White House taking aim at surprise medical bills, 'junk' insurance

President Joe Biden announced a series of actions aimed at addressing surprise medical billing, unfair medical debt and "junk" short-term insurance plans. 

Here's what to know about the proposals:

Surprise medical billing

The Biden administration is issuing guidance to end the abuse of "in-network" designation, according to a July 7 White House news release. Some health plans contract with hospitals, but try to claim that they are not technically in-network. The administration said it is "making clear this is not allowed under federal law." Healthcare services provided by these providers are either out-of-network and subject to the surprise billing protections, or they are in-network and subject to the ACA's annual limitation on cost-sharing, further protecting consumers from excessive out-of-pocket costs.

The administration is also issuing guidance making it clear that health plans and providers must make information about facility fees publicly available to consumers, as well as other price information for services and items they cover or provide, according to the release. Additionally, nonparticipating providers and nonparticipating emergency facilities cannot evade the protections of the No Surprises Act — including the prohibition on balance billing — by renaming charges otherwise prohibited under the No Surprises Act as "facility fees."

Short-term insurance

Federal lawmakers have been calling on the president to address short-term health plans, which President Biden called "junk" during the 2020 presidential campaign. 

Short-term plans don't have to cover preexisting conditions and are allowed to bypass the ACA's requirement to cover such services as maternity care and mental health treatment. The Obama administration imposed a three-month limit on the short-term plans, but the Trump administration changed the rules to allow people to stay on the plans for a year and renew coverage for up to three years.

Under the newly proposed rules, short-term plans would be limited to three months — or a maximum of four months, if extended, according to the release. 

The plans would also need to make it clear that people signing up for these plans would get a defined benefit, like $100 per day of illness, instead of thinking that they have comprehensive insurance.

The proposal also requires plans to provide consumers with a clear disclaimer that explains the limits of their benefits, including to existing consumers currently enrolled in these plans. 

Unfair medical debt

In May, the Biden administration cautioned consumers about medical credit cards. A report from the Consumer Financial Protection Bureau said patients often do not understand the terms of medical credit cards and end up with more credit than they can afford. The medical credit card industry has grown significantly over the past several years. One credit card provider, CareCredit, grew from 4.4 million cardholders in 2013 to 11.7 million cardholders in 2023, according to the report. 

Now, the Consumer Financial Protection Bureau and Treasury are releasing a request for information to learn more about the emerging practice and solicit comments on potential policy actions, according to the release. Part of the request for information will explore whether providers are operating outside of existing consumer protections because once medical bills are placed on medical credit cards, there may be gaps in how various consumer protections apply.   

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Top 40 articles from the past 6 months