BIP Fall 2024

“ Capping out of-pocket costs doesn’t mean those costs disappear. The costs have to go somewhere.” — MICHAEL ANDEL, VP OF CONGRESSIONAL AFFAIRS AT NABIP

surprise billing was most prevalent in emergency situations, but it also occurs in non-emergency care. In 2022, between 9% and 16% of non emergency in-network hospitalizations included surprise bills from out-of-network providers that patients did not select, according to the Kaiser Family Foundation. Ending surprise medical bills The landmark passage of the No Surprises Act in December 2020 marked a critical step in bipartisan efforts to safeguard patients from surprise medical bills. Based on survey data released by America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association (BCBSA), the law has prevented approximately 1 million surprise bills per month since its implementation in January 2022. A recent analysis by nonprofit FAIR Health of national claims data focused on specialties previ ously associated with surprise billing also found that the No Surprises Act is also leading to larger provider networks, a key part of the law’s goal to expand access to affordable, in-network care. Looking ahead Despite this progress, challenges remain, including lawsuits that could weaken the patient protections included in the landmark law. “While the No Surprises Act is succeeding in its two most important goals of protecting patients

from surprise medical bills and expanding access to affordable, in-network care, there are ongoing threats to the law’s safeguards,” says a spokesperson for the Coali tion Against Surprise Medi cal Billing. “The Coalition Against Surprise Medical Bill ing is eager to continue work ing with Congress and the administration to strengthen the law’s provisions moving forward and ensure all Ameri cans are protected.” Out-of-pocket maximum policies Out-of-pocket (OOP) maximum limits may cap annual healthcare expenses,

but they still impose a significant burden on most Americans. The ACA’s out-of-pocket limits are rising faster than wage growth, as reported by the Kaiser Family Foundation, leaving many consumers struggling with medical bills even before hitting their OOP limit. This financial strain forces many to delay or avoid essential care, including diagnostics and pre scriptions. The Commonwealth Fund’s 2023 Health Care Affordability Survey found that 60% or more of those covered by marketplace or individual market plans, Medicaid or Medicare reported that cost-related delays or missed care worsened their health conditions. However, simply lowering caps won’t solve the issue. “Capping out-of-pocket costs doesn’t mean those costs disappear,” says Michael Andel, VP of congressional affairs at NABIP. “The costs have to go somewhere.” Taking the message to the Hill NABIP has encouraged Congress to lower healthcare costs by increasing price transparency, ending surprise billing and ensuring site-neutral payment reforms. Two of the primary bills that NABIP supports are moving through Congress: The Lower Costs, More Transparency Act and The PRICE Transparency Act.

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