AUSTIN (Nexstar) — The Texas House of Representatives on Thursday voted to prohibit state money from funding private school vouchers or education savings accounts.

The move is a setback to one of Gov. Greg Abbott’s top priorities to provide “school choice” with state-funded private school tuition subsidies.

The House approved State Rep. Abel Herrero’s amendment to the state budget on a bipartisan 86-52 vote. The amendment prohibits the budget from funding “a school voucher, including an education savings account, tax credit scholarship program, or a grant or other similar program through which a child may use state money for non-public primary or secondary education.”

“These are public funds for public schools as is outlined and stated specifically in the Texas Constitution,” Herrero said. “And for that, members, please stick with our public school teachers, our neighborhood schools, and our public charter schools and vote for this amendment.”

Cheers erupted in the Texas House as the amendment to prohibit state-funded education savings accounts passed. (Ryan Chandler/Nexstar)

Freshman Republican Rep. Nate Schatzline tried to make the case that allowing state money to go to private schools would actually help public schools.

“The reality is that I believe that we have never seen any type of competition, harm an industry, our public schools are no different,” said Schatzline in response to the amendment.

Just before the chamber voted on the amendment, House Public Education Committee Chair Brad Buckley, R-Killeen, moved to table the amendment, arguing the issue would be best debated in committee. The House voted against his motion to table.

“I feel like this process with this amendment turns things really in the wrong direction. It is the proverbial cart before the horse,” Buckley said. “So with that I will respectfully oppose and speak against this amendment.”

But hours later, a vote in the Texas Senate brought a much different result. In a party line vote, senators passed Senate Bill 8, which top Republicans call the “Parental Bill of Rights.” The bill would create “education savings accounts” (ESAs), a top priority for Abbott.

Through those accounts, the state would spend half a billion dollars over the next two years to subsidize some families’ educational costs. Parents who wish to transfer their children from public school to private school would be eligible to receive $8,000 from the state to do so.

Abbott has traveled around the state advocating for the “school choice” initiative, expending significant personal capital and betting the session on the issue.

A committee hearing scheduled for Tuesday could give another indication of the outlook for ESAs this session. The House Public Education committee is expected to hear public testimony on legislation to create ESAs. The committee will decide whether that bill advances to a vote in the full House.

Gov. Abbott announces new initiatives to fight fentanyl crisis

Abbott also made addressing the state’s “growing fentanyl crisis” as one of his key legislative priorities this session. On Thursday, he announced additional steps the state is taking to curb deaths from a drug that took the lives of 2,012 Texas last year.

Speaking at a summit with state leaders, stakeholders and families of Texans who died from fentanyl poisoning, Abbott announced the state will be doling out millions of dollars to take immediate action while the legislature works on passing bills aiming to curb the crisis.

The Republican governor directed the Texas Division of Emergency Management to begin distributing Narcan, an opioid reversal tool, to every county in Texas. Additionally, he announced the state unveiled a $10 million multimedia PSA-style campaign to educate Texans on the dangers of the drug and how to prevent and reverse fentanyl deaths.

“We are eager to distribute life-saving medication to counteract the impacts of the fentanyl crisis,” TDEM Chief Kidd said. “As we work together to help Texas communities combat these deadly drugs, I look forward to working with local officials and first responders to provide medication that reverses the deadly effects of opioids.”

The “One Pill Kills” campaign will be made up of television, radio and online public service announcements and is being led by the Texas Health and Human Services Commission. Proceeds from Texas’ settlements with pharmaceutical companies and opioid manufacturers are funding the $10 million effort.

During his State of the State address, Abbott expressed he wants prosecutors to have the ability to charge those who make, distribute or sell fentanyl with murder. Sen. Joan Huffman, R-Houston, wrote SB 645 to do so, which the Senate has already passed.

So far this session, dozens of bills aiming to increase awareness and prevent deaths from fentanyl have been filed by teams of Republicans and Democrats working together.

