AUSTIN (Nexstar) — Gov. Greg Abbott on Thursday projected confidence that his push for education savings accounts will pass the Texas legislature, following months of intractable disagreements between the Governor and some reluctant lawmakers in his own party.

“As we begin this final push, we are on the one-yard line, a good place to be,” Abbott said at an event arranged by the conservative think tank Texas Public Policy Foundation. “I am committed. However long it takes, that race is going to continue. I will not stop until we get ESAs passed in the state of Texas.”

Unstoppable force, meet immoveable object.

“Nothing changes,” State Rep. Drew Darby, R-San Angelo, told Nexstar on Wednesday. “Now’s not the time for timidity…Now I think we need to make sure all our positions are known and then stand by our position and never retreat. If I’m here in November, December, January, February, March, I’ll be here. This is one of those things that I feel passionate about. And we’re not just going to shrink from the responsibility.”

Darby is one of about two dozen rural Republicans who have so-far blocked Abbott’s plan from passing the House. He said he will not be convinced until a plan includes more funding for public education and guardrails that ensure accountability for private schools that accept state money.

“I’m not even going to consider it until we properly fund the education. And then even if we do fund education, and we fund the subgroups, special needs kids, that sort of thing, then I’m just not going to turn the money loose. I’m gonna want accountability,” Darby said.

Abbott signaled to lawmakers, however, that he is demanding those items in reverse order.

“I want to make sure that we provide a carrot to make sure this legislation gets passed. The legislature has already set aside $4 billion to add to more funding for public education in the state of Texas. But I wrote the agenda for the special session, as only addressing ESAs,” Abbott said. “Once ESAs are passed, I will put on the legislative call for full funding for public education, including teacher pay raises for teachers across the state of Texas.”

Just after the clock passed midnight on Thursday, the Texas Senate passed their $500 million plan for education savings accounts, offering $8,000 to eligible families for each child taken out of public school. The House has far more opposition to court, however, and is moving much slower on this issue. Their version of an ESA bill has not yet been deliberated publicly.

Opponents have expressed concern that creating such a program will take away funding from public schools, which are accountable to the legislature. The bill’s author, Sen. Brandon Creighton, R-Conroe, said he believes that the packages would work in tandem, not against one another.

Full interview with State Sen. Brandon Creighton

“There can be harmony between lifting up our public schools like never before, our public school teachers like never before,” he said. “And also making sure that moms and dads across this state, if they don’t find what they need and they need other options, that they have a chance to apply to a program that will give them those options.”

Both chambers are back in session on Monday. The governor has promised to call the legislature back into session if they cannot come to a compromise and deliver an ESA program this month.

Call to return campaign donations fuels feud between Patrick and Phelan

Tensions between two of the state’s top leaders hit a new high this week, after Texas House Speaker Dade Phelan called on Lieutenant Governor Dan Patrick to give back donations from a powerful political group.

The tension started after The Texas Tribune reported leaders of the Defend Texas Liberty PAC met last weekend with white supremacist Nick Fuentes. He’s a far-right commentator who has praised Adolph Hitler and denies the Holocaust happened.

Defend Texas Liberty issued a statement condemning Fuentes’s views. But news of the meeting led Phelan to call on Republicans who took donations from Defend Texas Liberty to return the money.

Patrick accepted a $3-million dollar donation from the PAC earlier this summer.

“It should not be that difficult to disavow yourself from this political action committee. It should be so easy to send that money back or give it to a charity and say I don’t have anything to do with this,” Phelan said in an interview with reporter Phil Prazan of NBC 5 in Dallas.

On Monday, Patrick condemned news of the meeting. He released a statement saying “Nick Fuentes and his anti-semitic rhetoric have no place in the United States. Those who spew such vile loathsome abominations will have to answer for it.”

But Patrick also condemned Phelan, writing, “For anyone to try to use these invectives for their own political gain is below contempt.” Patrick also called on Phelan to resign.

Phelan said he’s not going anywhere.

“It’s very easy to say I reject Hitler sympathizers. I reject an individual who denies the Holocaust,” Phelan said. “I’ve yet to see some of these individuals do that. That’s on them. It’s not me. I’ve never taken a dime from these people and I never will.”

Some Republicans did return donations – including State Rep. Jared Patterson of Frisco. Patrick said he decided to keep money he received from the PAC after speaking with billionaire Tim Dunn, who provides much of the funding for Defend Texas Liberty.

In a statement, Patrick said Dunn condemned the meeting with Fuentes and called it a “serious blunder.”

Patrick said Dunn assured him the PAC would not have further contact with Fuentes.

