The House Committee on Insurance met on March 17 to take up a number of bills. In order, this report focuses on bills HB 316 (Buckley), HB 928 (Sherman, Sr.), HB 1164 (Oliverson et al.), and HB 1490 (Dean). In addition, House members voted to pass several bills from previous agendas.
This report is intended to give you an overview and highlight of the discussions on the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.
Votes
- HB 119 (Landgraf) passed 8-0
- CSHB 652 (Dean) passed 8-0
- CSHB 797 (Howard) passed 8-0
- CSHB 780 (Oliverson) passed 9-0
Bills on Agenda
HB 1490 (Dean) Relating to the notice of the cash price of certain health care services by certain hospitals.
- Asks hospitals to provide pricing information on website and upon request; already in federal rule but wants Texas to have it in law for security
- Does not tell patients what they owe after insurance
Cameron Duncan, Texas Hospital Association – Neutral
- Texas hospitals committed to giving patients all the information needed to make decisions
- Since 2007 been required to provide estimates to patients
- Jan 1 Federal laws required hospitals to post this kind of info or provide real time price estimator
- Main concern is that hospitals do not always have set price for services; do not want to require hospitals to post information that they do not have
- EMTALA concern; not able to talk about price until medical emergency is dealt with
- Concern about price list: thousands of lines of data
- Want to ensure federal and state requirements are lock step
- Oliverson – if a hospital doesn’t offer a cash price discount, I still feel that is useful information. If it’s a shoppable service, is it not reasonable to require hospital to disclose there isn’t a posted price?
- I think it is reasonable to post that or cash discounts, just might not be able to do that with every service.
- Oliverson – The question is what can we do as stakeholders to be as good spirited about cooperating with this as possible?
- We just want to align state and federal so that they are cohesive, not against this
- Oliverson – Can you elaborate on EMTALA? You said it prohibits you from providing cash price?
- If a patient comes to the emergency department, they must be screened and stabilized before they can discuss financials.
- Oliverson – But EMTALA is not a reason that prices can’t be posted on the internet?
- Absolutely; Only applicable in emergency room, don’t want to dissuade someone from receiving emergency care
- Collier – Do you think people will not go to the hospital if they can see cash prices listed?
- No that’s not the issue, just concerned about violating the law in emergency situations
- Collier – I don’t see that as an issue/reason to not provide information online
- The online aspect not an issue, concerned about physical handing of a list to patients and ensuring it is after stabilization
- Collier – this bill does not prohibit a hospital from offering benefits, correct?
- Yes that’s right, just not all hospitals have set discounts for charity care, some have a range
- Collier – what do you mean when you say range?
- It could be variable; potentially a 40-60% discount based on income and other factors
- Collier – I think that there is a way to word that
- I’m happy to work on that
Rep. Dean – Closing
- Posting website price is already a federal law
HB 1490 left pending
HB 928 (Sherman) Relating to the marketing and sale of catfish and similar fish by food service establishments; providing administrative and civil penalties.
- Several written testimonies to share
- Prohibits mislabeling of swai fish as catfish with a penalty when mislabeling occurs
- Swai fish sold under the identity of over 19 different fish; cheaper, swai fish farms have multiple environmental concerns and fail to meet requirements of food safety standards
- Oliverson – so we are talking about swai fish which is also called Vietnamese catfish?
- Yes
- Guerra – When I order fish on a menu, do you know on your research whether there are any requirements that what’s on the menu is actually what’s being sold?
- I do not know about the practices of food labeling other than focusing on swai Fish
- Can tell you it is used to advertise up to 19 different fish, catfish most popular
- Has been written about with disdain from local publications in my district
Stephen Paul, DSHS – Resource
-  Zwiener – want to follow up on Guerra’s question, are there any other fish mislabeled that you enforce?
- Food for human consumption is required to be properly labeled through Texas Food Establishment, just broad
HB 928 left pending
HB 1164 (Oliverson et al.) Relating to the designation of centers of excellence for the management and treatment of placenta accreta spectrum disorder.
- Could have the immediate effect of lowering maternal mortality
- Targets medical condition where the placenta has difficulty separating for the uterus, has 2-4% mortality rate in the state of Texas
- Any hospital could apply for and obtain center of excellence status; would not be a barrier to entry, just an extra step for preparedness
- Shared experience in treating patients with placenta accreta spectrum disorder
- Guerra – Did your past patient make it?
- Yes, long process but she was just fine
- Collier – Are women of color disproportionately affected with this?
- Not aware if there’s a racial disparity for the condition itself but could be socioeconomic factors resulting in disproportionate impact
Christina Reed, Baylor College of Medicine, Texas Children’s Hospital – For
- Women’s health nurse practitioner; Shares personal story of her experience with placenta accreta spectrum disorder and not being taken seriously by many doctors and nurses
- After visiting with an experienced team, put on bed rest in hospital
- This bill can help women regardless of race/zip code/status
Steve Wohleb, Texas Hospital Association – Against
- Placenta accreta spectrum disorder is extremely serious, not against the overarching goal of the bill but the method
- Many physicians in Texas equipped to treat this, existing framework is adequate and represents the gold standard
- Regional perinatal system has been established with hospital levels of care; levels range from 1-4, currently 21 level four hospitals equipped to deal with this
- Instead of creating centers of excellence, we should continue relying on the perinatal council and cover a wide range of conditions rather than just one
- Collier – are you aware of maternal mortality rates and where Texas stands in the nation?