One bipartisan bill written by Sen. Nathan Johnson, D-Dallas, and Sen. Bob Hall, R-Edgewood would decriminalize fentanyl testing strips and other tools used to detect fentanyl in other drugs. It’s a measure the governor previously opposed but now supports.

And as the usage of the illegal opioid rises amongst young people, there are also bills aiming to tackle the problem in schools.

SB 629 by Sen. José Menéndez, D-San Antonio, would store Narcan on Texas campuses, requiring school staff to be trained on how to use it.

Overdose deaths involving fentanyl increased by 89% in Texas from 2020 to 2021. And 99% of these deaths are accidental, according to information provided at the summit from the governor’s office, which cited the CDC and DEA on its data.

“Each branch of our administration is informing Texans about this crisis and how they can avoid falling victim to deadly fentanyl,” said Abbott during the summit.

Ban on transgender youth treatments passes Texas Senate

The Texas Senate approved legislation Tuesday banning treatment options for transgender young people, and it will ultimately apply to those already receiving that kind of health care in the state after a reversal among Republican lawmakers.

Senate Bill 14, spearheaded by Republican State Sen. Donna Campbell of New Braunfels, passed by a vote of 19-12 along party lines. The legislation now moves to the Texas House of Representatives for debate, where it has to clear before the governor can potentially sign the bill into law.

“Children who are on puberty blockers or cross-sex hormones need more counseling and love. They don’t need blades and drugs,” said Campbell ahead of the vote Tuesday.

The legislation includes a number of provisions affecting the state’s doctors and the transgender minors they might treat. It prohibits anyone under 18 from receiving puberty-blocking medication, hormone therapy or surgeries for “the purpose of transitioning a child’s biological sex.” Doctors could also lose their medical license in Texas if they provide these options, according to the bill. State health insurance plans would also no longer be able to cover this kind of care.

Sen. José Menéndez, D-San Antonio, delivered almost 15 minutes of remarks explaining his opposition to the legislation before the final vote happened. The conclusion of his speech drew loud cheers and applause from people sitting in the Senate gallery Tuesday, which led to Lt. Gov. Dan Patrick sounding his gavel several times trying to quiet the chamber.

“Who are we protecting? It seems like it’s a moving target with this legislation, but what is clear to me is who we are targeting,” Menéndez said. “This session, over 100 bills have been filed in the House and Senate that address the needs of the LGBTQ community, yet we choose to give the stage to the bills that exclude them.”

Menéndez also directed a message to transgender kids in Texas.

“I see you. Please know you have a lot of life to live. There are many people who love you, and you have much growth ahead of you,” he said. “Please don’t let this or anything we do in this building discourage you from flourishing.”

Sen. Sarah Eckhardt, D-Austin, spoke against the bill, too, and directed part of her comments at the GOP lawmakers.

“I know you believe you’re acting heroically to protect children, and I know most of you have had little contact with transgender people and they scare you,” she said. “But we have heard overwhelming evidence that the protection you imagine this bill would provide comes at the cruel expense of a small and already bullied class of Texas children.”

The senators voted along party lines (19-11) Monday afternoon to remove an amendment introduced by Campbell, which notably passed last week with no opposition. It would have created a “grandfather clause” to allow transgender minors who are receiving this care 90 days before the effective date of the proposed law to continue to do so. However, the vote Monday resulted in an about-face that stripped that exemption for some Texans to finish their gender-affirming treatments.

Campbell called the change she introduced last week a “surprise amendment” that ended up creating confusion among “communities,” which she cited as reasons for withdrawing it.

“The amendment was not discussed in committee, and there were so many questions that have been brought up since the amendment was put on that,” she said Monday. “Out of respect for the body, we’re going to just take it down.”

Menéndez rose Monday to also speak against Campbell’s decision to go back and remove the “grandfather clause” amendment. Last week she said he worked with her to craft that exemption. He called the reversal “medically unwise” and “not a thoughtful or a kind thing to do” to the Texas children currently receiving treatments and their families.

