Sep 27, 2019

The effects of California's surprise medical billing law

Illustration: Sarah Grillo/Axios

California's law prohibiting surprise billing has led to an increase in care delivered by in-network providers, according to a new analysis by the USC-Brookings Schaeffer on Health Policy initiative.

The big picture: The leading federal surprise billing solution is similar to the California bill in that it creates a benchmark payment rate for out-of-network care. Providers have lobbied fiercely against the approach.

  • But while provider groups have warned that such a policy would lead to doctor shortages and threaten patients' access to care, that's not borne out in the data, according to USC-Brookings.

By the numbers: There was a 17% decrease in the share of out-of-network services delivered by the affected provider specialties after the California law took effect.

  • Conversely, the share of in-network services increased from 79.1% to 82.6%.

Yes, but: What the approach likely does do is reduce providers' bargaining leverage with insurers, leading to lower overall payment rates.

  • As the NYT succinctly puts it, "Some doctors may be hurting from a pay cut, but that doesn't seem to be hurting patients."

Go deeper: We all pay for surprise emergency room bills

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New York's very expensive surprise medical billing solution

New York's surprise billing law — which providers hope will become the model for a national solution — has resulted in providers receiving some very high payments, according to a new analysis by the USC-Brookings Schaeffer Initiative for Health Policy.

Why it matters: Surprise medical bills impact two groups of people: The patients directly responsible for paying them, and the rest of us, who pay higher premiums as a result of their existence.

Go deeperArrowOct 25, 2019

House committee floats new proposal to ban surprise medical billing

Illustration: Aïda Amer/Axios

The House Ways and Means Committee is considering banning surprise medical bills and forcing the administration to decide how providers get paid for out-of-network care, according to a letter sent by Chairman Richard Neal to Democratic members.

The big picture: Payment resolution has sparked an intense fighting among insurers, hospitals and doctors.

Go deeperArrowOct 2, 2019

What's next for Walmart's employer-provided health benefits

Photo: Frederic J. Brown/AFP/Getty Images

Walmart is expanding its unique employee health benefit.

Why it matters: Walmart is the largest private-sector employer in the country, and it has taken a remarkably hands-on approach to seeking out quality in its health coverage — even when that comes at a considerable cost.

Go deeperArrowOct 3, 2019