Texas Patient Bill of RightsJose Navarro Balbuena • Texas Governor 2026
Texas working families should never open their mailbox to a terrifying, ludicrous surprise medical bill. As a licensed Texas health insurance agent, I know how insurance conglomerates and Big Pharma rig the system against patients and doctors. My platform establishes an ironclad Patient Bill of Rights: permanently outlawing surprise medical bills, mandating that insurance companies cover whatever treatment and medicine a doctor prescribes, capping prescription drugs at $25-$30, mandating tandem non-dependency drug manufacturing, and reclaiming $5.4B in Medicaid funds to pave the road to Medicare for All funded by lifting the FICA cap on billionaire wealth.
Real statutory protections drafted by a licensed Texas health insurance agent who fights for patients every single day:
"As an active, licensed Texas health insurance agent (TDI compliant), I don't look at healthcare through abstract academic white papers—I look at it through the eyes of the working families, independent contractors, and retirees I fight for every single day.
I sit with parents in tears because they went to an in-network emergency room during a medical crisis, only to open their mailbox a month later to a ludicrous $8,000 surprise bill from an out-of-network doctor or path lab they never chose. I talk with diabetics who are dangerously rationing insulin because Big Pharma prices a vial at $300 that costs $3 to make. And I watch insurance company algorithms deny surgeries and medications that a doctor with fifteen years of medical training explicitly ordered.
A desk clerk or corporate algorithm in a distant skyscraper has zero business overruling your treating physician. When a doctor writes a prescription or orders a treatment, insurance companies operating in Texas must be legally bound to cover it. We will cap prescription costs, mandate that drug companies manufacture non-addictive alternatives in tandem when seeking market approval, and accept the $5.4 billion in federal Medicaid expansion that Austin politicians threw away—reopening the 26 rural hospitals that have shuttered across our state.
And as someone who files individual and small business taxes, I know exactly how to fund universal healthcare without raising a single cent of taxes on working families: lift the FICA wage cap on billionaires and apply FICA taxes to high-bracket unearned capital gains, rolled out in tandem with our $100,000 Standard Deduction. Working folks keep their money tax-free, while the ultra-wealthy finally pay their fair share to guarantee Medicare for All."
Rigorous, enforceable statutory reforms to protect Texas patients, restore the authority of treating physicians, eliminate predatory drug pricing, and guarantee universal healthcare solvency.
No Texan who experiences a medical crisis should open an envelope weeks later to a terrifying, ludicrous surprise bill. Today, patients can carefully choose an in-network emergency room or hospital, only to be ambushed by five-figure invoices from an out-of-network anesthesiologist, assistant surgeon, pathologist, radiologist, or ground ambulance company they had zero opportunity to choose or decline.
Under state law, patients who seek emergency care or receive services at an in-network facility are completely shielded. The patient is legally liable ONLY for their standard in-network copay and deductible. All balance billing is statutorily illegal.
Closes federal loopholes by extending state surprise billing bans directly to emergency ground ambulance transit, neonatal transport, post-stabilization hospitalists, and arbitrary facility surcharge fees.
Removes the patient completely from billing disputes. Insurers and out-of-network providers must resolve reimbursement through binding state arbitration overseen by TDI, with a strict ban on debt collection or negative credit reporting against the patient.
Health insurance companies have quietly replaced the medical judgment of licensed physicians with automated algorithms, non-practicing corporate medical clerks, and deliberate bureaucratic delays. When a physician examines you and prescribes a vital medication, diagnostic scan (MRI/CT), or surgical procedure, an insurance corporation has zero moral or legal right to deny it to pad their quarterly stock dividends.
Codifies the statutory rule that all HMOs, PPOs, and state-regulated health benefit plans under TDI jurisdiction MUST cover and reimburse any FDA-approved medicine, diagnostic scan, or therapy prescribed by the treating physician as medically indicated.
Abolishes abusive step-therapy protocols where insurance companies force patients to take cheaper, ineffective medications and suffer disease progression before approving the drug their doctor actually ordered. Physician discretion immediately overrides formulary tier locks.
Enforces strict binding timeframes: 2 hours for emergency prescriptions/procedures, 24 hours for urgent care, and 48 hours for routine requests. If an insurer fails to respond within the statutory window, the request is automatically approved by law.
Life-saving medicine should never be a luxury good. Millions of Texans with diabetes, asthma, heart conditions, and chronic illnesses are rationing their doses or skipping refills because Big Pharma marks up drugs by thousands of percent. Insulin—invented over a century ago and costing just $3 to manufacture—is routinely billed to Texans at $300 a vial.
Enacts non-negotiable monthly out-of-pocket caps: $25 per 30-day supply of insulin (all formulations and pens) and $30 per month for asthma inhalers, EpiPens, and cardiovascular maintenance medications, applicable regardless of deductible status.
Establishes an independent state watchdog board with statutory authority to investigate predatory price increases and establish binding upper payment limits on high-cost prescription drugs, pegged to actual R&D costs and international reference pricing.
Combines the immense purchasing power of Texas Medicaid, the Teacher Retirement System (TRS), Employees Retirement System (ERS), and public universities into a single unified purchasing consortium, negotiating volume wholesale discounts directly from manufacturers.
The current pharmaceutical system is fundamentally broken in two critical areas: when supply chain crises strike, bureaucratic barriers prevent doctors from prescribing safe, evidence-backed off-label medications that could alleviate acute drug shortages. Meanwhile, Big Pharma floods our communities with high-potency, dependency-inducing narcotics and sedatives as primary regimens, fueling devastating addiction crises without providing non-habit-forming alternatives.
