Tammy Nichols — Senator Nichols is recognized and makes motions to send Senate Bill 1275 and later Senate Bill 1273 to the floor with due-pass recommendations.
Tammy Nichols — Senator Nichols is introduced as the next questioner and then continues a line of questioning about the bill’s scope and fairness. She asks Mr. Reynolds to explain the complaint and timing of the bill, then raises equal protection concerns, specifically questioning why the bill applies to freestanding ERs rather than hospital-based ERs. The exchange remains focused on whether the bill’s distinction between types of emergency rooms is justified.
Tammy Nichols — Said she supports the motion and expressed concern about patients being left with bills.
Tammy Nichols — Raised concern about federal preemption and the fairness of the dispute resolution mechanism.
Tammy Nichols — Said she is not supporting the motion for now, but may revisit it after further review.
Tammy Nichols — Appears to respond 'Me' in the roll call; likely a transcription error for an affirmative vote or response.
Janie Ward-Engelking — Was identified as the second on the motion to send Senate Bill 1273 to the floor.
Janie Ward-Engelking — Senator Ward-Engelking participated in a clarification exchange about whether the business automatically sends claims to arbitration because it dislikes the reimbursement rate, asking whether claims are routinely sent to arbitration.
Janie Ward-Engelking — Added concern that the facility is not taking TRICARE, Medicare, or Medicaid.
Janie Ward-Engelking — Voted aye.
Van Burtenshaw — Senator Burt was introduced as the sponsor and presenter of Senate Bill 1319 and then introduced the bill, describing it as the Emergency Care Affordability Act.
Mr. Mike Reynolds — Senator Burt requested to yield time to him for testimony on behalf of Blue Cross of Idaho.
Mr. Mike Reynoldson — Senator Burt yielded the remainder of his time to him for testimony.
Mike Reynoldson — Identified himself as an employee of Blue Cross of Idaho and said he was there representing the organization.
Mike Reynoldson — Continues explaining the pricing difference between standard emergency rooms and freestanding emergency rooms.
Mike Reynoldson — Provides additional examples comparing market rates to freestanding emergency room charges.
Mike Reynoldson — Clarifies that the bill applies only to emergency care and not non-emergency imaging or other services.
Mike Reynoldson — Agrees that the described billing confusion is accurate.
Mike Reynoldson — Continues testimony and notes there are a little over 40 emergency rooms in Idaho, with Blue Cross contracting with all but one.
James Ruchti — Asks whether freestanding emergency rooms are standalone facilities with only emergency care.
James Ruchti — Is addressed in the response confirming the consumer-billing explanation.
James Ruchti — Referenced as having previously testified about the bill.
James Ruchti — Asked to ask a quick question after audio was restored.
James Ruchti — Addressed in the question about TRICARE and Medicare patients.
James Ruchti — Addressed by Mr. Reynolds in response to the question.
James Ruchti — Asked whether extended stays or overnight stays are sent to arbitration.
James Ruchti — Ms. Kavanaugh corrected herself and addressed him while discussing CPT codes.
James Ruchti — Ms. Kavanaugh corrected herself and addressed him while discussing CPT codes.
James Ruchti — Seconded the motion on Senate Bill 1319.
James Ruchti — Addressed in the floor discussion; the transcript likely mishears the chair or another senator name.
James Ruchti — Began speaking in support of the motion after Senator Lakey.
James Ruchti — Said he supports innovation in the market but is concerned about the business model being discussed.
James Ruchti — Voted aye.
Mr. Reynolds / Mike Reynoldson — Explains that freestanding emergency rooms may also provide some non-emergency imaging, but are primarily emergency-care facilities.
Mr. Reynolds / Mike Reynoldson — The witness is being addressed and corrected by name.
Brian Lenney — Vice Chair Lenney questions the basis for the dollar amounts being cited, pressing Ms. Reynolds on where the pricing figures came from rather than accepting them at face value.
Brian Lenney — Called on after the response; likely Senator Brian Lenney.
Brian Lenney — Addressed as 'Senator Lenny'; the speaker responds to his question.
Mike Reynolds — Was asked how emergency rooms handle patients covered by TRICARE or Medicare.
Mr. Reynolds — Mr. Reynolds responded to a series of related questions about how hospitals and emergency rooms would handle patients under the bill. He said he was not entirely sure of the exact EMTALA process but believed the emergency room must treat the patient, with the patient likely paying first and then seeking reimbursement. He also noted that the entities in question must comply with EMTALA, but refuse to contract with commercial insurers, instead sending inflated bills into dispute resolution. Finally, he explained that the bill would not change longer-term admission or ongoing care processes, which would continue to be governed by hospital contracts and the insured patient’s coverage.
Mr. Reynolds — Mr. Reynolds explained that Blue Cross is addressing the reimbursement dispute from multiple angles and that the provider’s business model relies on obtaining reimbursement through arbitration when the insurer and provider cannot agree. He noted that this arbitration process is the only route to settle such disputes and that the entity sends all emergency claims through it. When asked to set aside the insurer-provider dispute and focus on patient impact, he said commercially insured patients are unaffected, while TRICARE, Medicaid, Medicare, and uninsured patients are not in the same position. He also confirmed that federal law requires payment.
Christy Zito — Senator Zito was called on and then asked a series of related follow-up questions about the bill, first inquiring how many freestanding medical centers exist in Idaho and then asking what federal code is being incorporated by reference in the proposal.
Christy Zito — Senator Zito engages in a continuing exchange with the chair and the bill sponsor about the business’s billing and arbitration practices. He asks why the company sends billing disputes to arbitration and follows up with additional clarifying questions about how the arbitration process works, while the responses explain that this is part of the company’s business model.
Christy Zito — Voted no.
James Woodward — Senator Lakey questioned whether the federal arbitration process is broken, biased, or both.
James Woodward — Senator Lakey questioned whether the payment dispute changes anything for the patient beyond higher charges, whether the patient outcome remains the same regardless of the dispute, whether the issue affects Blue Cross, Regence, Select Health, and other insurers similarly, and then raised a broader concern that government intervention on pricing is inconsistent with a free market while asking whether payment is required by federal law.
James Woodward — Welcomed by the chair to the committee discussion.
Mr. Rennelton / Mr. Reynolds (questionable) — Said the federal IDR process is '100% broken, biased' and criticized East Coast entities deciding reimbursement for Idaho emergency care.
Mr. Raulson — Responded that other tools could be used absent the No Surprises Act, but not under the current system.
Mr. Relton / Mr. Reynolds (questionable) — Said other witnesses may testify about whether the issue affects other insurers the same way.