The California Assembly adjourned Saturday morning without passing legislation to prevent patients from facing surprise out-of-network bills after they get care in in-networks hospitals or other facilities. AB533 (Bonta), sponsored by Health Access California, would have held consumers harmless for surprise bills reflecting out-of-network charges that were outside of their control (See separate AB533 fact sheet).
A broad coalition of consumer groups, insurers, the California Labor Federation and the California Chamber of Commerce) actively supported the measure, but the California Medical Association and related physician groups pulled out all the stops in a vigorous day of lobbying. The bill was “on call” throughout the day, with the vote total building each time the vote was called, but never making to the 41 votes needed for passage, even at the last vote of the night.
Health Access plans to bring the issue back, given the widespread impact of these “surprise bills”: a recent survey by Consumers Union found 1 in 4 Californians received a surprise medical bill. Even the most careful consumers can end up being treated by an out-of-network provider at in-network facility only to receive a surprise bill for the difference between the provider’s charge and what the health plan pays—after the fact. That difference can run into hundreds or thousands or even tens of thousands of dollars–an amount that could easily destabilize family finances or damage personal credit. Examples include a consumer goes to an in-network imaging center, only to find that a non-contracting radiologist he’s never even met was responsible for reviewing the film, or a consumer who selects an in-network surgeon for an operation at an in-network hospital or surgery center but the bill he opens in the mail says the anesthesiologist is a non-contracting provider. Many legislators recounted their own experience with unfair surprise bills.
This is the farthest this type of patient protection has advanced in the California legislature–just a few votes away from passage. And in each of the Assembly districts, thousands of patients will get “surprise bills” and may be informed that it was the vote of their Assemblymember that prevented the remedy–but that the issue will be returning. Those dealing with this problem should consider sharing their story for next year’s effort (click here).
TOBACCO CONTROL: The other disappointment of the night was that there was no vote on the tobacco control legislation pending–proposals from a tobacco tax to regulating e-cigarettes to raising the age to purchase cigarettes to 21. All of those measures are in special session, so there is not the same deadline as there was for regular legislation–but practically the Legislature is expected not to return until January of 2016.
OTHER LANDMARK PATIENT PROTECTION LEGISLATION PASSES TO GOVERNOR’S DESK
Several measures against unfair out-of pocket costs were passed and sent to the Governor over the last week, including:
- SB137 (Hernandez): would require accurate, standardized, and updated provider directories by health plans. Recent surveys by the Department of Managed Health Care found that 25% of the directories of two major health plans were found to be inaccurate or out-of-date (see separate SB137 fact sheet).
- AB339(Gordon) to require insurers to cover medically necessary prescription drugs and limit cost-sharing on specialty drugs and other needed medications. The bill ensures coverage for drugs for which there is no therapeutic equivalent; prohibits placing most or all of the drugs to treat a condition on the highest cost tiers of a formulary; requires formularies to be based on clinical guidelines and peer-reviewed scientific evidence; places monthly cap on specialty drug cost sharing; and more (see separate AB339 fact sheet).
These bills join the following bills already sitting on the Governor’s desk:
- AB1305 (Bonta) would ensure an individual patient does not face higher out-of-pocket costs just because they are in family plans, closing a potential loophole in the out-of-pocket maximum protections in the Affordable Care Act (see separate AB1305 fact sheet).
- AB 248(R. Hernández) Minimum Value Guarantee for Large Employer Coverage, to prohibit the sale of subminimum coverage, defined as coverage with less than 60% actuarial value, by insurers to large employers. Such plans put workers in a double bind: with unmanageable costs for uncovered care; but because they took up that coverage, often unwittingly, they are automatically ineligible for premium subsidies through Covered California (see separate AB 248 fact sheet).
Several other bills that passed of note include a rate transparency measure SB546(Leno), and also AB1231(Wood) to ensure Medi-Cal coverage of nonmedical transportation for the purpose of getting rural patients timely access to care. Getting a bipartisan vote in both the Assembly and Senate was SB4(Lara), which provided technical improvements to make it easier for undocumented children to be enrolled in the expanded Medi-Cal program agreed to in the budget in June.
The Governor has until October 11, 2015 to sign these bills.
To urge Gov. Brown to sign each of these bills into law, follow these steps—separately for each bill you wish to support::
- For each bill, visit this link: https://govnews.ca.gov/gov39mail/mail.php
- Enter name and email address.
- Under Choose Subject, select Legislation Issues/Concerns
- Do not check that you want a reply (unless you do).
- Position: select Pro
- Write your email: keep it brief and to the point. For example:
“Please sign SB 137 into law. Provider directories should be accurate so that patients can shop for the best plan and get care at the right time and place.
- Click on Send Email.
Thank you for helping to bring these bills all the way to the finish line.