Insurance Bill Undermining Patient, Physician Protections Heads to House
By Amy Lynn Sorrel

An insurance bill headed for a House vote aims to create a new kind of health insurance plan that medicine is concerned could undermine decades of advocacy and bypass key state-mandated patient and physician protections.  

The latest version of House Bill 139 is a top target for TMA, with more than 30 state and national medical, pharmacy, and patient advocacy organizations joining medicine in opposition to the bill.  

Take action now by contacting your district’s representative to vote no on HB 139 with a ready-made message from TMA.  

“We believe this legislation will take Texas in the wrong direction by undermining long-standing patient and provider protections, removing oversight and accountability from the insurance market, and exposing working Texans to hidden costs and harmful coverage gaps,” said Zeke Silva, MD, chair of TMA’s Council on Legislation, testifying against the original version of the bill on March 26.  

Set to debut before the House as soon as May 12, HB 139 would exempt the so-called “employer choice of benefits” (ECOB) plans from:  

• Providing a minimum set of state-mandated benefits and following state network adequacy requirements;  
• State utilization review laws and the 2021 gold-carding prior authorization law; and 
• State prompt-pay laws.

Skirting 2009 protections TMA was instrumental in securing, the bill also permits ranking and tiering physicians without transparency regarding how those ratings are made. It also would allow ECOB plans to steer patients to health care entities of their choosing, including ones plans are affiliated with. 

Nor does the bill guarantee lower premiums. 

Rather than adding a meaningful health care coverage option to the market, TMA has expressed concerns to lawmakers that HB 139 only adds uncertainty, administrative complexity, and costs for physicians, patients, and employers, which can harm access to care.  

“It only guarantees fewer rules for insurers,” Dr. Silva said in his testimony. “Texas lawmakers have spent years working thoughtfully to build a framework that balances innovation with accountability. Removing these safeguards benefits insurance companies – not Texans.” 

Stopping more bad bills 

As lawmakers seek other ways to address the health care market, TMA also registered opposition to another pair of bills – one of which, House Bill 4012, died on the way to the House thanks in part to medicine's advocacy. Despite the fact Texas already has enforcement mechanisms in place against bad actors in insurance claims disputes, HB 4012 would have created new criminal and civil penalties, a private cause of action, and a bounty hunter law against physicians.

TMA, along with the Texas Hospital Association and specialty groups, expressed major concerns to lawmakers the bill would empower health plans in what often amount to good-faith billing disagreements or documentation discrepancies related to commercial insurance claims. Nor did HB 4012 include any of the safe harbors in existing state laws that guard against abuse, like clinical due process and insurer transparency on how these investigations would be conducted.  

Meanwhile, TMA so far has helped prevent a bill targeting health care consolidation, House Bill 4408, from advancing out of committee as it would impose onerous administrative burdens on small physician practices. The deadline to hear bills in the House is May 15 if they are to advance any further. 

HB 4408 would require practice groups of four or more physicians – alongside large facilities, hospitals, systems, and carriers – to report extensive data on ownership, revenue, staffing, and even affiliated clinicians. That requirement would apply on both an annual basis and following any so-called “material change transaction,” a category that includes routine contract updates, management agreements, and lease modifications.  

The reports must be submitted to the secretary of state and, in some cases, shared with the attorney general, “without clear procedural safeguards,” Dr. Silva said in testimony against HB 4408. Violators could face civil fines of up to $10,000. 

“TMA has long supported responsible antitrust enforcement, including increased scrutiny of vertical integration between insurers and health systems,” Dr. Silva said. “However, HB 4408 does not apply equally to all actors in the health care market. Physician practices – already the least consolidated and most patient-focused segment – should not be the primary target of this legislation.” 

Check out TMA’s state advocacy page for the latest on the 2025 session as it winds down to its conclusion June 2.