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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People who are part of the Deferred Action for Childhood Arrivals program, known as DACA, will be dropped from their CoveredCA health plans at the end of August.

The move comes after the Trump administration changed a Biden-era definition of "lawfully present" to revoke health care eligibility for thousands of immigrants.

Christine Smith, policy and legislative advocate for the nonprofit Health Access California, said people only have a few weeks to get medical appointments in before their coverage ends.

"If you're enrolled in Covered California and you're a DACA recipient, the Trump administration just ended your coverage," Smith emphasized. "People should use as much of your health care as you can before the August 31st deadline."

The Centers for Medicare and Medicaid Services defended the move, saying it will save taxpayers money. CoveredCA estimated the change affects about 2,400 DACA recipients in the state who make too much to qualify for Medi-Cal and have jobs not providing health insurance. They can still buy private insurance but it is much more expensive. People who prepaid for their coverage can seek a refund.

Smith predicted it will be a blow not just to those who lose coverage but to the state's health care system as a whole.

"The lines in the ERs are going to be longer because people are not going to be able to get affordable preventive care," Smith projected. "They're just going to get sicker and then end up in the ERs. People will overall incur more medical debt. Hospitals will have more uncompensated care."

The change is nationwide. As of mid-July, about 538,000 people in the DACA program across the U.S. are ineligible to enroll in any state-based insurance marketplace and are unable to access premium subsidies or cost-sharing assistance.

Artificial intelligence is appearing more prominently in many aspects of life and research suggests older populations are curious, yet remain wary of using the technology in their everyday lives.

According to Stats Indiana, there are more than 1.5 million Hoosiers aged 65 and older, or 18% of the state's population. Experts said it is likely the demographic will use AI in some form in the next few years, either by choice or necessity.

Dr. Shaun Grannis, vice president of data and analytics for the Regenstrief Institute on Aging, said AI offers real benefits.

"It can reduce loneliness through conversation, provide reminders for medications and appointments," Grannis outlined. "It can support cognitive stimulation via games, storytelling, news updates."

The technology can also offer a low-pressure way to access information on public services, he added, which is valuable for those with mobility issues or those who feel intimidated by technology.

Grannis cautioned any tool which can be used for good can also lead to problems. He noted AI can create a false sense of companionship and mask social isolation. Overdependence is a legitimate concern, he argued, if the technology becomes a "crutch" for all forms of interaction.

"All cognitive activities or decision-making, it can actually lead to and create a negative feedback loop, lead to a decline in engagement and even basic self-management skills," Grannis explained. "This is risky."

Grannis believes one solution is designing AI systems to complement, not replace, human interaction. He stressed it can be done though building broader support ecosystems including family, friends, caregivers and community services. Grannis emphasized it would encourage real-world activity, prompting the user to go for a walk, call a grandchild or attend a local senior event.

If you have an extra five minutes, you can save a life because you can learn cardiopulmonary resuscitation at no cost from a new mobile, hands-only CPR kiosk.

The new kiosk is in the lobby of Saint John's Health Center in Santa Monica. The machine's touch screen gives a brief overview of hands-only CPR and you can practice right there, on a mannequin.

Dr. Rigved Tadwalkar, cardiologist at St. John's, said it is an easy way for people to get more comfortable giving chest compressions in an emergency.

"It's a lot like a video game but of course, a lot more important than a video game," Tadwalkar pointed out. "It gives real-time feedback about the depth and rate of compressions, proper hand placement, which are all factors that influence the effectiveness of CPR."

The American Heart Association operates the St. John's mobile kiosk and a stationary model at L-A-X with support from the hospital. Santiago Canyon College in Orange County also has a mobile hands-only C-P-R kiosk now through September, sponsored by Edwards Lifesciences.

Steven Munatones, an Orange County business owner, said he survived what's known as a "widowmaker" heart attack which led to cardiac arrest nine years ago, thanks to his 17-year-old son, who gave him immediate CPR with instructions from a 911 operator.

"You don't have to put your mouth to anybody's mouth," Munatones explained. "You just put your hand on their chest and pump. He saved me, and others can do the same, anywhere. So, it's absolutely a lifesaving, heroic act that anybody can do."

Statistics show 350,000 Americans suffer from cardiac arrest outside a hospital each year and about 90% die, in part because they do not receive CPR. About 70% of those cardiac arrests happen at home, so people often depend on family or friends to give CPR before an ambulance arrives.