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Divided Senate advances bill letting employees 'swing out' to chosen doctors for added actuarial cost
Summary
Senate debate on third-substitute SB 66 centered on granting employees a point-of-purchase option to retain or choose providers outside an employer's panel by paying actuarially determined additional costs; sponsors framed it as patient choice while opponents warned of cost-shifting, and the chamber recorded a narrow 15–13–1 vote to advance the substitute.
Senators spent an extended portion of the Feb. 9 floor session debating third-substitute Senate Bill 66, a measure that would require insurers that offer employer plans to provide a point-of-purchase or 'swing-out' option allowing employees to use out-of-panel providers if they pay actuarially determined additional costs.
Sponsor Senator Wadobs said the policy is about patient and employee choice: if an employee wants to keep a trusted doctor who is not impaneled on a new employer's plan, the employee could elect a point-of-purchase option and pay the actuarial premium to do so. The sponsor emphasized that the additional cost should be borne by the enrollee and that premiums and copays must be actuarially sound.
Opponents — including senators and representatives of the insurance industry who were referenced during floor debate — warned the policy could produce cost-shifting. Some senators questioned whether the state or other large employers could be left covering higher-cost services while enrollees 'swing out' for profitable procedures; others pressed staff to provide actuarial analysis and draft amendments to prevent unintended effects on Medicaid, CHIP or state employee plans.
Key floor points and sponsor responses: - Cost and actuarial basis: Sponsor repeatedly said the swing-out option must be actuarially based and that higher deductibles, coinsurance or premium differences could be charged to enrollees to avoid shifting costs to the insurer or employer. - Medicaid/CHIP treatment: The bill as presented exempts state Medicaid and CHIP programs from being required to offer the swing-out option; senators asked for amendments to ensure providers accepting point-of-purchase patients do not discriminate against Medicaid beneficiaries. - Vote and disposition: The third substitute (as amended on the floor) passed on a roll-call tally of 15 yes, 13 no, 1 absent; sponsors and opponents left the floor with outstanding questions about cost containment and protections to avoid cream-skimming.
What remains: Sponsors invited senators to file and consider additional amendments on third reading to clarify Medicaid protections and actuarial safeguards; they also asked for actuarial inputs before final passage. The bill will return to the third-reading calendar with those issues in focus.
Representative quotes from the floor: "This bill is in the best interest of patients. It's for employee choice," said Senator Wadobs when presenting the core policy rationale.
"I feel that we ought to have more choices; but at the same time ... we may be allowing the swing-outs on profitable parts and leaving the plan with the unprofitable components," said Senator Stevenson in explaining his 'no' vote.
Next steps: Sponsors indicated amendments will be prepared for third reading and requested actuarial analysis to demonstrate whether cost-shifting to state plans or other large employers can be avoided.
