Healthcare has quickly become one of the most important issues throughout the country, and healthcare legislation has—of late—become a hotbed of frenzied activity. Issues including better patient access, increased payer transparency, and even a single-payer system have all jockeyed for position as top issues in both the federal and state arenas.
MDLinx takes a closer look at the most recent healthcare legislative efforts, as well as some of the healthcare-centered, state-driven legislation currently in play in the legislatures of Maine, California, and New York—key states that have historically set the tone for the rest of the nation—and what they may mean for clinicians and patients.
Lower Health Care Costs Act of 2019: Better patient access
The bipartisan Lower Health Care Costs Act of 2019 was just introduced on June 19 by the Senate Health, Education, Labor, and Pensions Committee. The act is a proposal geared to promote better exchange of health information, improve security and privacy of health data, and reduce healthcare costs for patients.
In Section 501 of the act, Senate members included a requirement to provide network and cost information to patients submitting health claims that would enable them to make better insurance decisions.
According to the summary of the draft bill, the goal is: “To help patients pick the best health insurance plan for their family and then navigate that plan when they need care, this ensures that patients have full, electronic access to their own health information and information on what the patient would pay out of pocket for specific care.”
What this means for physicians: The burden here will rest largely on payers, not clinicians. Payers will be required to provide patients health insurance claims data and list in-network practitioners and out-of-pocket costs. If the Lower Health Care Costs Act of 2019 is passed, patients will have better access to their own healthcare data, allowing them to make better choices and decisions about their own care. However, passage of this act may also lead to physicians having to make changes to their EHR systems to improve patient accessibility.
Lower Health Care Costs Act of 2019: Ending surprise medical bills
Larger goals of the Lower Health Care Costs Act include creating a benchmark for health insurer-provider payment disputes, prohibiting out-of-network deductibles during emergencies, and limiting patients’ out-of-pocket expenses for air ambulance transport.
Insurance companies would be required to reimburse providers based on the local median contracted commercial amount they have agreed to pay other contracted providers in a geographic area defined by the US Department of Health & Human Services (HHS).
Yet, in the fight against surprise medical billing, the federal government lags behind state legislatures throughout the country. Texas Governor Greg Abbott just signed legislation (Senate Bill 1264) to protect patients from getting surprise medical bills when a dispute between the insurance company and the patient’s medical provider cannot be resolved.
Other states with comprehensive surprise billing protection laws include Florida, California, Oregon, Illinois, New York, New Hampshire, Connecticut, New Jersey, and Maryland. These laws cover emergency departments and non-emergency hospital services, and apply to HMOs and PPOs. They serve to protect patients from financial liability, determine how much money insurers must pay providers, and/or establish a dispute-resolution process.
States with partial surprise billing protection laws—which are not as inclusive as the comprehensive laws—include Arizona, Colorado, New Mexico, Texas, Minnesota, Iowa, Indiana, Mississippi, Pennsylvania, West Virginia, North Carolina, Vermont, Maine, Massachusetts, Rhode Island, and Delaware.
What this means for physicians: Not only will this bill promote laws protecting patients from unexpected medical costs, it will also help establish fair reimbursement standards for healthcare providers, and boost payer transparency. Physicians, especially those in emergency care, should familiarize themselves with the specifics.
State healthcare legislation update
Here’s a look at some of the other key legislative actions that were taken on the state level during the month of June that may affect your practice.
Maine legalizes assisted suicide. Joining seven other states (CA, CO, HI, NJ, OR, VT, and WA) and the District of Columbia, Maine has approved legislation that gives some terminally ill patients the legal option to pursue medically assisted suicide. Governor Janet M. Mills singed the Death with Dignity Act into law, and issued an executive order mandating tracking of the use of the law by the state.
This legislation holds that mentally competent adults who have terminal diseases that will result in their death within 6 months may request medication to end their lives. Patients must make one written and two verbal requests for the lethal medication, with waiting periods between the requests and receipt of the prescription for the medication.
What this means for physicians: Both the American public and medical professionals remain deeply divided on the mores and legality of medically assisted suicide, and this legislation may put many physicians into an ethical quandary. For guidance, the American Medical Association has included statements both for and against this practice in their code of medical ethics. If you live in any of these states, familiarize yourself with the specifics—paying close attention to the protocol for verbal and written requests—and the exact timing of the waiting periods that are required.
California re-ups on Affordable Care Act non-coverage penalty. In California, there are currently 22 bills before the legislature geared towards making health care more affordable and accessible to Californians. Most recently, the California legislature voted to impose a tax on individuals who do not have health insurance, essentially reimplementing a key part of the Affordable Care Act, which was struck down by Republicans in Congress in 2017. The current bill that proposes enacting a penalty for non-coverage was passed by the Democrats in the state assembly, with no Republicans voting for it, and one Democrat voting against it.
It is now in the hands of Governor Gavin Newsom who had proposed something similar in January 2019, and will likely approve it. Similar laws have been passed in Massachusetts, New Jersey, Vermont, and Washington, DC.
A trailer bill attached to the original bill also specifies that the monies the state collects as a result of the penalty will subsidize health insurance premiums for Californians who earn as much as six times ($75,000–$130,000/year) the federal poverty limit. Since the majority of Californians who paid the penalty in 2014 had taxable incomes of $50,000 or less, some argue that this is taking money from the poor and giving it to those who are richer.
The penalty would not apply to illegal aliens, prisoners, or American Indian tribe members.
What this means for physicians: The bottom line here is that more of your patients will be insured, and be able to seek and pay for healthcare.
New York doesn’t pass single-payer law, but still optimistic. The single-payer healthcare law—universal healthcare (financed by taxes) that covers the costs of essential healthcare for all residents—is a proposal that has languished in the New York legislature for nearly 20 years, did not pass. Democrats and Republicans, however, agreed to hold more hearings with healthcare experts, and are hopeful that they will be able to craft legislation that receives bipartisan support and will be passed in the near future.
What this means for physicians: The passage of a law to make universal coverage for every resident of the state of New York would set a precedent and possibly influence legislation in other states—not to mention a possible move toward a single-payer system on a federal level.
“This matters nationally. If a state like New York were to pass single-payer, the nation would arguably follow suit. That is roughly what happened with the Children’s Health Insurance Program, which began at the state level about a decade before it was enshrined in federal law. Much has been made of the Trump administration’s likely refusal to grant a waiver to redirect certain funds to the New York Health Act. But [Richard] Gottfried [who has sponsored the pro-single-payer New York Health Act for nearly 30 years] said that while federal cooperation would certainly ease the way, ‘we can do it legally without federal waivers,’” wrote Raina Lipsitz in The Nation.
These are just some of the many legislative happenings throughout the country. Healthcare has become a priority for the nation, and you can expect to see more attention focused on lowering costs for patients, as well as improving both access to care and provision of care in the coming year. Pay attention, get involved, and be aware of what these changes will mean for you as a provider.