Surprise billing, also called surprise out-of-network balance billing, is a common problem when, through no fault of their own, families receive medical treatment from an out-of-network provider. The surprise comes in the form of doctor bills for the difference between what a provider charges and what the insurer pays that provider. Congress is currently considering legislation to address this problem for families all over the country. This piece describes the legislation under consideration in Congress and Families USA’s recommendations for a Congressional fix to this problem.
On April 18, 2019, the Trump Administration finalized the Notice of Benefit and Payment Parameters for 2020 (NBPP). This rule will govern health insurance marketplaces and set the framework for insurance companies to propose plans and premium rates for 2020. Consumer advocates achieved several important victories in the final 2020 NBPP. Contrarily, the final rule also establishes harmful changes that will decrease access to high-quality, affordable coverage and care for families across the country.
Final “Public Charge” Rule Discriminates against Lawfully Present Immigrants and Visa Applicants, Harming Health
The Department of Homeland Security (DHS) has published a final rule, scheduled to go into effect October 15, 2019, that takes direct aim at middle- and lower-income immigrants who are lawfully residing in the United States, or who seek visas to come to the U.S. Under the new rule, DHS will determine whether, given the “totality of circumstances,” people are “more likely than not” to receive certain public benefits over the course of their lifetime; if DHS finds that they are likely to receive those benefits, they may be denied lawful permanent residency or visas.
On July 9, 2019, the Fifth Circuit Court of Appeals in New Orleans will hear oral arguments in the case Texas v. United States. This case threatens access to health care and financial security for millions of Americans. In December 2018, U.S. District Court Judge Reed O’Connor issued a dangerous ruling that would strike down the entire Affordable Care Act (ACA), including provisions that:
Health and Health Care in 2019 Legislative Sessions: States Step Up on Public Options, Coverage, Drug Pricing, and More
On March 26, 2019, the chairs of three House committees with jurisdiction over core health care issues jointly introduced legislation that would lower health care costs for millions of people. The "Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019," would: increase financial assistance for families who buy their own insurance, without help from Medicaid, Medicare, or an employer; protect people with preexisting conditions by repealing Trump administration policies that sabotage the safe operation of insurance markets; and take other steps to help consumers understand and sign up for coverage.
On May 16th, the Centers for Medicare and Medicaid Services announced a final regulation for Medicare’s Part D drug benefit for 2020. The regulation backed off of a proposal that would have created significant exceptions to requirements that Part D plans cover all drugs in six “protected classes”.
Oral Health Coverage in the 2019 State Legislatures: Victories, Budget Cuts, and Opportunities for Future Progress
Comprehensive oral health coverage allows us all to have better oral health, better overall health, and improved quality of life. Yet oral health coverage and care remain out of reach for millions of people in America — particularly adults who rely on Medicare and Medicaid for their health coverage. Many states, however, are realizing and elevating the importance of oral health as they improve dental coverage for adult Medicaid participants.
High and rising drug prices jeopardize consumers’ health and well-being.1 To address the harms of high drug prices, families across America want and deserve meaningful reforms that target and reduce the underlying “list” prices of drugs. Polling shows that nine out of 10 voters support allowing the government to negotiate lower drug prices in Medicare.2