A new effort to limit and standardize out-of-pocket costs…

Earlier today, Health Access was proud to join Assemblywoman Fiona Ma (D-San Francisco and San Mateo Counties), the MS Society, and other health advocates and patients, to a press conference in support of AB1800, a measure to implement a key aspect of the Affordable Care Act in limiting out-of-pocket expenses.

The proposal would implement a capped deductible on out-of-pocket expenses in the amount of $5,950 for a single patient, or $11,900 for a family of any size. This deductible would pay for all out-of-pocket (OOP) costs for covered benefits including: doctor visits, lab tests, and prescriptions for patients that have cancer, Multiple Sclerosis, HIV and other chronic conditions that are costly to manage.

Too often, patients are tricked or confused by having multiple deductibles for different categories of treatment, such as for prescription drugs.

Also, as current law stands, out of pocket expenses have no limit. The hefty bills associated with expensive “specialty tier” drugs prescribed to patients like Mary Ann Braubach, who spoke at the press conference and has been living with Multiple sclerosis for fourteen years, costs tens of thousands of dollars each year. AB1800 would ensure insurance plans do not continue to pass the buck on to patients.

AB1800 seeks to alleviate the stress of unexpected bills for the more than 1.9 million Californians who spent over $3 billion dollars in out-of-pocket expenses in 2011 alone.

AB 1800 would also strengthen the independent medical review process by allowing patients like Mary Ann, to appeal to the California Department of Managed Health Care when their health plans deny their doctor’s recommended prescription or treatment.

This effort is another step making the promise of the new federal Affordable Care Act real for many Californians, and preventing insurance company shenanigans in how they design their benefits. If signed, it would introduce the limit on out-of-pocket expenses in 2013, a year earlier than the federal law requires, and it also would go beyond the federal law in applying to grandfathered plans, so all Californians get the benefit.

Patients should have confidence that their coverage will be there for them when they need it. This aligns with the federal health reform goal to prevent families from having to choose from facing significant medical debt, or going without needed treatments.

Health Access California promotes quality, affordable health care for all Californians.
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