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Tuesday, July 14, 2015

Tackling Health Care Challenges in the States: Legislative Roundup

Patrick Willard

Senior Director of State and National Strategic Partnerships

While Congress wrestles with budget reconciliation and takes another swipe at the Affordable Care Act, most state lawmakers are back at their day jobs and finished with legislative business for the year. The 2015 sessions produced a few highlights, and some lowlights, for health care advocates. Lawmakers continued to grapple with full implementation of the ACA, but some looked beyond the health care law to move their states toward a health reform 2.0 agenda. Below we note some of the significant work this year in state capitals.

Medicaid expansion alternative finds a silver bullet—While Republican governors in Tennessee, Wyoming, and Utah were unable to win approval for their Medicaid expansion programs, Montana managed to adopt its own version of the program. Montana used a legislative procedure known as a “silver bullet” to bring the Health and Economic Livelihood Partnership Act to the floor and pass it with a majority vote. Montana Women Vote and the Healthy Montana Coalition succeeded in getting 10,000 calls to lawmakers to support the HELP Act

Covering undocumented residents in California—California legislators continued to work on legislation to provide health coverage for all low-income state residents. In a big step for inclusive health coverage, the legislature provided $40 million in funds to enroll undocumented low-income children under a state health care program regardless of immigration status. The effort is expected to provide coverage for an estimated 170,000 children when fully funded. On its blog, Health Access California described the victory, “California will be the largest state to make this commitment to cover all its children (along with NY, IL, WA, MA and DC), regardless of where they were born, and we expect additional steps in short order.” 

Health Access is supporting a broader bill to cover undocumented low-income adults, SB 4, which passed in the Senate in a historic vote, but still awaits consideration in the assembly. More details about the California program will follow in a blog from the Health Equity team.

Protecting consumers against surprise medical bills—Advocates in New York led the way in fighting surprise medical bills last year. In 2015, Texas was among the states that challenged the practice where consumers unknowingly face charges from out-of-network providers. The surprise bill is also known as a “balance bill” because the charge is the balance of the amount after the insurer pays the out-of-network provider. A new law in the Lone Star state will allow patients who use in-network facilities to challenge surprise bill charges above $500 for out-of-network care from radiologists, anesthesiologists, pathologists, emergency department physicians, neonatologists, or assistant surgeons. The patient can seek mediation to address the balance bill. After opposition from medical providers to the original proposal, which would have allowed for mediation regarding balance bills of any amount, the legislation was scaled back. 

“The legislature made progress to limit surprise medical billing, yet Texans still risk getting stuck with expensive bills from in-network hospitals,” noted the Center for Public Policy Priorities in its legislative wrap-up. California and Florida have also adopted legislation to address balance billing charges.

Omnibus health care bill brings reforms to Connecticut—Legislators in the Nutmeg State sought to improve the health care system in a comprehensive bill that addressed the trend of hospital sales and mergers. In addition to tackling requirements for hospital sales, the new law includes an array of measures to protect consumers, increase transparency, and create a statewide health information exchange for health records. “The passage of this bill is promising for Connecticut—we are, yet again, pulling out ahead in health reform,” the Universal Health Care Foundation of Connecticut reported on its blog. 

Among the consumer measures in the legislation are requirements for insurance companies to provide information on the cost of medical care on a website and through a toll-free number. The new law also prohibits balance bills for emergency treatment and for non-emergency treatment without advance notice.

Bills about telemedicine and experimental cancer drugs proposed

Other notable trends in legislatures this year included increasing attention on insurance coverage for telemedicine and “right-to-try” legislation. The right-to-try bills are modeled on a Goldwater Institute proposal to allow cancer patients to gain access to experimental drugs (read the Health Affairs blog, How State Right-to-Try Laws Create False Expectations, for concerns about these bills). Incidentally, the bills are being considered in many conservative states like Tennessee where lawmakers are turning down Medicaid expansion. 

While most legislatures have adjourned their 2015 regular sessions, several will continue through the balance of the year, including Michigan, New Jersey, Ohio, Pennsylvania and Wisconsin, which meet year round. Other states that traditionally continue to meet include California and New York and Massachusetts. Lawmakers in these state will likely consider additional health care legislation this year, including Medicaid expansion waiver proposals in Michigan.