TMA Legislative News Hotline: Thursday, April 16, 2015


TMA’s bill to make it easier for physicians to identify patients who are receiving subsidies for coverage under Affordable Care Act (ACA) exchange plans won unanimous approval from the House Insurance Committee Wednesday. House Bill 1514 by Rep. J.D. Sheffield, DO (R-Gatesville), would require issuers of ACA exchange plans (qualified health plans) in Texas to display “QHP” on the plan ID card, and display “QHP-S” on the card if the person covered is receiving a subsidy. The ACA gives patients who receive a federal subsidy in exchange plans three months (the “90-day grace period”) to pay their premiums if the patient has paid at least one full month’s premium during the benefit year. For the first 30 days, insurers must pay claims and accept the subsidy as payment of the premium in full. If the patient still does not pay the premium during the grace period, the insurer may recover any payments made to the practice for services provided during months two and three. The patient must then pay for all past services out of his or her own pocket. The ability to identify easily patients with subsidized premiums will allow office staff to counsel patients on the importance of continuing to pay their premiums. This will further emphasize the patients’ personal responsibility and ensure their health care services continue to be covered — especially if any proposed treatment spans several months or occurs even in the next month.

Also on Wednesday, the House of Representatives unanimously approved House Bill 1945 by Rep. Greg Bonnen, MD (R-Friendswood.) The bill would streamline the process by which patients can contract for medical services directly with primary care physicians outside of insurance coverage.


The physician of the day at the Capitol is John E. Green III, MD, of San Antonio. Dr. Green graduated from The University of Texas Health Science Center at Houston. He is a member of TMA and the Bexar County Medical Society.


TMA's Texas Legislature main page

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