Network Adequacy

Close-up on AB 533 (Bonta): Protecting Consumers from Surprise Medical Bills

Consumers know they can save money and limit their out-of-pocket costs by going to an in-network provider.  Too often, however, consumers who do the right thing by going to an in-network hospital or facility end up getting a surprise bill by a doctor who turns out not to be in-network. According to a recent survey by Consumers Union, nearly one in four Californians have received a surprise medical bill after a hospital visit or surgery with the price they are asked to pay an out‐of‐network rate when they thought the provider was in‐network. These surprise or “gotcha” bills can add up to hundreds, even thousands of dollars, driving some patients into medical debt. The consumer is stuck paying the bill […] Read More

Medi-Cal and Medicare Turn 50–With Much To Celebrate & Room for Improvement

As we celebrate how much help Americans have gotten from Medicare and Medicaid after 50 years, including the many improvements to both programs from the Affordable Care Act, we are reminded of the work left to do. In particular, we need to close the gaps in both programs to cover the remaining uninsured. Building on the success of Medicaid, Medicare, and the ACA, California can make more progress toward the goal of health for all with bills like SB4 and SB10, while strengthening the health care system on which we all rely. Medi-Cal’s Central Role in California Covering more than 12 million Californians, nearly one-third of the state population, Medi-Cal is a critical pillar of California’s health care system.  Thanks to the Affordable Care Act, […] Read More

DMHC Hearing on Blue Shield Acquisition of Care1st Gets at Larger Questions on Nonprofit Obligations

Yesterday’s hearing (covered today in the LA Times) on nonprofit Blue Shield of California and its bid to acquire for-profit Medicaid managed care plan Care1st provided better clarity on the issues at stake in the $1.25 billion transaction, and little reason to doubt whether the assets Blue Shield proposes to use should be subject to charitable trust obligations. The comment period is open through this Friday, June 12 (details below), for the public to raise their issues and concerns. Health Access submitted comments with Consumers Union and other consumer groups on the charitable trust issues, and also published a recent issue brief/discussion draft on the obligations of a non-profit insurer in a post-ACA world. Requested by Consumers Union, Western Center on Law and poverty, CALPIRG, and Health Access, […] Read More

Kaiser Family Foundation Survey Findings Affirm Results of State Reform Efforts to Date and Consumer Advocates’ Legislative Focus Two Years into Affordable Care Act

Findings from a recent Kaiser Family Foundation survey of low and moderate income California residents, released yesterday, suggest the state is generally on the right track in ACA implementation, specifically in its choice to build a robust “active purchaser” exchange and to target communities with the largest coverage gaps. Those and other priorities of Covered California are paying off—starting with dramatic reductions in the state uninsured rate, the fact that enrollment of communities of color are very close to academic estimates, and in the slower rate of growth in premium costs. Survey findings further suggest the need to build on the state’s reform efforts through legislation and targeted appropriations that consumer advocates are seeking.  Though it may be purely coincidental, it’s fitting […] Read More

The LA Times weighs in…

The LA Times editorial board endorsed two Health Access California-sponsored bills this weekend to prevent surprise out-of-pocket out-of-network costs. SB137(Hernandez) would require real-time accurate and standardized provider directories; AB533(Bonta) would ensure that consumers who go to an in-network hospital or facility does not get out-of-network bills from any of the doctors or other providers they may encounter. The entire editorial is worth reading, but here’s an excerpt: “…people want to know before they sign up for a narrow network plan whether they’ll be able to keep the doctors they like, or how far they’d have to travel to see someone willing to take new patients. And in too many cases, they’ve enrolled only to be turned away by doctors who […] Read More

Health Committees Vote….

This week we had key policy committee hearings, in advance of the end-of-the-month deadlines to pass bills. Yesterday, in the California Assembly Health Committee, numerous key bills advanced. Surprise Bills: Our sponsored legislation, AB533(Bonta) passed on a 17-0 vote, to prevent consumers from getting out-of-network bills when going to a in-network hospital or facility. Even when patients do the right thing and make sure to go to an in-network facility, these “surprise bills” can amount to hundreds if not thousands of dollars and put a family’s finances at risk–if not prevent lower-income patients from getting needed care. Broad support for the bill came from consumer groups like Consumers Union, labor groups, and insurers. Assemblyman Bonta recognized that all stakeholders agreed […] Read More