Legislature(2017 - 2018)CAPITOL 106
03/29/2018 03:00 PM HEALTH & SOCIAL SERVICES
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HB 193-HEALTH CARE; BALANCE BILLING 3:08:40 PM CHAIR SPOHNHOLZ announced that the next order of business would be HOUSE BILL NO. 193, "An Act relating to insurance trade practices and frauds; and relating to emergency services and balance billing." [In front of the committee was Version T, adopted as the working draft on March 8, 2018] 3:09:06 PM RYAN JOHNSTON, Staff, Representative Jason Grenn, Alaska State Legislature, offered a brief recap of the proposed bill, HB 193, stating that the bill was effectively a ban on balance billing for medical providers, while also instituting a hold harmless clause for insurance providers. He explained that the bill would only remove a patient from this billing situation in emergency situations. 3:09:38 PM CHAIR SPOHNHOLZ opened invited testimony on HB 193. 3:09:57 PM ANNE ZINK, MD, Alaska American College of Emergency Physicians, paraphrased from a letter of support, dated March 28, 2018, which read: [included in members' packets]: 3:10:35 PM Representing more than 80% of the emergency physicians providing emergency medical care to the people of our state, the Alaska Chapter of the American College of Emergency Physicians writes today to support HB193. HB 193 will protect patients and families across the state from the high costs and sticker shock that can come from "surprise medical bills." Both doctors and patients support this important measure, which will provide consumer protections for patients, strengthen access to care, and put an end once and for all to surprise bills. As emergency physicians in Alaska, we know firsthand about the gaps in patient healthcare coverage that can cause patients to postpone or avoid treatment until it's too late. According to a national survey, 44% of people reported that they didn't seek treatment when they were sick or injured because of costs. At the same time, 35% of Americans would have trouble paying their regular bills if faced with a $400 health emergency. This is alarming, but not surprising, and we must work together to ensure that patients can safely access emergency care without worrying about going bankrupt. What good is insurance if it fails us in an emergency? Insurance companies are shifting hundreds of millions of dollars in costs to patients and doctors each year through higher premiums, deductibles and cost-sharing requirements. At the same time, Alaska insurance companies are narrowing their networks making them smaller through limiting access to doctors and care, which means fewer options and choices for patients and creating large coverage gaps where care patients thought would be covered, turns out not to be. These gaps are leading to surprise bills, adding even more costs for patients. Alaska patients and families deserve better. Right now, the state has a regulation in place that requires insurance companies to cover these unexpected out of network costs during emergencies through fair and appropriate payments to doctors. But, Alaska insurance companies are working to undermine this regulation and we need your help to ensure patients are protected in the long run. We're working to support a new bill, HB 193, that will end surprise billing altogether and provide the protection patients need. HB 193 is a comprehensive solution that protects patients and ends surprise bills by requiring insurers to cover unexpected, emergency out of network care, and limiting patient financial exposure. HB 193 will protect patients from receiving large bills that their insurance companies have refused to pay. By establishing an appropriate and fair reimbursement standard between insurers and doctors, the bill takes patients out of the middle and improves access to care. HB 193 sets a fair minimum standard, the 80th percentile rule that has been working in Alaska since 2004, which insurers use as a benchmark to pay out-of- network physicians, providers or facilities for unexpected care. HB 193 bans balance billing, meaning no further bills would go to patients in these situations. Because doctors will be payed fairly, there is no need for additional bills. Despite negative attention created by misleading information by insurance companies, patients support the 80th percentile rule, and want their insurance plans to fairly cover out-of-network emergency care. The 80th percentile rule relies on transparent market- based information that takes into account local market prices for services. They are based in market costs and not set by government or manipulated by insurance companies. Although critics have claimed that providers with extremely large market share can impact prices under this standard, there's no evidence or report of foul play. ISER (UAA's Institute of Social and Economic Research) is currently looking at this issue for Alaska. Research in New York State has shown that a similar standard did not increase cost after its implementation there. Without the 80th percentile rule in HB193, patients will be left unprotected as insurance companies shirk their responsibility to pay. In fact, insurance companies would be allowed to set any rates they wanted with no regard for costs or impact on emergency room staffing or services. Alaska patients and families need this full protection from surprise bills. This bill with strengthen the healthcare system, offering protection first and foremost to patients, and ensuring the doctors and emergency rooms can keep their doors open and keep staffed with needed specialists and providers to best treat patients in emergencies. We hope we can count on your support for HB 193. 3:12:28 PM REPRESENTATIVE JOHNSTON, noting that there were two major insurance providers in Alaska, asked if her business was currently in-network for either of those providers. DR. ZINK expressed agreement that her group was in-network. REPRESENTATIVE JOHNSTON asked if her group contracted with out of network physicians. DR. ZINK replied that her group covered the emergency department at the Mat-Su Regional Medical Center, and, as they billed as a unified group, they were in-network with all the major providers. She explained that most providers wanted to be in- network and did not want to shift that burden to patients. She stated that they did not have any contract negotiations, and, as they were busy with patients, they "just take what the insurance companies give us." She declared "that's the reason why this legislation is really important." DR. ZINK expressed her agreement with Representative Johnston, that the bulk of their emergency room visits, if insured, were in-network. 3:14:00 PM REPRESENTATIVE JOHNSTON asked about the operations in other emergency room facilities in Alaska. DR. ZINK replied that there was a similar model throughout the state for emergency providers, that most were independent groups contracted with a hospital. She pointed out that the networks were shrinking in the Lower 48, resulting in larger insurance gaps. She expressed her hope that this proposed legislation would get in front of that. She declared that her group did not send many balance bills, although this was a huge issue in the Lower 48. 3:15:04 PM CHAIR SPOHNHOLZ opened public testimony on HB 193. 3:15:33 PM SAMI ALI, MD, Alaska Emergency Medicine Associates, explained that her group of physicians staffed the emergency room at the Providence Alaska Medical Center and provided care to all patients who came through the emergency room. She pointed out that the facility did not use mid-level providers. She asked that the 80th percentile rule be preserved to prevent any reduction in quality care or to accessibility for medical care for patients in Alaska. She declared support for proposed HB 193 as it would enable physician groups in Alaska to recruit and retain high quality physicians, as this was a difficulty in Alaska. 3:18:38 PM STEVEN COMPTON, MD, President, Alaska Heart and Vascular Institute, stated that practicing cardiology in Anchorage was a challenge, as it was difficult to recruit physicians to come to Alaska. He reported that to attain the same ratio of cardiologists to population as the Lower 48, it would be necessary to more than double the number of cardiologists in the state. He noted that, as the Baby Boomer demographic was entering the age for needing more cardiology care, the demand for services had "accelerated tremendously in the last decade and will continue to do so," and that the state was already underserved. He stated that it was a fundamental commitment of his organization to provide care to anyone who walked through the door. He reported that his group served 30 percent of the state Medicare population, and noted that all Medicare clinics lost money and were heavily subsidized by the hospitals. He said that the "way we keep the lights on is by cost shifting." He explained that the Medicare charges were paid with funds from private payers, allowing them to maintain access to care. He declared support for the proposed bill. 3:23:10 PM CHAIR SPOHNHOLZ closed public testimony on HB 193. 3:23:28 PM REPRESENTATIVE ZULKOSKY moved to report CSHB 193, Version 30- LS0466\T, Wallace, 3/6/18, out committee with individual recommendations and the accompanying fiscal notes. There being no objection, CSHB 193(HSS) was moved from the House Health and Social Services Standing Committee.