SACRAMENTO, Calif. - When you go to an emergency room, you often don't have a say in choosing the hospital - and sometimes, patients get slapped with huge "surprise" bills if it is out-of-network with their insurance provider. On Tuesday, the state Assembly Committee on Health passed legislation to change that.

Assembly Bill 1611 would make sure patients only pay their co-pay and deductible, even at an out-of-network facility, and would cap the amount hospitals can charge on out-of-network bills.

Nicki Pogue, who went to the emergency room at Zuckerberg San Francisco General Hospital with bronchitis and came out with a massive bill, sees the practice of so-called "balance billing" as unconscionable.

"When you are suffering from life-threatening symptoms, the last thing you should be thinking about is whether or not your hospital is considered in-network," said Pogue, who gave input for the legislation. "To receive a bill for $13,000 - that I was responsible for $10,000 of - was stunning."

Hospital networks have said the changes outlined in AB 1611 would be a major blow to their finances. Last week, under pressure, Zuckerberg SF General discontinued the practice of balance billing for its insured patients.

After five months of fighting, Pogue's insurance company paid her bill. However, she said, many other patients face financial ruin for something they couldn't control. Pogue said she hopes changing the law would spur insurance companies and hospitals to negotiate lower rates.

"It gives room for the insurance companies and the hospitals to meet somewhere in the middle, and to cut the patient out of it," she said. "I mean, that's the problem, right now - the patient is in the middle, and if you don't have the resources to fight it, you get left holding the bill."

AB 1611 now goes to the Appropriations Committee.

The text of AB 1611 is online at leginfo.legislature.ca.gov.


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In the first experiment of its kind, Purdue University researchers treated canines diagnosed with cancer using chemotherapy to see if their response could lead to future treatment for human cancer patients.

Chemoresistance, a patient's adverse reaction to chemotherapy, can lessen remission and survival time.

Michael Childress, professor of comparative oncology in the College of Veterinary Medicine at Purdue University, said the dogs were chosen because they had diffuse large B-cell lymphoma. The condition mimics the cancer phenotypes or traits that would be needed when treating human cancer patients.

"Every dog's cancer is a little bit different from every other," Childress explained. "That's what makes dogs an especially valuable research model when you're trying to develop a technology that predicts which individual's cancers are going to respond to chemotherapy and which are not."

Armed with more information on a patient's reaction to certain medications, researchers can better customize a patient's wellness plan. The Indiana Cancer Consortium reported many cancers can be prevented through lifestyle changes such as diet, eliminating tobacco use, regular physical activity and avoiding excessive sun.

Another method of cancer treatment used to measure chemoresistance is Doppler ultrasound, or biodynamic imaging.

David Nolte, professor of physics and astronomy at Purdue, said light is scattered through pieces of biopsied tissue, to match with the light image's reflection pattern to see how patients respond to chemotherapy. He hopes other oncologists see Purdue's findings as useful.

"We work with doctors, but the doctors are not making any decisions based on our technique yet," Nolte noted. "We have a collaborator down at IU School of Medicine, looking at esophageal cancer in human patients. But we are not currently influencing how the doctors make their decisions."

Nolte pointed out a clinical trial is also needed. Then, the Purdue team would start to inform doctors of the trial's results. The cancer consortium reports surgery, chemotherapy, hormone therapy, immunotherapy and radiation are the top methods used for cancer treatments.

Amid ongoing concerns about reproductive access in the Magnolia State, a Jackson-based organization is offering financial help and other support services to women seeking abortions and other resources. More than 23 million women in the U.S. live in states with abortion restrictions, raising concerns about reproductive rights.

Laurie Bertram Roberts, executive director and co-founder of the Mississippi Reproductive Freedom Fund, said they assist Mississippi women travel out of state to either Illinois, New York or Orlando, Florida, to access abortion care since it is illegal in Mississippi.

"We can help them with travel costs, with helping pay for their procedure. We can give them a mobile abortion doula support person that they can have by default by phone through the process. Just letting folks know that they still can have an abortion outside of Mississippi," she explained.

She said they are no longer able to provide monthly birth-control pills because of a lack of funding. In the meantime, the Mississippi House passed HB 1725. It would provide access to health care via a Medicaid expansion bill for pregnant mothers that are facing a financial hardship. The bill now awaits a vote by the state Senate and approval by Governor Tate Reeves.

Bertram-Roberts said the demographics of women requiring their organization's assistance with reproductive health have grown and changed as a result of the Mississippi abortion ban, and added that they have also had an increase in women needing access to emergency contraception.

"I feel like a lot of people didn't understand how the morning-after pill works for a long time, but now because people who are hyper aware of not wanting to be pregnant. Our demand on how people picking up Plan B has really picked up. We give away about 8,000 units a year if we have them in stock," she continued.

Bertram-Roberts pointed out that they also provide women with diapers, menstrual-cycle products, food from their pantry, library resources, condoms and pregnancy tests. Mississippi legislators in the state House have proposed eight bills this year to either tighten abortion laws or repeal abortion restrictions.

Tennessee healthcare advocates and leaders are headed to the State Capitol on Wednesday to voice their concerns over issues that affect patients' access to care.

The Tennessee Primary Care Association and its member health centers want lawmakers to address funding for these clinics, and their ability to use federal programs, like "340-B", which allows drug companies to give discounts to health centers on medications for low-income patients.

Association Chief Executive Officer Libby Thurman said Community Health Centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay.

"All community health centers provide primary medical care services. Often that is inclusive of labs, wraparound services such as care coordination. As needed by their community -- and as they have the funds and capacity -- they also add services like behavioral health care, substance abuse treatment services, onsite pharmacy services," she explained.

An estimated 7.7% of Tennesseeans are uninsured. Thurman pointed out that Community Health Centers offer care not only to that population, but also to people with commercial insurance and Medicare.

Thurman is focused on narrowing the gap in health disparities at Community Health Centers across the state. She added health outcomes overall are often worse in the Southeastern United States compared to other regions of the country.

"We are really engaged on helping health centers track those metrics, and helping them implement programs and services that can improve those conditions in their patients," she continued. "So, everything we do is focused on, again, access and then making sure people are getting not only health care, but that their actual health is improving."

She noted Community Health Centers are in need of adequate funding to deliver these services, and it's been a struggle to plan ahead, since federal funding from Congress is currently up for reauthorization.