. Amid a flood of media attention spotlighting patients who had been hit with astronomical hospital charges for procedures they thought were covered by their insurance, lawmakers took up the issue. In May, the Legislature passed one of the nation’s strongest laws against surprise medical bills—a rare bipartisan measure that was touted both by state Democrats and Lieutenant Governor Dan Patrick.
Then, a curveball: The Texas Medical Board, tasked with implementing parts of the law, proposed rules that would have dramatically widened a narrow exception for patients who intentionally seek out nonemergency care from out-of-network doctors. Patient advocates said that the proposed rule would have created a major loophole that undermined the very point of the protections. The board, primarily comprised of doctors, said that was not its intent and that it supports the new law. But advocates countered that the rules, proposed in October, would have required all doctors to give patients confusing waiver forms, which could leave them mistakenly agreeing to hefty bills in nonemergency situations. Patrick released a stern statement threatening to reject the Senate appointments of board members who approved the changes. Then, late last week, the board relented in a surprise reversal, announcing it would turn over its rulemaking to another agency with authority over a wider swath of the providers impacted by the law. (Patient advocates suspect this will be the Texas Department of Insurance.)
Surprise medical bills occur when a patient goes to an in-network hospital and is seen by an-out-of-network provider. They’re the rarest of subjects in Texas politics: an issue with widespread, across-the-aisle support. Yet the last-minute upheaval before the Texas law goes into effect on January 1 is indicative of the tensions and challenges involved in addressing even a relatively narrow problem that almost everyone agrees ought to be solved.
