AUSTIN, Texas — It can be a major setback for Texas health care consumers: a surprise bill for thousands of dollars from a doctor who isn't in your insurance company's network. Texas lawmakers approved a mediation plan in 2015 to allow patients to negotiate those bills, but health care advocates say it's so complex that too few consumers are using it.

According to Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities, under the current payment system, a medical procedure can become a Catch-22 for the patient.

"Say, a colonoscopy - they often find out if their doctor is in-network and the facility is in-network,” Pogue said. "But they don't know to ask - or they can't get good information on - whether the anesthesiologist is going to be in-network; if they have a biopsy and it goes to a lab, if that pathologist in network."

Pogue said patients, particularly during emergencies, are rarely informed that they may be treated by an out-of-network provider, and those bills must be paid in addition to any deductibles or co-pays. She said Texas legislators are looking at several ways to address the problem, simplify the process and make it easier to arbitrate the bill.

Surprise bills have become a hot potato the health care system doesn't want to deal with, Pogue said.

"Insurance companies, as you can imagine, and doctors don't agree on who should pick up the tab. Today, they just push it off on patients because they can,” she said. "And so, if the Legislature says 'No, you can't push that cost off on a patient,' what these other agencies care about is who has to pick up that cost. And that's the complicating factor."

Since 2015, about 250,000 Texans who received out-of-network bills were eligible for mediation, Pogue said, but fewer than 4,000 have taken advantage of it.

"Hopefully, it'll also help consumers know about the program, because that's one of the biggest barriers is that they created this program to help consumers, but they don't know about it,” she said. "It does require that there's a notice that's put on your medical bill that you have a right to mediation."

Pogue said she's confident that the Legislature will act on surprise medical bills this session. She said the issue has bipartisan support in both the House and Senate.

A report, written by Pogue, on the issue of surprise out-of-network medical bills is available here.


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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.