Senate advances bill to let insured patients seek non-panel care; moves SB34 to third reading

The Utah Senate voted 22–7 on Feb. 7, 2005 to advance second substitute Senate Bill 34 to third reading, clearing the way for a later floor vote on a measure that would let insured patients seek care from non-panel providers and require insurers to pay non-panel providers 95% of the panel rate while disallowing balance billing.

Sen. Butters, the bill sponsor, framed the proposal as an access measure, recounting a constituent’s experience that he said showed how panel restrictions can delay diagnosis and care. “When you have the facts, you argue the facts,” Butters told colleagues, “And when you don't, you argue fear and confusion.” He said he pared the bill’s earlier market-share and program provisions to focus narrowly on patient access and that he had consulted physicians who indicated a 90–95% payment level would be necessary to attract non-panel providers.

Opponents and cautious supporters expressed several concerns. Sen. Hatch urged restraint and invoked the medical axiom “first do no harm,” warning the measure could disrupt Utah’s integrated provider system and have unintended cost consequences. Sen. McCoy, who said his practice has represented IHC on antitrust issues, warned that the bill risks antitrust and market-structure problems if smaller HMOs exit the market. Sen. Bell argued the question raised antitrust issues that might be better handled by legal authorities rather than a statutory change.

Supporters including Sen. Stevenson said the bill contains checks intended to limit costs: “The bill before us provides only 95% payment to the non panel providers, and it disallows any balance billing,” he said, adding that employers retain options to control exposure by selecting different plan designs. Several rural senators argued the proposal would improve access where any-willing-provider arrangements are already closer to practice and where Medicaid accounts for a large share of billing.

The bill as debated excludes Medicaid and CHIP from its immediate scope; the sponsor and others repeatedly said including Medicaid/CHIP would create a large fiscal note and leave the bill vulnerable. Proponents said the measure is a step that could be expanded later if it does not produce an adverse fiscal impact.

The Senate’s procedural roll call to read the bill for a third time passed 22–7; the measure will return later for a full third-reading vote. Lawmakers said they expect further debate in committee and on the floor, and several senators asked staff to prepare fiscal and implementation details before a final vote.

Key next steps: SB34 is set for third reading on the Senate floor; supporters and opponents both signaled they will seek amendments or fiscal analyses before final passage.