ERIC continues to work towards protecting Ohioans from surprise medical bills. Today, ERIC advocated against legislation introduced by the Ohio State Senate’s Committee on Insurance and Financial Institutions. ERIC’s testimony focused on S.B. 198, legislation that would end surprise billing in fully-insured plans in the state, using an arbitration mechanism and focused on provider’s billed charges.
Last month, ERIC supported H.B. 388, a bill that creates a reasonable, market-based benchmark in surprise billing situations, taking the patient out of the middle, and providing certainty to plans, plan sponsors, patients, and providers.
ERIC’s testimony today focused on the following provisions:
The flaws of S.B. 198 – S.B. 198 would subject health benefit plans to government-mandated binding arbitration, with unduly low thresholds, and requires the employer to pay 80% of the provider’s fake “billed charges” – essentially, medical list prices that no competent fiduciary would ever agree to pay. When prices are NOT market-based, such as under S.B. 198’s mandate to base payments on medical list prices, payors will have vastly increased financial exposure, which will inevitably lead to price increases and jeopardize patients’ access to care. Even if medical list prices are not included in a proposal, employers still prefer predictability – rather than the uncertainty posed by binding arbitration.
Urging the committee to support H.B. 388 and not S.B. 198 – H.B. 388 creates a benchmark payment rate based on median prices that have been agreed to under contract by providers and insurers in a given geographic region. This proposal leverages market forces to enhance and improve networks for patients, without harming providers’ bottom lines. The legislation distinguishes between fully-insured health plans and those that are self-insured and thus governed exclusively by ERISA – as self-insured plans are not, and should not be, subject to state law. In addition, the bill omits arbitration that would incur exorbitant costs.
ERIC will continue to work with Ohio lawmakers and our allies in the state to end the surprise billing crisis.