“He stated emphatically that everyone at the PAC understands that mistakes were made and are being corrected,” Patrick wrote in the statement, referencing his conversation with Dunn.

Phelan voiced skepticism, as well as concern that Republicans linked to Defend Texas Liberty could hurt the party.

“Of course, the Lieutenant Governor and others have condemned [Fuentes] and said that what he said is totally incorrect and irresponsible and distanced themselves from him. But that didn’t change the fact that he is now associated with a political action committee that is at the heart and soul of this civil war in the Republican Party,” Phelan said.

“They are funding the type of Republicans that are unacceptable the ballot box, and they keep losing at the ballot box,” he added.

Texas Senate passes ban on COVID-19 vaccine mandates for private employers

At the end of a marathon 15-hour day Thursday, the Texas Senate voted along party lines to approve legislation that bans COVID-19 vaccine mandates for private employers, though the author carved out a slight caveat on how some of the rules will apply to hospitals and health care facilities in the state.

Senate Bill 7, introduced by Sen. Mayes Middleton, R-Galveston, passed on a vote of 19-12 Thursday evening, sending it to the Texas House of Representatives for further consideration. The legislation would bar employers from adopting or enforcing a mandate “requiring an employee, contractor, applicant for employment, or applicant for a contract position to be vaccinated against COVID-19 as a condition of employment or a contract position.”

Patrick released a statement applauding the Senate’s decision.

“The passage of SB 7 will return medical freedom to Texans and ensure that they will not lose their livelihood over their personal health decisions,” Patrick wrote. “The Texas Senate will pass this bill over and over again until it passes the Texas House.”

The Senate’s version of this bill would also prohibit employers from taking an “adverse action” against someone who does not want to get this shot.

Middleton brought forward an amendment Thursday that health care facilities could adopt “reasonable” rules requiring unvaccinated workers to wear certain protective equipment, and that would not be considered an “adverse action” if they did so. He told the chamber he sought to make this change after discussing concerns with medical groups that previously opposed the legislation.

The bill would still allow people to file a complaint at the Texas Workforce Commission to investigate alleged retaliation. However, Sen. Lois Kolkhorst, R-Brenham, added language that the commission would have to reach out to the Texas Department of State Health Services if the complaint focused on an unvaccinated health care worker’s concerns about preventative measures taken by a hospital.

The initial version of the legislation proposed employers could face a fine up to $1,000 for each violation, but the updated language approved Thursday raises that penalty up to $10,000. The commission would also have a mechanism where it can recoup investigative costs from employers if its efforts result in a finding of a violation.

Sen. Borris Miles, D-Houston, introduced another amendment Thursday that would exempt all health care facilities from this legislation. He argued this ban would potentially put employees at risk of infections on the job.

However, that failed — with all 19 Republicans voting against the proposed change and 12 Democrats supporting it.

It remains unclear when the Texas House will take up a similar proposal. Abbott identified expanding the ban on COVID-19 vaccine mandates as one of his four agenda items for this 30-day session.

New medical bill transparency law in effect

Michelle Ledesma breathed a sigh of relief as lawmakers voted to send Senate Bill 490 to Abbott. It was May and she had already been tracking the bill for months during the last regular session.

“I was getting email alerts,” Ledesma said. “I started to follow each stage.”

It was the first time she had followed legislation this closely. Ledesma, who is from Cedar Park, added she realized the impact was wide reaching and not just personal.

Ledesma explained in 2018 she was hospitalized for a severe bacterial infection. She said she had insurance but was billed more than $2,000 out of pocket. Two years after her treatment, she was sued by an area hospital for medical debt. 

“I was sued for a bill that I received from a hospital, and I kept asking for the itemized statement. I never received it,” Ledesma added. “All I wanted was to know what I was being charged for.”

State Rep. Caroline Harris, R-Round, explaining the itemized medical bill legislation on Wednesday, May 10, 2023.(Courtesy: Melva Gomez, Rep. Harris' Chief of Staff)
State Rep. Caroline Harris, R-Round, explaining the itemized medical bill legislation on Wednesday, May 10, 2023.(Courtesy Melva Gomez, Rep. Harris’ Chief of Staff)

Stories like Ledesma’s have been heard by lawmakers who pushed for medical billing transparency.

Effective Sept. 1, hospitals and health care facilities are required to give patients a written itemized bill before sending it to collections or trying to collect any money owed.

The law states the itemized bill has to be in terms the patient understands and include medical codes and prices. The invoice can also be issued electronically through a patient portal.