- Not aware of the specific statistics
- Collier – in 2018, Texas rated 43rd out of 50. We do not want that number, if this is a measure we can take to reach better outcomes for Texans then we need to do this. Is your option because of the cost? Do you not want to be recognized as a center of excellence?
- No, we simply believe the perinatal advisory council is capable of implementing criteria and would be the mechanism to pursue improvements
- Collier – well if they could have done it, they would have. There is a greater need, especially in rural communities, where this could open up access to telemedicine and other resources.
- Guerra – Echoing Rep. Collier, what you’re doing isn’t working. I don’t understand your position on this serious issue. Do you have any suggestions or recommendations beyond what Oliverson has presented?
- I think this bill could be the spark to make the perinatal advisory committee take a stand on this issue
- Guerra – this bill is the catalyst to wanting to do something about this when we have known about these large number of deaths occurring, I don’t understand your comment.
- I do think there is great work in the 21 level four facilities, my comment is that this could be a catalyst, even though we are doing great work we could be doing more.
- Guerra – I appreciate your comment that there is good work being done, but it just isn’t good enough
Michael Belfort, Baylor College of medicine – For
- Absolutely there is a health disparity when it comes to race; at our hospital we were able to target the disparity, it is possible
- Last 8 years there have been 274 placenta accreta spectrum cases; there is need for this, we are not doing enough and current system is not working
- Provides additional explanation of what the condition is/symptoms
- Most experienced private practitioners lack the team to deal with this issue adequately
- This is the most life-threatening thing in obstetrics; people need to be involved and work together to be able to do this surgery
- Coleman – Federal gov’t is about to send us money to do the things you’re talking about, I think it’s important to reestablish this office with the funds that existed in 2017. Need to identify what’s important and spend the money through treatment modalities
- Oliverson – you are one of the world’s leading experts in treating this condition, in your expert opinion, are current conditions adequate to treat this?
- No, they aren’t. With respect to the level four teams doing work, they are lacking the full team; doesn’t designate team training or a 24-hour call system
- We know how to deal with this because we have done the surgery multiple times
- Oliverson – Just to clarify, if the bladder and ureters are lost in this procedure can you explain what life is like going forward?
- Not only has she lost her fertility, she has lost her external urinary tract; you don’t see that in the mortality numbers
- Oliverson – hear that it is impossible to diagnose these people early in pregnancy, can you discuss that?
- We can diagnose this in the second trimester
- Can train people in all hospitals to know that a previous C-Section plus a placenta previa need to be referred to an experienced doctor; this can even be done through video call
- Coleman – I come to this because I know there is a disparity. There are people who don’t have access to this care, there is an implicit bias
- No question, we are doing everything possible to change that. This bill is doing that
- Coleman – so that’s the whole point; prevent, intervene, treat, and cure
- Outcome’s reporting must be better; need to know what is going on
- Quality assessment performance committees can also specifically address this and work on community outreach
Jorie Klein, DSHS – Resource
- Collier – Question about fiscal note; when we did designation for nurses did you have a fiscal note for that?
- Yes, brought 2 additional staff members in from neonatal
- Oliverson – feel like this is a small price to pay to save women’s lives. Will be filing rider.
HB 1164 left pending without objection.
HB 316 (Buckley) Relating to the advertising and labeling of certain meat food products.
- Have found a way to use protein to create a product that will look like meat; thinks these technologies are brilliant but we need to have clear and accurate labeling
- Obligation to public health is that the consumer knows what they are putting in their body
- Today, plant-based protein with certain nutrients and yeast create qualities and taste consistent with meat
- Need to have clear and accurate terminology so consumers know what they are purchasing
- Invitro meat; can take muscle cell to create myofiber, little control over what those cells do, often go through cyto dysregulation
- Need to ensure that consumer’s have these products clearly pointed out; 316 provides definition of meat as “any edible portion of a livestock carcass that does not contain lab cultured, cell grown, insect, or plant-based food products”
- Must be guardrails in place so that consumers do not become secondary concern to new technology
- Klick – do you have any concerns with some of these products as far as allergies?
- Yes, it’s about setting standards for clarity so people know what they are eating
Dustin Dean, Cattle Producer and Beef Scientist, TSCRA – For
- Market our beef across the state and have our own USDA cattle slaughterhouse and process cattle down to retail; deal with state regulations and labeling on a daily basis
- Not against competition with new beef-like products, just concerned that consumers are protected and understand the difference
- Explanation of use of cell cultures or plant-based synthetics to create “beef-like” products
- Transparent about all facets of our operation; don’t mislabel anything for sale or to intentionally mislead public, which would violate USDA protocol
- Mislabeling has nothing to do with free speech, has to do with truthful labels
- Price – Texas proud of being the beef capital of the country/world. Heart and soul of our economy and I appreciate the job you do. Talked in another committee of the residual effect, which effects consumers. Are you concerned about the prospect of some meat labeled products causing issues that will affect your ability to sell meat products?
