Texas' lawsuit over the Affordable Care Act could roll back protections for pre-existing conditions even among people who don't get their coverage through the Affordable Care Act.
Why it matters: These protections are the most popular part of the ACA, and have led to a lot of sick people getting coverage. Millions of people could lose all or part of that security if this lawsuit succeeds.
How it works: Before the ACA, the federal privacy law known as HIPAA prevented employer-based insurance plans from denying employees coverage because of a pre-existing condition or charging those employee a higher premium. The ACA extended similar protections to people who buy insurance on their own.
Yes, but: There's a chance some of the HIPAA protections could go away if Texas' lawsuit succeeds, because of the way the ACA incorporated them, Kaiser Health News reported.
Republican attorneys general want the courts to strike down the entire ACA, while the Trump administration says only its protections for pre-existing conditions should fall.
Staggering surprise medical bills are finally getting some scrutiny from policymakers. But to take patients off the hook for those bills, the money has to come from somewhere else — usually from higher insurance premiums or out of doctors’ bottom lines.
The big picture: Getting an unexpected bill for thousands of dollars is a gut-level problem. Yet that problem is a product of the health care system’s complexity, and every potential solution runs into roadblocks from an industry that wants to protect its profits, or skepticism from policy experts or political opposition.
How it works: Surprise hospital bills frequently stem from a practice known as “balance billing.”
Putting a stop to balance billing requires shifting the cost to someone else or reducing the size of the bill, or both.
"Far and away the biggest challenge is deciding on the 'right price,'" the American Enterprise Institute's Benedic Ippolito said.
Balance billing is especially common for emergency-room care, where patients are often in no position to inquire about their insurance networks.
What we're watching: Most state laws so far have stopped short of imposing direct price caps on providers, and they can still adjust to avoid profit losses. But that may be unsustainable.
Even in California, one of the nation's most liberal states, industry pressure and moderate lawmakers have stymied ambitious efforts to control health care costs.
Why it matters: As the national Democratic Party swings left on health care, California shows that even with strong liberal majorities, it's still an uphill battle to successfully chip away at the health care industry's bottom line.
Details: Even aside from California's failed single payer bill, more substantively realistic proposals have hit roadblocks, too.
An ambitious bill to cap dialysis payments also died, after Gov. Jerry Brown vetoed it late last month. The dialysis industry is now working to defeat a related ballot initiative that would cap dialysis clinics' profits.
There are exceptions. California has passed laws regulating pharmacy benefit managers, requiring a justification for prescription drug price hikes above a certain amount, and creating more oversight of health plan mergers.
Yes, but: California has so far had a lot more success expanding coverage and defending the Affordable Care Act than in controlling costs — widely seen as the next big health care debate.
What's next: California lawmakers will likely continue to duke it out over high-profile efforts like the all-payer bill, but they will also continue to focus on coverage-related issues, like increasing the Affordable Care Act's subsidies.
"There are now high expectations for what a new governor might do beginning next year," Levitt said.
