This week state legislators across the country are engaging in an annual week of action to lift up policies that promote economic opportunity and security for all families. Ensuring meaningful access to affordable, quality health care should be the foundation of any economic security agenda. As state legislators look for policy levers to address the uninsured rate, affordability of health insurance coverage and state-level protections against the Trump administration’s attacks on health care, here are the five policies we think should be at the top of their list.
1) Close the coverage gap.
Fourteen states continue to leave federal dollars on the table that would allow them to expand Medicaid coverage to more residents and improve the health and economic security of individuals and families in their communities. For example, North Carolina has the tenth highest uninsured rate in the country at 10.7 percent of its population. According to a new report from the North Carolina Justice Center, nearly 400,000 uninsured North Carolinians fall into this coverage gap because they don’t currently qualify for Medicaid and they earn too little to qualify for financial assistance to purchase a private health plan. They estimate that beyond expanding coverage, expanding Medicaid in the state would create approximately 43,000 new jobs by 2020 while bringing more than $2 billion in federal funds to the state.
With a supportive Governor and expansion bills filed in both chambers of the state legislature last week, North Carolina has the momentum to be one of the next states in line to close the coverage gap with hopes of several more to follow suit this year.
2) Expand coverage for immigrants.
Immigrant families have been the target of many unjust policies threatening their access to basic programs that safeguard their health and economic security. From federal action to change the “public charge” test and threats to the DACA program to the persistent fear of family separation, it’s clear that protecting immigrant families in the short-term must be done at the state level.
States like New York and California are leading the way as they look to ensure more immigrant families have access to health insurance coverage. Both states already cover immigrant children regardless of immigration status through public programs but are now considering more ambitious proposals to expand coverage to low-income adults regardless of immigration status.
3) End surprise balance billing.
According to a recent survey out of the University of Chicago, 57 percent of American adults have been surprised by a medical bill they thought would be covered, and 20 percent of those bills were the result of a doctor not being a part of a patient’s insurance network. Surprise balance billing occurs when providers directly bill patients the difference between what their health plan agrees to pay and what the provider charges. No matter what kind of health insurance you have a carefully planned visit to an in-network facility or an emergency visit to a local hospital could result in services delivered by out-of-network physicians like the anesthesiologist in the emergency room assisting a surgery. With the potential for tens of thousands of dollars in medical debt on the line, state policymakers should prioritize this issue when looking for ways to improve economic security for families.
As of 2018, 25 states have enacted laws offering some protection from surprise balance billing, but very few have passed comprehensive legislation. A comprehensive approach must not only prohibit surprise balance billing in any instance where a patient could not reasonably be expected to avoid it but also include a process to resolve payment disputes between insurers and providers, provider payment standards for out-of-network care in surprise scenarios, transparency requirements in provider networks and notice to consumers, and an effective enforcement mechanism.
4) Lower prescription drug costs.
The high cost of prescription drugs are a growing concern for many families across the country managing chronic health conditions. According to a recent poll from the Kaiser Family Foundation, one in five individuals report they’ve skipped filling a prescription and one in eight report cutting pills in half or skipping doses due to costs. Although there is interest at the federal level to address this issue, states shouldn’t wait for a federal fix and should continue to find ways to make prescription drugs more affordable for families whose health and well-being are dependent on them.
Legislators are already filing bills across the country in the first month of the new session to curb prescription drug costs. As states continue to explore the best path forward, check out our report that includes a comprehensive policy menu for state action.
5) Protect coverage for people with pre-existing conditions.
Federal administrative changes to promote junk insurance plans and a disastrous ruling out of a district court in Texas aimed at taking down the Affordable Care Act (ACA) both threaten the ACA’s protections for the 133 million people across the country living with pre-existing conditions. Without protections for pre-existing conditions, the economic security health insurance provides a family becomes dependent on their ability to pass a health screening.
While we don’t know the ultimate fate of the lawsuit currently making its way through the federal court system, state policymakers can act now to protect people with pre-existing conditions. As the primary regulators of their health insurance markets, states have the power to keep junk insurance out of their state or at least put limits on how they are sold. Similarly, state policymakers could preserve the ACA’s pre-existing condition and other consumer protections into state law, as several states have already done.
When it comes to opportunities to promote economic security through state-level health care policies, the list of opportunities is far greater than five. However, this list reflects the issues that are top of mind for families across the country right now. Therefore, these policy changes should be top health care priorities for state policymakers looking for a way to fight for families in their state today.