March 8, 2018

Dear Speaker McCall and Leader Echols:

As Oklahoma’s leading business advocate statewide, representing nearly 1,500 businesses and approximately 350,000 employees, we are
writing to express serious concerns on a number of health care related bills. Without decisive action from House leadership, HB 3228,
HB 3229 and HB 3230 could be considered on the House floor. These measures, which narrowly passed out of the House Insurance
and Public Health committees, will have detrimental impacts on health care costs for employers and will diminish quality health care
services in our state.

• HB 3228 mandates health plans cover out-of-network services at an in-network reimbursement rate. A network of health care
providers is developed by a health plan to ensure quality providers are accessible for patients, while helping to keep costs low
for consumers and employers. HB 3228 will undermine contractual agreements between health care providers and health
plans, which will increase costs elsewhere for health care services and threaten quality care by weakening provider networks.

• HB 3229 prohibits health plans from intervening when a physician participating in a preferred provider organization
(PPO) network refers a patient to a health care provider not participating in the PPO network. HB 3229 eliminates
accountability for providers who refer patients, without notice, to out-of-network providers. This often leads to “surprise
billing” with increased out-of-pocket costs for the patient who is often unaware the referred provider is out-of-network.

• HB 3230 allows for the licensing of non-hospital owned, “Free Standing Emergency Rooms” (FSERs). As we have seen in other
states, these FSERs do not meet federal standards for Medicare and Medicaid reimbursement and therefore require a high volume
of privately insured patients (whose health plans often consider FSERs out-of-network) to remain viable. By charging up to 10
times as much for typical services provided in physician’s offices, these freestanding facilities ultimately increase the cost of health
care services for patients and employers.

Rising health care costs continue to be a point of consternation for businesses of all sizes in Oklahoma. With employers trying to
balance their responsibility of providing practical health care benefits for their employees, while seeking out opportunities to contain
costs when possible, these three bills will only serve to increase the cost of care, interject the state government into private contracts and
perpetuate mediocre quality and outcomes.

The State Chamber strives to work with the Legislature to draft state laws and policies that create a strong environment for business
growth and opportunity in Oklahoma. HB 3228, HB 3229 and HB 3230 will only exacerbate health care costs for our state’s businesses.

We respectfully ask that HB 3228, HB 3229 and HB 3230 not be heard on the House floor.

Respectfully,

Fred Morgan
President and CEO
State Chamber of Oklahoma