The No Surprises Act: Implications for States

In the waning days of 2020, Congress enacted the No Surprises Act, which provides, for the first time, protections for consumers against surprise bills from out-of-network medical providers. The legislation has numerous implications for states that have their own balance billing protections, as well as for those that do not. In their latest Expert Perspective article for the State Health & Value Strategies program, JoAnn Volk and Sabrina Corlette review some of the more critical issues state regulators will need to consider as this new federal law is implemented. Continue reading

Unpacking The No Surprises Act: An Opportunity To Protect Millions

Congress included the No Surprises Act in the omnibus spending bill that was passed and signed into law by President Trump on December 27, 2020. The bill protects patients from unexpected bills for out-of-network emergency and other services consumers are unable to agree to in advance. Georgetown experts Jack Hoadley, Katie Keith, and Kevin Lucia unpack the legislation in a blog post for Health Affairs. Continue reading

Surprise Billing Protections: Help Finally Arrives for Millions of Americans

Congress enacted the “No Surprises Act” as part of the $900 billion COVID-19 relief and government spending bill. The Act will protect millions of patients from surprise out-of-network medical bills. In their latest To the Point post for the Commonwealth Fund, CHIR experts Jack Hoadley, Kevin Lucia, and Beth Fuchs unpack the legislation and what it means for patients. Continue reading

2020 – It’s a Wrap. CHIR Takes Stock of a Tumultuous, but Busy Year

We at Georgetown CHIR look back at this tumultuous, tragic, and eventful year and are thankful we have the opportunity to do the work we do. When the world went on lock down in early March, our team quickly pivoted to researching and writing about the government response to COVID-19 and its impact on health care coverage. We also wrote about surprise balance billing, junk insurance, and trends in provider-payer dynamics We share some of the highlights from our work here. Continue reading

The Provider Relief Fund: How Well Does it Protect Patients from Surprise Medical Bills for COVID-19 Related Services?

The $175 billion Provider Relief Fund prohibits participating providers from balance billing COVID-19 patients, regardless of their source of coverage. While this could help many patients avoid surprise medical bills, there remain several questions about the scope of protection this will provide. In an update to his April 30, 2020 post, Georgetown expert Jack Hoadley takes a look at the fine print of the program as well as new guidance from HHS. Continue reading

In the Age of COVID-19, Short-Term Plans Fall Short for Consumers

During February’s State of the Union address, President Trump touted his administration’s efforts to expand access to short-term health plans that do not comply with any of the ACA’s consumer protections. Short-term plans are often cheaper than ACA-compliant plans because they can deny coverage to people and exclude entire categories of services. In a recent post supported by The Commonwealth Fund, we reviewed 12 short-term plans to determine what coverage consumers would have if they needed treatment for COVID-19. We found that consumers in short-term plans are likely to have less financial protections than those enrolled in ACA plans. Continue reading

How States Are Using Independent Dispute Resolution to Resolve Out-of-Network Payments in Surprise Billing

As Congress and a number of states craft legislation to protect consumers from surprise out-of-network billing, a critical issue is resolving how insurers will pay out-of-network providers for their services. In their latest post for the Commonwealth Fund’s To the Point blog, CHIR’s Jack Hoadley and Maanasa Kona assess the experience of states that use an independent dispute resolution process to determine these payments. Continue reading