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Lawmakers Mulling Health Care Changes

Health Care Reform and Policy
by Kimberly Shores
Lawmakers Mulling Health Care Changes
Lawmakers Mulling Health Care Changes

The health care landscape in the U.S. has changed a lot in recent years and lawmakers continue to try fine-tuning various aspects of the issue. Indeed, "health care reform" has been a major driver of news stories for more than a decade and there are no signs lawmakers will tire of working to ensure consumers get the best possible care.

However, the Centers for Disease Control and Prevention recently found that over the course of 2018, the number of people across the U.S. without health insurance slipped by 1.1 million, with a total of 30.4 million Americans falling into these coverage gaps. That represents some 9.4% of all residents, up from 9.1% a year before. The good news, though, is that even with this setback, about 18.2 million more people have coverage than in 2010, before the implementation of the Patient Protection and Affordable Care Act.

Meanwhile, the share of children under the age of 18 who are uninsured has grown, rising to 5.2% from the 4.5% seen in 2015. In addition, the percentage of adults under 65 who were without insurance at the time of the interview rose once again on an annual basis, as did the share of people who had been uninsured for at least part of the previous year. 

What's being done?
With concerns obviously still lingering on Capitol Hill about national health care law, legislators in the House of Representatives recently advanced a bill with two intentions. The first of these will overhaul how prescription drugs are allowed to be priced, as well as new changes that help the federal government reduce uninsurance rates nationwide.

Vox notes that the rule changes around drug pricing are popular on both sides of the aisle, as regardless of political leaning, lawmakers seem to generally agree that prescriptions cost more than they should and are difficult to afford even for many Americans who have coverage.

The other aspect of the bill is likely to prove less popular, as it would give states funding to start their own insurance marketplaces (thus moving themselves off the federally run Healthcare.gov model), boost the power of state and federal agencies to sign people up during the open enrollment period, and alter rules relating to lower-cost "association" health insurance plans that are intended only for short-term use.

It remains to be seen whether this bill will pass, given that the latter provisions could be a deal-breaker for many in the Senate and, certainly in the Oval Office, where the goal is to reduce the role the federal government plays in the exchanges.

The White House weighs in
Another bill federal lawmakers are now pushing for, which has a greater chance of passing into law sometime later this year, would increase pricing transparency around health care to help people avoid shockingly high costs they didn't know were coming. President Donald Trump recently held a press conference urging lawmakers to put aside party differences and pass the bill - part of a larger health care reform package currently being worked on in the Senate - that could protect millions of Americans.

"Surprise bills" involve people being charged far more than they expected for health care, typically because the provider treating them is out of their insurance network. Often, these surprise charges can run into the tens or hundreds of thousands of dollars, and even insured patients will face these incredible costs out of pocket. In some cases, procedures that cost less than $100 can lead to bills in the five figures.

Included in the law are provisions that would prevent people from being charged for out-of-network emergency care with which they didn't agree, requirements that costs for scheduled non-emergency care be more clearly explained and a prohibition on out-of-network billing from providers patients did not personally choose. Trump also noted that more legislation to reduce surprise billing is on the way in the near future.

At the state level
While all this is going on in the halls of Congress, individual states are also working to tackle various issues related to shoring up their health care environments. The state of Washington recently passed a bill creating a public health insurance option that would allow people to sign up for insurance run by the state government, rather than through private insurers. Likewise, Connecticut is considering a bill that would allow workers at small business in the state to sign up for insurance through the system that insures employees of the state government, providing what would effectively be a public option for many, but not all, residents. 

Meanwhile, California seems to be edging closer to a law that would bring back penalty fines - this time at the state level - for those who go without health insurance, an idea that has not necessarily been popular with consumers in the past.

Obviously, there is a lot to unravel as the nation continues to work toward a more efficient and cost-effective health care system. Insurance companies, brokers, lawmakers and consumers alike would be wise to keep a close eye on any proceedings that would affect them directly. With the way the landscape is shifting, how the entire system works just a few years from now could be very different from what it is today.



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