| Perspectives on Texas

When Texans walk into the grocery store, they know what they’re going to be charged for a loaf of bread or a gallon of milk. Texans should also know what they’re going to be charged for medical tests and procedures.

Unfortunately, that’s increasingly not the case — and they’re fed up, according to a recent statewide poll.

A majority of Texas voters are so frustrated by a lack of transparency by some medical providers that they support new laws that would protect consumers from price-gouging, according to a survey of 801 Texas voters, conducted by Baselice & Associates using accepted statistical methods.

The poll assessed support for the creation and enforcement of state laws that would protect Texans from price gouging by free-standing emergency rooms (FSERs). The poll results revealed a strong desire for charge transparency by FSERs, hospitals and other medical providers:

• 97 percent of Texas voters believe patients should be told upfront, before being treated, what amounts they will be charged for medical tests and procedures, how much they will be responsible for paying out of their own pockets, and how much will be covered by insurance.
• 95 percent of Texas voters want greater transparency from FSERs.
• 94 percent believe there should be a fee schedule posted by hospitals and FSERs, so they know prices before they are treated.
• A majority of Texas voters, nearly 60 percent, do not believe that out-of-network doctors are underpaid.

The poll results also showed that Texas voters overwhelmingly support protecting patients and going after price-gougers who are taking advantage of Texans during personal medical emergencies. Among the findings:

• 9 out of 10 Texans believe the Texas attorney general (AG) should have the authority to go after bad actors who price-gouge Texans in emergency medical situations.
• 71 percent of Texas voters favor state laws that set or cap prices that doctors, facilities and other medical providers can charge, to keep prices in line with what the government pays for those same services.
• In the Dallas-Fort Worth area, 92 percent of voters favor an anti-price-gouging proposal, while 91 percent of Houstonians favor it. (The numbers were roughly the same among self-identified Republicans and Democrats.)
• Regionally, the highest rate of favorability for giving the AG the authority to prosecute offenders was in the San Antonio/South/El Paso region, at 93 percent.
• For age groups, the highest rate of favorability for giving the AG that authority was for ages 45-54, at 92 percent.

Furthermore, 95 percent of voters polled agreed that “freestanding ERs should be more transparent about what they are going to charge for medical services and procedures.”

A total of 94 percent polled believe “there should be fee schedules that hospital ERs and FSERs follow so that patients know something about the likely medical charges before they are treated.” And 91 percent believe “insurance companies should report to the Texas AG situations in which they witness price-gouging.”

The poll was conducted in November 2018 and has a margin of error of ±3.5 percentage points. The largest concentrations of voters interviewed for the poll were in the Dallas-Fort Worth and Houston metro areas, 30 percent and 25 percent, respectively. Overall, 61 percent of interviews were conducted in urban areas, and 39 percent were in rural areas.

Texas FSERs resemble urgent care centers, but on average, an FSER costs 10 times as much as an urgent care visit for the same condition. They are responsible for 83 percent of all out-of-network emergency room services and lead to more than $3 billion a year in avoidable health care costs. FSERs are rarely in-network with patients’ health plans, resulting in medical care that often leads to expensive surprise bills.

Fortunately, Texas lawmakers are listening. A number of bills have been filed this legislative session seeking to address some of the problems regarding transparency, price-gouging and surprise billing:

Sen. Kelly Hancock, R-North Richland Hills, and Rep. Trey Martinez Fischer, D-San Antonio, have filed Senate Bill 1264 and House Bill 3933, respectively, to prevent surprise medical billing of consumers in Texas.

Rep. Tom Oliverson, M.D., R-Cypress has filed House Bill 2041, which would require FSERs to increase disclosure of information related to insurance. The bill would prohibit the popular practice by some FSERs of informing patients they “take” or “accept” patients’ insurance and advertise using health plan logos even though they are not actually in networks.

And companion bills have been filed that would allow the Texas Attorney General to act against FSERs that charge consumers unreasonable prices for health care services. Senate Bill 866 by Sens. Kirk Watson, D-Austin, and Nathan Johnson, D-Dallas, and House Bill 1941 by Rep. Dade Phelan, R-Port Neches, would protect Texans from price-gouging for emergency medical care provided by FSERs.