“I’m concerned that under the guise of protecting children, that we’re actually going to hurt many children and their families. Possibly some who will leave the state, and maybe that’s the overarching goal,” Menéndez said.

If the legislation becomes law, it will go into effect on Sept. 1 of this year.

The bill’s passage in the Texas Senate comes a few days after the recognition of International Transgender Day of Visibility, which is dedicated to celebrating transgender people and raising awareness of discrimination they face. President Joe Biden issued a proclamation for the day, mentioning the wave of transgender restrictions passed in several state legislatures across the country.

“Transgender Americans shape our Nation’s soul — proudly serving in the military, curing deadly diseases, holding elected office, running thriving businesses, fighting for justice, raising families, and much more,” Biden wrote in his proclamation. “As kids, they deserve what every child deserves: the chance to learn in safe and supportive schools, to develop meaningful friendships, and to live openly and honestly. As adults, they deserve the same rights enjoyed by every American, including equal access to health care, housing, and jobs and the chance to age with grace as senior citizens. But today, too many transgender Americans are still denied those rights and freedoms.”

On Tuesday last week, a Texas House committee began its discussions on a companion bill to what passed in the Senate. Advocates for transgender Texans gathered inside the Texas Capitol overnight after the end of that hearing, where hundreds signed up to testify. House Bill 1686 by State Rep. Tom Oliverson, R-Cypress, would prohibit physicians from providing gender transition surgery or “puberty blockers” to Texans under 18.

“This whole cottage industry operates without self regulation to the detriment of vulnerable children,” Oliverson tweeted Monday.

The House Committee on Public Health left that bill pending as of March 28.

In a statement sent out Tuesday afternoon, Campbell said, “I look forward to continuing to work with Rep. Tom Oliverson, a fellow physician and author of the House companion bill, as well as all relevant stakeholders as this legislation works its way through the Texas House so we can get a bill to Governor Abbott’s desk as quickly as possible.”

Senators on Wednesday passed a pair of bills that would enact new consequences for drag-related events held in the state.

Lawmakers first approved an expanded version of Senate Bill 12, which would make it a crime to hold a drag show or any other performances considered overtly sexual if they’re in front of or could possibly be seen by minors. The bill passed by a final vote of 20-11. It received initial approval Tuesday after a tense exchange during a debate.

The legislation would levy a penalty of up to $10,000 against any business owner hosting a “sexually oriented performance” with anyone who’s younger than 18 present. A city or county would also not be able to host these kinds of performances on public property, according to the proposal. The bill defines “sexually oriented performance” as a “male performer exhibiting as a female, or a female performer exhibiting as a male” who “appeals to the prurient interest in sex.”

Drag performers could also face a criminal misdemeanor charge if they perform in front of children or on public property, according to the language in SB 12.

Following that vote Wednesday, the lawmakers also approved Senate Bill 1601 by a vote of 19-10, with two senators voting present. This legislation would cut off state funding to any public library that hosts a children’s reading event led by a drag performer.

Sen. Bryan Hughes, R-Mineola, introduced both bills this session. He and other Republican lawmakers said these restrictions are needed to protect children from inappropriate conduct and materials. However, Democrats and other advocates argue these measures are government overreach targeting the LGBTQ+ community.

The House will now have to consider and approve both pieces of legislation before the governor can potentially sign them into law.

Legislation to itemize medical bills meets opposition

State lawmakers and a representative of the Texas Hospital Association expressed concern Monday about legislation that would require health care providers to send patients an itemized bill when billing for medical services, according to testimony at a House Public Health Committee meeting.

Rep. Caroline Harris, R-Round Rock, testifies on her itemized medical bill legislation at a House Public Health Committee hearing Monday, April 3, 2023. (Courtesy: Melva Gomez, Rep. Harris’ Chief of Staff)

House Bill 1973, by State Rep. Caroline Harris, R-Round Rock, said a health care provider would not be allowed to pursue debt collection against a patient without providing an itemized bill.

Currently patients can request an itemized bill, but they don’t get it automatically, Harris said.

