AUSTIN, Texas - Legislation at the state Capitol aims to put an end to surprise medical bills, or so-called "balance billing," which has left a growing number of Texans facing a financial crisis while trying to recover from a health crisis for which they thought they were covered.

Trey Berndt, associate state director for outreach and advocacy with AARP Texas, says the problem is many hospitals that are in-network under the state's major health insurance providers use physicians that are outside the network, unbeknownst to patients.

"Most consumers pay their premiums and look at their insurance card and it says usually a co-pay and some coinsurance, and that's all they expect to pay," Berndt says. "Yet they come home and get maybe sometimes thousands of dollars of bills later on."

A proposal now awaiting a committee hearing in the Texas House would end such surprise medical bills by limiting the patient's out-of-pocket to no more than they would have paid in-network.

Berndt says the legislation would also take consumers completely out of any billing disputes between insurers and providers.

"When somebody is in the ER, the last thing they're going to be thinking about is in-network doctors, out-of-network doctors," says Berndt. "They've gone to a hospital they believe is in their network and they expect the providers to work with their insurance company and that's not happening and that's what we absolutely need to fix."

Among those Texans who have had insult added to injury with a surprise medical bill is Hugh Smith of Cypress. His wife broke her back three years ago and while in the hospital, they explicitly requested only doctors within their insurance network.

"I met my deductibles and all the co-pays and everything and then all of a sudden we get a doctor sending us a bill for a full amount, not willing to talk about it and says he's exempt from the process because he was not a doctor requested by us or used by us," says Smith. "He was an advisor to the chief of surgery at the hospital."

After battling over that surprise bill for two-years, the Smiths were able to get the amount reduced, but still ended up having to pay $3,000. While the practice of balance billing is legal, Berndt says AARP considers it one of the most unfair practices in commercial health insurance today.


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Oregon is working to address the state's digital divide with hundreds of millions of dollars in funding.

Infrastructure presents the largest challenges for connecting people in Oregon to high-speed broadband internet.

Nick Batz, director of the Oregon Broadband Office, said there are more than 170,000 residencies in the state with no or slow internet access.

"Our goal through the broadband office and with all our stakeholders throughout Oregon is to provide access to all 112,000 unserved locations and as many of the 60,000 underserved locations as we can," Batz explained.

The state has received federal funding from a variety of sources, including nearly $690 million from the Broadband Equity, Access and Deployment program, and more than $150 million from the Capital Projects Fund approved in the American Rescue Plan Act from 2021.

Oregon's Digital Equity Plan has also been approved and along with it, nearly $10 million in funding.

Bandana Shrestha, state director of AARP Oregon, said there was a time when high-speed broadband internet was considered a luxury.

"Now, it's such a big necessity for everyone, including for older adults," Shrestha pointed out. "Because we know that if you don't have connectivity, you're not going to be able to see your doctor when you want to. Telemedicine is not going to be possible."

Batz added his office is working to ensure every Oregonian can get on the internet.

"It is an interesting challenge," Batz observed. "Nothing has been done like this in Oregon's history of trying to get internet access to everybody. So, it's going to be quite the challenge and it's absolutely going to require participation from everybody to make this happen."

Nursing homes across South Dakota will soon receive a boost in support, as part of the most recent legislative session.

Facilities caring for Medicaid recipients are reimbursed by the state for some of the cost. Reimbursement rates have been calculated based on patient needs, occupancy and funds available in the state budget. Last year, the South Dakota Legislature increased the rate from about 75% to 100%.

House Bill 1167 now allows the Medicaid reimbursement rate to be adjusted annually, to keep up with inflation and other changes.

Erik Nelson, advocacy director for AARP South Dakota, is glad lawmakers are giving nursing homes attention.

"We have seen a number of nursing homes close in recent years," Nelson pointed out. "Financial considerations were a factor in that, along with workforce and some other issues."

Since 2019, 15 nursing homes have closed across the state, with six of the remaining 98 on a federal list of facilities not meeting basic standards of care. In addition to a lack of funding, the average staff turnover rate is 54%.

State lawmakers also approved the use of $5 million in American Rescue Plan Act funding toward expanding telehealth services in facilities including nursing homes, allowing patients to receive some health care services remotely.

Nelson noted telehealth is one way to supply needed support.

"For not only the residents, but the family caregivers that are supporting their loved ones in the nursing homes," Nelson emphasized. "And of course, the staff of the nursing home that's in the community."

Census data show South Dakota's population is aging and by 2030, one-fifth of residents will be older than 65.

Meals on Wheels programs could be a powerful tool for addressing the needs of people living with dementia, according to a study from Ohio State University researchers.

The community-based program delivers weekly meals to food-insecure seniors.

Lisa Juckett, assistant professor of occupational therapy at Ohio State University, conducted interviews with caregivers, people living with dementia, and the staff of LifeCare Alliance, the largest Meals on Wheels provider in the state. She said the findings revealed delivery drivers are often a critical source of social interaction and an "extra set of eyes" on homebound individuals.

"That Meals on Wheels driver is then able to perform very brief but important wellness checks and safety checks," Juckett explained. "To make sure that meal is actually being delivered, the door is being answered."

According to Meals on Wheels America, last year more than 90,000 Ohio seniors received over eight million home-delivered meals through the program. More than 80% of people with dementia in the U.S. live at home, and an estimated 60% are unable to eat or prepare food on their own.

States rely on a combination of federal funding, private donations and fundraising agencies to keep local Meals on Wheels programs operating. Juckett added the findings come on the heels of Congress deciding to cut funding for the Older Americans Act, which allocates money to Meals on Wheels programs nationwide.

"Meals on Wheels programs are always on the chopping block, when it comes to federal budgets being adjusted every year," Juckett pointed out. "We need more advocacy efforts to validate or justify the importance of these programs."

According to the group Alzheimer's disease International, more than 55 million people around the world live with dementia, a number expected to double over the next two decades.