- USDA and state either consider labels to be generic or make a claim
- Takes a long time for me to produce what I produce, any allergy situations will affect my product and ability to sell
Brett Christoffel, All Y’alls Food – Against
- Not uncommon to be allergic to plant-based foods
- Plant based foods are not mislabeled or confusing, no need for unnecessary restrictions on businesses trying to compete in the industry
- Label using words that people can understand, while keeping it clear in all marketing materials that products are plant based
- HB 316 is an attack on all producers in the food industry
Dan Colegrove, Plant Based Foods Association – Against
- Point of view similar to Christoffel testimony; our companies are in favor of appropriate labeling that provides clarity, flexibility and trust
- Think that there is room in the marketplace for everyone, no need for government intervention
- Do not believe there is any consumer confusion
- Guerra – I don’t understand your testimony. Proposed bill is full disclosure, is trustworthy, and provides more clarity for Texans. You say you want the same thing, where is the dividing line?
- We think we are already doing that, clearly label that it is from plants and not animals
- Guerra – do you have objection to the public having more clarity?
- We think that this bill would limit our ability to describe our product to customers
- Guerra – proposed bill does provide for more disclosure and trust, so I do not understand where you’re coming from other than you just don’t like it.
- Smith – did you happen to bring any of these labels with you today?
- I did not.
- Smith – Do these labels provide terms that would normally be associated with meat? Do they say meat?
- Not at all really, they may say “plant-based burger” or “veggie” or something of that nature
- Smith – Do they stay steak? There is nothing preventing them from doing that?
- I don’t know of anyone saying steak, no
- Smith – When I see “burger” I think beef, would you agree with that?
- Will respect no, I don’t think there is any confusion when it comes to these products right now
- Smith – Technology is growing, we need to inform the public of what they are putting in their bodies.
Rhonda Miller, American Meat Science Association – For
- AMSA is non-profit scientific organization that generates and disseminates information to make recommendations for producers, consumers, and regulatory entities
- This bill provides direction that align with science and federal recommendations
- Plant based products defined as “meat analogs” produced to mimic animal products harvested for human consumption
- There are FSIS regulations on labeling that provide standards of identity so that beef and meat products that do not contain non-meat ingredients cannot be called meat
- Biggest issue discussed is consumer acceptance; while we don’t fully understand it surveys indicate consumers are more enthusiastic about products with more clarity
- This bill will protect and educate consumers; in-step with the meat science community
- Price – stood out to me that familiarity is important to new products, like plant-based and cell derived, and if consumers want truth in labeling, do you see that as an incentive to use commonplace terms? In your professional judgement is there confusion out there?
- Do not support using terms like “bacon,” “bacon flavored” is a different word
- Appreciate companies trying to provide products that taste like meat to those who can’t eat regular meat
- Deal with people who are beef eaters, most people understand what the products are
- Curious food eaters might purchase the product but they want to know what they’re purchasing; believe plant based is niche market and will not replace major meat producers
Oscar Rodriguez, Texas Association of Broadcasters – Against
- Radio/TV stations are at the center of media marketplace and advertising
- Sustain daily news coverage with money from advertising; new products and services are important to local media marketplaces
- Think this bill will negatively affect advertising and keep a new consumer product out of the marketplace; the more creative hurdles there are the harder it is to craft ads
Brandi Richards, Texas Cattle Feeders Association – For
- Produce meat for 440,000 Texans
- Beef provides essential nutrients that are critical to mental and physical health, especially for adolescents
- Expect labels to be clear and truthful; there is unnecessary confusion that benefits no one
Shalene McNeill, Nutrition Scientist and Dietician – For
- Frustration and confusion starts with food labels; sacred for consumers to make their decisions
- Meat is most important to know what you are eating truthfully and accurately
- Products that aren’t healthier when they are marketing that way are connected to poor health in the US and increase in skepticism; plant-based higher in sodium and fat than real meat
- Texans must be able to know that what they put in the body is truthful with what is on the package
- Price – as a dietician, you are saying there could be aspects of plant-based products that are not as healthy as some believe them to be? Is there research around that?
- Looking at the effects of ultra-processed foods vs. Whole foods, concerns that our body can’t process them
- Work looking at metabolic signatures of these products
Jessica O’Connell, Beyond Meat – Against
- Shares copy of Beyond Meat label
- Beyond Meat doesn’t want anyone who is looking for animal meat, marketing campaign is very clear and there to attract consumers who want plant-based food
- Concerned about features of the bill that limit use of terms like meat or beef; overly restrictive and raises first amendment concerns
- Concerned that plant-based products are regulated by different entities; subject to requirements of FDA already, regulations federally and within TX
Stephen Paul, DSHS – Resource
- Price – could you talk about regulatory authority over meat and poultry products? Would clarification be helpful?
- Oversee state inspected plants and meat sold in commerce
- As a regulator anything that could add clarity is beneficial
- Price – have you received any comments or concerns regarding labeling?
- We have, few and far between but there have been a few
HB 316 left pending