“The lack of an itemized bill continues to hide actual prices from patients – even after they’re being told what they owe – and doesn’t allow patients a chance to check and make sure that the correct services were billed for,” Harris testified Monday at the Capitol. “I think we can all agree that transparency in health care is critical, especially when it comes to costs. Research shows that six out of 10 Americans have medical debt, and that 80% of hospital bills have errors.”

Harris, a freshman, said she block-walked and knocked on 11,000 doors, and the overwhelming majority of her constituents want this legislation.

The itemized bill would have to include the amount the provider would accept as full payment for each service or supply, a plain language description of the charge, and the billing codes and costs provided to third parties involved in reimbursement, according to the legislation.

State Rep. Caroline Harris recently filed a bill that would help patients get an itemized medical invoice. (KXAN Photo/Arezow Doost)
State Rep. Caroline Harris recently filed a bill that would help patients get an itemized medical invoice. (KXAN Photo/Arezow Doost)

A patient could request the itemized bill again after it is initially provided, and the itemized bill could be sent electronically or through a patient portal, according to the legislation.

Michelle Lindsley – who spoke on behalf of the Texas Hospital Association and Memorial Hermann Health System where she is vice president of managed care – registered and testified in opposition to the bill.

Lindsley said legislation would present challenges to implement, cause confusion among patients and create additional hospital expenses.  Memorial Hermann has more than 1.6 million patient encounters per year, and less than 2% of its patients request itemized bills, she said. An itemized bill could be two pages for outpatient services, or it could be hundreds of pages for in-patient care, she said.

The charge rates noted in an itemized bill also may not reflect the ultimate cost a patient would need to pay because of their health insurance benefits or an up-front payment for services, which could lead to confusion, she said.

“Under the proposed requirement, we estimated the cost to be upwards of $3 to $5 million annually,” Lindsley said.

Lindsley said those costs would cover enhancing the hospital’s processes to send itemized bills, more staff to handle more patient calls, making patient portal space larger and sending potentially large and sensitive documents through the U.S. certified mail.

“Hospitals continue to be well intended and committed to transparency specific to a patient’s health care costs,” Lindsley said. “We absolutely have opportunity to communicate better with our patients and Memorial Hermann continually reviews how we best maximize the many vehicles we have to share information.”

Rep. Tom Oliverson, R-Cypress, was also troubled by the increased costs of providing voluminous itemization. Oliverson is a licensed medical doctor and anesthesiologist.

“If that becomes the law, and that increases their costs, then we all know how this game works, right?” Oliverson said. “That just ends up getting passed along down the food chain, and ultimately everyone’s premiums go up as a result.”

Rep. Ann Johnson, D-Houston, also voiced concern about the impact of the bill on hospitals. Johnson, an attorney, said medical bills aren’t necessarily comparable to bills in other industries, such as restaurants. As an example, Johnson said a person would not be able to understand every charge they incurred while under sedation in an operating room.

“I don’t want to create a burden on hospitals to do something that, as we said, currently under law you can opt in and say, ‘I want it,’” Johnson said during the hearing.

Harris said she was open to recrafting language in the bill to address issues raised by the hospital industry and lawmakers.

Harris’ legislation follows a KXAN investigation into a Williamson County hospital that filed hundreds of lawsuits against patients for unpaid medical bills. KXAN spoke with defendants in those small-claims cases who said they struggled to get itemized invoices even after several attempts.

Harris spoke specifically at the hearing about hospital lawsuits originating in her district in Williamson County and one woman couldn’t get an itemized bill before getting sued.

“Instead of going to court, she decided to reach into her savings and pay that bill. She couldn’t get an itemized receipt, and she’s a single mom with three daughters,” Harris said.

In 2021, Sen. Paul Bettencourt, R-Houston, filed legislation similar to Harris’, but it didn’t pass.

The current House bill has an identical counterpart in the senate – SB 490 by Sen. Bryan Hughes, R-Mineola – and Bettencourt is a co-author.

Harris’ bill was left pending in committee Monday. Her office will present a committee substitute that could be voted on.