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Federal and State Healthcare Reform Activities

Federal and State Healthcare Reform Activities

By Ken Ruotolo, Chief Operating Officer, Jul 10, 2017, 3 Minute Read

At the Federal level, the Better Care Reconciliation Act (BCRA), the Senate’s version of healthcare reform, remains stalled, with conservative Republican senators asking for more extensive modifications to current law (the ACA), while moderate Republican senators are asking for fewer changes. Senate leader McConnell is amending the bill to address these concerns. After modifications are in place, the Congressional Budget Office will “score” the bill again to determine its impact on the number of insured, likely affect on premiums and on the federal budget. Senate watchers think that McConnell would like to put the BCRA to a vote before the Senate leaves for a month-long recess in August.

Other items being considered:

California Reform Activities

SB 562 – the Single-Payer bill – was put on hold by the State Assembly on June 22. Assembly Speaker Anthony Rendon, said the bill:

“…was woefully incomplete. Even senators who voted for SB 562 noted there are potentially fatal flaws in the bill, including the fact it does not address many serious issues, such as financing, delivery of care, cost controls, or the realities of needed action by the Trump Administration and voters to make SB 562 a genuine piece of legislation.”

With that action, the Assembly Speaker ended any chance that SB 562 would progress during the remainder of the 2017 legislative session. However, it was drafted as a two-year bill and proponents are expected to reintroduce it in 2018. Presumably, they will work on the bill’s shortcomings in the interim and if changes at the federal level threaten consumers’ ability to get or pay for care as enjoyed under the current system, the bill may garner much broader support next year.

AB 72 – the “No Surprise Bills” law – passed the legislature and was signed by Governor Brown in late 2016. It took effect on July 1, 2017. The law protects individuals from being balanced billed by out of network (OON) providers when receiving non-emergency services at an in-network facility. Individuals covered by private plans regulated by the California Department of Insurance or the California Department of Managed Healthcare are protected by AB 72, those covered by plans regulated by the Department of Labor (typically self-insured plans) are not protected by this new law.

Starting July 1, if an OON provider delivers services without advance consent from the covered individual (via a process specified in the law), the individual will only be responsible for their portion of in-network cost-sharing. No more surprise OON billing. The provider is reimbursed by the insurance carrier the greater of 125% of the Medicare rate for the service or the average contracted rate for that carrier in that region. This Kaiser Health News article illustrates how surprise balance billing can have a big impact on individuals and this Fact Sheet from Health Access and the California Labor Foundation provides an excellent, consumer-oriented description of the key provisions of the law.

If the law functions as intended, unapproved balance billing will be eliminated, brokers and agents will need to resolve fewer claims issues on behalf of clients and individuals will have a better experience with their health insurance product.

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