“My team and I are already kind of getting ready to make sure that those hospitals and medical facilities are in compliance with it,” said State Rep. Caroline Harris, R-Round Rock. “And we’re also ready to just figure out, ‘Hey, if they’re not in compliance, why, you know, how can we help? Is there some issue with the language, you know, to clear up.'”

Harris worked closely with Sen. Bryan Hughes, R-Mineola, to pass the legislation.

“It’s remarkable how much opposition there was to a bill like this. The second session for this bill to go through,” said Hughes on the Senate floor moments before final passage. 

The legislation follows a KXAN investigation into a Central Texas hospital that sued hundreds of patients over unpaid medical bills. Many of those patients told KXAN they received vague bills and couldn’t get an itemized invoice before being served with a lawsuit. 

The Texas Health and Human Services Commission will oversee the rollout of the law and compliance. The agency published a Guidance Letter on Monday which outlines provider responsibilities and expectations. 

people gathered around a table while governor signs bill
Sen. Bryan Hughes, R-Mineola, and Rep. Caroline Harris, R-Round Rock, at the ceremonial signing of their medical billing transparency legislation on June 7, 2023. (Courtesy Melva Gomez, Rep. Harris’ Chief of Staff)

The letter states providers must submit the itemized bill to the patient no later than the 30th day after the provider receives a final payment for the service or supply from a third party. 

“While a patient may request to not receive an itemized bill, the provider must make an itemized bill available if the provider is requesting payment from the patient,” the letter outlined.

It also added that if the provider is not attempting to collect money from the patient, the provider is not required to provide the patient with an itemized bill except as required under any other state or federal law. 

HHSC is also primarily responsible for taking disciplinary action against providers in violation. In an email, a spokesperson explained enforcement could include denying, suspending or revoking a license and administrative penalties ranging from $1,000 to $25,000 for each day in violation depending on provider type. 

“The other piece of this is that the courts can be involved as well,” Harris said. “So, a lot of these cases have gone to court where a hospital has sued somebody for not paying a medical bill. And so those judges and justices have the opportunity to say, ‘OK, well, I know now that the hospital has to provide an itemized bill. Did you do that? You know, where’s the proof of that, so that we can see if this charge is actually accurate or not.'” 

The Texas Hospital Association, which opposed the legislation due to anticipated costs, said in an email it’s been working to make sure hospitals know about the law and has been offering guidance so they’re ready. 

“Hospitals want to provide the best care and the best information possible for patients. Transparency is in everyone’s best interest, and Texas hospitals are fully engaged to ensure their patients have everything they need,” said Carrie Williams with THA.

The legislation only applies to health care facilities and hospitals but does not apply to doctors or federally-qualified health centers.

Providers impacted include abortion facilities, ambulatory surgical centers, birthing centers, chemical dependency treatment facilities, crisis stabilization units, end stage renal disease facilities, freestanding emergency medical care facilities, general hospitals, limited services rural hospitals, private psychiatric hospitals, narcotic treatment programs, special care facilities and special hospitals, according to the Guidance Letter.

“A lot of times with a new law that’s so big like this, there is a little bit of runway where you kind of have to figure out how you help people get into compliance,” Harris said. 

The law is not retroactive, so it doesn’t apply to cases before Sept. 1 like Ledesma’s. However, she thinks the new law’s already having an impact.

“When I have gone to an emergency room or to a recent doctor — different types of procedure — I’ve asked for the itemized statement, and I noticed I’m getting it faster. You know and that’s a good plus for us because we’re able to see it sooner,” Ledesma said. 

Michelle Ledesma was sued for medical debt after being hospitalized in 2018. (KXAN Photo/Arezow Doost)
Michelle Ledesma was sued for medical debt after being hospitalized in 2018. (KXAN Photo/Arezow Doost)

Her case initially resulted in a judgement in her favor but records show lawyers representing the hospital are appealing. 

“A patient shouldn’t have to go through that. You know, they’ve already been — they’ve already gone through a hardship of — of an illness or an injury. They shouldn’t have to go through that all over again two years later to get hit with a lawsuit because an itemized statement wasn’t sent to them,” Ledesma said. 

Harris urges Texans to contact her office if they come across a provider not complying. Complaints can also be filed through HHSC, which is in the process of developing rules to implement the law. 

“If anybody’s not able to get it still, if they’re having difficulty, we need to hear those stories,” Harris said. “So that we can get back to HHSC and say, ‘OK, now we might need to see some sort of disciplinary action, you know. But hopefully we won’t have to see any of that. Hopefully, we’ll see compliance across the board. And, again, we’re prepared to look at that, watch it, make sure that it is doing its job that the law is helping people like we wanted it to.”