According to the Legislative Budget Board (LBB), HB 388 is expected to have no significant fiscal implications for the state. The Texas Department of Insurance, which is tasked with implementing the legislation by adopting rules to create the uniform coordination of benefits (COB) questionnaire, is anticipated to absorb any associated costs within its existing budget and resources. This suggests that the administrative burden of rulemaking, stakeholder engagement, and dissemination of the questionnaire is considered manageable under current agency operations.

Additionally, the bill is not expected to have any significant fiscal impact on local governments. Despite its broad applicability to various health benefit plans, including those sponsored by school districts and regional healthcare programs, there is no indication that implementing the uniform COB questionnaire will generate additional operational costs that would burden local entities.

The fiscal note references several state agencies, including the Teacher Retirement System, the Employees Retirement System, and the Health and Human Services Commission, none of which foresee financial strain or the need for supplemental appropriations as a result of this legislation. This underscores the bill’s character as a procedural improvement rather than a policy expansion requiring new infrastructure or funding streams.

Texas Policy Research recommends that lawmakers vote YES on HB 388 as it offers a practical, narrowly focused reform that enhances administrative efficiency in Texas's health insurance system without expanding the size or power of government or placing new burdens on taxpayers or consumers.

The legislation addresses a common administrative challenge in healthcare: nonstandardized coordination of benefits (COB) forms used by various insurance providers. These inconsistencies often lead to processing delays and billing errors, including "surprise bills" for patients with dual coverage. By requiring the Texas Department of Insurance (TDI) to adopt a uniform COB questionnaire for use by all health benefit plan issuers, the bill promotes clarity and uniformity across the insurance landscape. This change is expected to simplify the experience for both providers and patients and reduce errors in coverage coordination.

Importantly, the bill does not grow the size or scope of government. It stays within TDI’s existing regulatory role and does not create new programs, agencies, or enforcement mechanisms. Additionally, the fiscal note confirms that no significant cost to the state or local governments is expected, and implementation costs can be absorbed using existing agency resources. Thus, the bill does not increase the financial burden on taxpayers.

With regard to regulation, while HB 388 requires insurers to adopt a standard form, this change is minimal and does not impose substantive restrictions on how businesses operate. Instead, it streamlines a process that is already required, resulting in a net reduction in administrative confusion and a likely increase in efficiency. It imposes no new mandates on individuals, and its practical effect is to reduce burdens on both providers and consumers.

In sum, HB 388 represents a measured and responsible policy that supports personal responsibility and consumer transparency, improves public service efficiency, and respects the boundaries of limited government. It aligns with the liberty principles of minimizing unnecessary regulation while improving the functionality of essential services.

• Individual Liberty: The bill improves access to transparent and consistent healthcare processes. By mandating a uniform coordination of benefits (COB) questionnaire, individuals with multiple health insurance plans will have a clearer, more predictable experience. This reduces confusion, administrative mistakes, and the risk of surprise billing, thus empowering individuals to better navigate and control their healthcare benefits. It enhances liberty by reducing institutional complexity in a key area of personal life—healthcare.
• Personal Responsibility: The bill facilitates and encourages responsible behavior by making it easier for individuals to accurately report coverage information. When insurers coordinate benefits effectively, it reduces fraud and misuse while encouraging individuals to take ownership of their health coverage. The uniform form supports responsible disclosure and accountability without imposing new obligations on consumers.
• Free Enterprise: While the bill does impose a standardized form requirement on health insurers, it does not restrict competition, pricing, or the design of insurance products. Businesses still operate freely within a competitive insurance market. The regulation is administrative, not economic. While it introduces a uniform requirement, it arguably benefits enterprises by reducing inefficiencies and administrative costs over the long term.
• Private Property Rights: There is no impact on physical property rights or ownership interests. The bill does not interfere with contractual rights or limit what businesses can offer; it merely requires that one administrative function—the COB process—follow a standardized template. This affects operations but does not infringe on property rights or the right to enter into private agreements.
• Limited Government: The bill adds a targeted and limited regulation within the Department of Insurance’s existing scope of authority. It does not create new agencies, expand enforcement powers, or require new funding. The required administrative task is a one-time rulemaking to create a uniform form, which is a streamlining effort rather than a growth in government oversight. It demonstrates good governance by reducing unnecessary complexity in regulation rather than expanding it.

• SB 684 (Same As)