H.R. 1304 and the Texas Law - They're Not the Same; They're Not Even Close
The State of Texas last year passed a bill that would permit doctors to bargain collectively with health plans. Many people mistakenly believe that H.R. 1304 is similar to the Texas law. Nothing could be further from the truth. Here are some of the salient differences:
How many providers can be represented by the negotiator?
Texas Law: 10% of physicians in a health plan's service area, except if State Attorney General sets higher or lower figure.
H.R. 1304: No limitation on number of physicians or on the service area (a cartel representing every doctor in the country would be permitted).
What terms can be collectively negotiated?
Texas Law: 16 enumerated "non-fee related" subjects, unless the State AG has found that health plan has substantial market power and terms that would otherwise threaten quality and access.
H.R. 1304: No limitation on what can be discussed - including fees - regardless of whether a health plan has substantial market power.
Who must approve the results of the negotiation?
Texas Law: State Attorney General.
H.R. 1304: No one.
Can providers negotiate fee-related terms with Medicaid plans?
Texas Law: No.
H.R. 1304: Yes. The bill as reported by the Judiciary Committee prohibits negotiations over benefits, not over fees.