BIP Fall 2024

C Without transparency and a truly shoppable marketplace, consumers will continue to face crippling bills from out-of-network charges and rising out-of-pocket maximums. NABIP is driving change through the Healthcare Bill of Rights, community education and legislative action. The association aims to create a healthcare system where costs are clear, and consumers can confidently make informed decisions. Here’s an overview of how we arrived at this point and the proactive steps being taken to lower healthcare costs and enhance transparency. Healthcare billing’s notorious history Consumer protection in healthcare billing is critical to the future of American healthcare. ▶ NABIP is focused on advocating for consumer protection in healthcare billing, emphasizing the need for transparency and eliminating “surprise bills” resulting from out-of-network charges and high out-of-pocket costs. KEY POINTS

Rising healthcare costs are driven not only by the aging U.S. population but also by the lack of transparency and confusion around billing and networks. The Centers for Medicare and Medicaid Services (CMS) reports that in 2020, per-person healthcare spending for those 65 and older was over five times higher than for children and nearly two and a half times higher than for working-age adults. With the median age increasing from 30 in 1980 to 38.9 in 2022 and the 65+ population projected to grow from 17% in 2022 to 23% by 2050, according to the U.S. Census Bureau, these challenges will only intensify without clearer, more transparent health care practices. Out-of-network billing issues Medical care from out-of-network providers can create a significant gap between insurance coverage and actual costs, often leaving patients responsible for the difference — what the industry knows as balance billing. Historically,

▶ The association is actively supporting key legislation, including the Lower Costs, More Transparency Act and the PRICE Transparency Act, which aim to make healthcare costs more transparent and manageable for consumers, ensuring a shoppable healthcare marketplace. ▶ Despite progress with the No Surprises Act, challenges, including potential legal threats, remain. NABIP continues to work with Congress and coalitions to strengthen consumer protections and ensure transparency in healthcare billing practices.

36 bip magazine Fall 2024