Legislators Can Request Health Insurance Mandate Analysis Via New State Law
By Phil West and Amy Lynn Sorrel

With a strong focus on curbing health care costs, Texas lawmakers during the 2025 legislative session passed a new law enabling legislators to request an analysis of any proposed legislation imposing requirements on health plans that mandate coverage for a particular health care service, require payment increases or decreases for a health care service, or introduce a new contractual or administrative obligation (e.g., gold carding).  

The Texas Medical Association had an equally keen focus on guarding against provisions that might undercut physician or patient protections in the name of cutting costs. 

House Bill 138 calls for a new Health Impact, Cost, and Coverage Analysis Program (HICCAP) to be established within the Center for Health Care Data at the University of Texas Health Science Center at Houston (UTHealth Houston) by Jan. 1, 2026. In conducting its analysis of proposed health insurance legislation, HICCAP would use information from the statewide All-Payor Claims Database (APCD), as well as scientific or peer-reviewed academic literature. Also housed at UTHealth Houston, APCD collects and analyzes medical, dental, and pharmacy claims data from public and private health insurers to inform quality and cost transparency.  

TMA initially opposed HB 138, a multisession effort that had medicine concerned the HICCAP program could be captured or weaponized by insurance companies, creating barriers to insurance reform. After defeating past versions of the bill that heavily favored insurance companies, TMA worked with legislators this session to add data transparency provisions to promote a comprehensive and unbiased analysis.  

For instance, TMA pushed to ensure a HICCAP report considers whether proposed legislation might decrease the total cost of health coverage in Texas (e.g., a mandate for a preventive care service that catches a condition or illness before a more expensive service or treatment plan is necessary), whereas earlier versions focused just on cost increases. TMA also succeeded in ensuring HB 138 incorporates “scientific or peer-reviewed academic literature” in its reports in addition to information from APCD, whereas earlier versions of the bill would have allowed for analyses based on information supplied solely by insurance companies themselves, permitting payers to self-select data and submit their own expected cost of compliance. 

“What we were really concerned about [previously] was all of the information was coming unilaterally from the insurance companies,” said Zeke Silva, MD, chair of TMA’s Council on Legislation. “If you’re going to look at a coverage mandate, and you want to look at different coverage policies, [in earlier bill versions] there was really no other source of data other than what the insurance companies have from their billing system.”  

HB 138 also requires HICCAP to prepare a written report of its analysis on a proposed law within 60 days of a legislator’s request outside of session, and within 30 days during a regular legislative session. HICCAP also must deliver the report to the lieutenant governor, speaker of the Texas House of Representatives, and appropriate committees in each chamber, as well as make the report available on a generally accessible website.  

Concerned report requests could be used to stall insurance reform bills, TMA successfully advocated for the shortened “during session” report timeline in the final version of the bill that became law.  

With price transparency another ongoing priority for the legislature, lawmakers also passed a handful of related bills that place new guardrails on how facilities can bill patients for services, including facilities that are physician-owned, like hospitals and ambulatory surgery centers (ASCs). 

• Building on a 2023 law calling for facilities to itemize billing when attempting to collect payment for services rendered, House Bill 216 specifies the biller can issue an itemized bill either as a hard copy in person at the facility; via mail to the patient or the patient’s designee; or electronically, including through a patient portal should the patient have an active profile.  

• House Bill 1314 shortens the timeline for facilities providing service cost estimates to patients from 10 to five business days after the patient’s request and spells out the process by which a patient can dispute final bill charges that are $400 or more than the estimated cost. TMA staff note the initial version of HB 1314 was more restrictive in proposing facilities couldn’t charge a patient more than 5% above its written estimate and needed to generate a good faith estimate within 24 hours. 

• House Bill 1612 requires hospitals to accept full payment for health care services directly from patients not enrolled in health plans, authorizing the hospital to adjust patient charges by no more than 25% greater than the amount generally billed for the service, or no more than 50% greater than the lowest contracted rate the hospital accepted from a health plan (other than the Children’s Health Insurance Program, Medicare, Medicaid, or Medicaid managed care). HB 1612, though hospital-specific, is similar to a 2023 bill that TMA opposed because it would have applied to physicians. 

• Senate Bill 331 adds facilities such as ASCs, freestanding emergency medical care facilities, and limited services rural hospitals, among others, to existing legislation requiring price transparency via machine-readable files maintained on the facilities’ websites. It also amends the law so it only applies to applicable facilities with a gross revenue of at least $10 million and increases the administrative penalties for facilities in violation. TMA was able to work with legislators to ensure physician offices were omitted from SB 331, though TMA remains concerned about the administrative burden for facilities resulting from its passage. 

“Any time we can exempt physicians from these kinds of bills, we try to do so, just to minimize burden,” Dr. Silva said of TMA’s efforts this session.  

Read Texas Medicine Today’s continuing coverage of state legislation impacting medicine.