Statutorily protects licensed Texas physicians who prescribe FDA-approved medications for peer-reviewed off-label indications during supply shortages. Mandates that Texas health insurance carriers reimburse evidence-based off-label regimens on identical terms as on-label treatments.
Any drug company marketing a dependency-inducing Schedule II, III, or IV controlled drug (opioids, benzodiazepines, habit-forming stimulants) in Texas MUST produce and maintain in commercial inventory a lesser-dosage, non-dependency-inducing alternative or micro-taper regimen in tandem to receive state formulary and market approval.
Establishes clinical standards of care requiring healthcare providers to start patient regimens on non-dependency-inducing or lowest-effective-dosage formulations first, providing safe pain management and neurological care while preventing chemical dependency before it takes root.
Texas currently leads the entire United States with the highest rate of uninsured residents (over 21%). Due to pure ideological spite, Austin politicians have rejected over $5.4 billion in annual federal Medicaid expansion dollars, forcing 26 rural community hospitals to close their doors and leaving 1.4 million working Texans without basic healthcare. Meanwhile, working-class paychecks pay FICA taxes on every cent, while billionaires pay zero FICA on tens of billions in unearned speculative wealth.
On Day One, draw down our fair share of federal funding (90% federal / 10% state match) to reopen rural trauma centers, stabilize county healthcare systems, and cover 1.4M working Texans who earn too much for traditional Medicaid but too little for ACA subsidies.
Eliminate the artificial payroll tax cap that lets mega-earners and billionaires stop paying FICA taxes early in the year. Millionaires and billionaires will contribute to Medicare and Social Security on 100% of their compensation, guaranteeing Medicare solvency for generations.
Apply FICA contributions to high-bracket unearned income (speculative capital gains, executive carried interest, and massive dividends) of the ultra-wealthy, ending the loophole where passive Wall Street fortunes escape funding the nation's healthcare system.
This expanded billionaire FICA reform is rolled out in direct harmony with our national centerpiece: exempting the first $100,000 for single filers and $175,000 for married couples from federal income tax. 90%+ of Texas working families and small businesses will pay zero federal income tax on their foundational wages, while unearned billionaire fortunes fully fund the Medicare Trust Fund, paving a fiscally bulletproof pathway to universal Medicare for All.
Examining the direct contrast between current insurance conglomerate exploitation and our working-class Texas patient protections.
| Policy Dimension | Current Status Quo (Austin Incumbents) | Navarro Balbuena Patient Bill of Rights |
|---|---|---|
| Surprise Medical Bills | Patients receive surprise 5-figure bills from out-of-network ER docs, labs, & ground ambulances. | 100% Legal Hold-Harmless: Banned across all emergency, hospital, & ground ambulance care. Only in-network copay applies. |
| Physician Authority | Insurance algorithms & non-physician corporate clerks overrule doctors, delaying or denying care. | Doctor's Orders Are Law: Insurers statutorily required to cover treatments and drugs prescribed by treating doctors. |
| Step Therapy ("Fail First") | Insurers force patients to fail on cheap, ineffective drugs before approving doctor-prescribed medicine. | Predatory Step Therapy Outlawed: Treating physician's prescription immediately overrides formulary restrictions. |
| Prior Authorization | Unregulated bureaucratic delays lasting weeks, causing disease progression and hospitalizations. | Binding Statutory Windows: 2 hrs for emergency, 24 hrs for urgent, 48 hrs for routine—or approved automatically by law. |
| Prescription Drug Prices | Unregulated Big Pharma gouging; $300/vial insulin and $350 inhalers force deadly patient rationing. | Hard Price Caps: $25/mo insulin, $30/mo inhalers/EpiPens; Texas Drug Affordability Board sets upper payment limits. |
| Prescription Shortages & Off-Label Care | Clinicians blocked from using effective off-label alternatives; insurance denies shortage substitutes. | Expanded Off-Label Access: Doctors shielded & reimbursed for evidence-based off-label regimens during shortages. |
| Dependency & Addiction Prevention | High-potency narcotics pushed as first-line regimens without non-addictive alternatives or tapers. | Tandem Manufacturing Mandate: Dependency-inducing drugs must produce non-addictive alternatives in tandem to sell in Texas. |
| Medicaid Expansion & Rural Care | Austin politicians reject $5.4B/year in federal funds; 26 rural hospitals closed; 21.6% Texans uninsured. | Reclaim $5.4B on Day One: Reopen rural trauma centers, stabilize community clinics, and cover 1.4M working Texans. |
| Medicare Solvency & FICA Taxes | Billionaires pay zero FICA above the annual cap and zero FICA on billions in speculative unearned gains. | Tax Billionaire Unearned Wealth via FICA: Fund Medicare for All in tandem with $100K tax-free standard deduction for workers. |
Practical action steps to fight predatory medical billing and know your rights under Jose Navarro Balbuena's statutory reforms.
Never immediately pay an out-of-network balance bill from an emergency or hospital procedure. Request an itemized bill with CPT billing codes and verify if the facility was in-network. Under our expanded law, emergency and in-network facility care cannot be balance-billed to you.
Demand an immediate written denial citing the exact clinical rationale and the Texas medical license number of the reviewing medical director. Under our Physician Authority Mandate, the treating doctor's clinical findings legally supersede corporate denial algorithms.
File a dispute notice with the Texas Department of Insurance (TDI). By statute, all debt collection actions are frozen, negative credit reporting is prohibited, and the insurer must negotiate directly with the provider in binding arbitration while you remain protected.