With Health Policy Lemons, Florida Advocates Make Lemonade: Protecting Consumers From Unfair Surprise Medical Bills

Policy and Research Director Laura Brennaman, PhD, RN, guest blogged this week for Community Catalyst about CHAIN’s work to protect Floridians from surprise medical bills. Governor Scott last month signed HB 221 into law effectively ending balance billing for consumers. Take a read of Dr. Brennaman’s blog below.

Despite political opposition to the Affordable Care Act at the highest levels of state government, Florida led the nation as the state with the most people gaining new health insurance through the Affordable Care Act. However, for Floridians with coverage, being insured has not completely provided assurance against exorbitant and unfair surprise medical bills. Stories in Florida newspapers and national media have highlighted the problem of “balance billing” for out-of-network services to people who thought they were covered. Fixing this problem for consumers became a focus of both opponents and advocates of the Affordable Care Act, resulting in Florida’s enactment of one of the strongest consumer protections against unfair out-of-network balance bills in the nation. The law exempts consumers from being held responsible for out-of-network rates in emergency and non-emergency situations if they’re denied opportunities to receive treatment by in-network providers.

As a statewide consumer health advocacy organization, Florida CHAIN is advocating to improve health insurance through state regulation and oversight of carriers. CHAIN has a seat, appointed by the Insurance Commissioner, on the Florida Health Insurance Advisory Board (FHIAB). For the past two years the CHAIN representative has recommended to the Board that the Insurance Commissioner propose and support legislation that protects consumers from out-of-network balance billing.

Despite the optics, the political will in Florida this year was strong to address high-health care prices. The Florida House and Governor remain unyielding in opposition to expanding Medicaid in conflict with the Florida Senate, which seeks to cover the expansion population with a waiver approach. This intra-legislature disagreement led to myriad health care-related bills in 2016 designed by the House in a charade that lowering costs, mostly through deregulation, would fix the health care access problem for more than three million uninsured Floridians. The bills to prevent out-of-network balance billing were a part of the pretense.

We took advantage of the unique political climate that positioned consumer advocates alongside our anti-ACA ‘surprise bedfellows’ in support of protections from unfair surprise medical bills. Using our proposal to the FHIAB, the Insurance Commissioner recommended legislation that prohibited balance billing and helped increase our visibility with other state agencies. When the Florida Insurance Consumer Advocate (ICA) convened a Balance Billing Forum, she invited CHAIN to present the consumer perspective along with industry speakers.

As a consumer advocacy organization, we stood firm on our goal to hold consumers harmless when they have no opportunity to choose an in-network provider. Our one-page brief for stakeholder groups and legislators highlighted that the consumer should not be party to any dispute resolution process. Despite a wide chasm in the design and definitions of a payment resolution process between providers and payers with no middle ground in sight, we successfully advocated for a “clean bill” that only addressed the consumer protections.

Our allies at Consumers Union worked to mobilize a groundswell of email and phone action from Florida constituents urging their legislators to “pass a bill – clean.” State media reported on the bills and the advocacy by highlighting consumer stories we referred to them as the bills made their way to the finish line.

Advocating through our seat on the state advisory board, working with close allies and key stakeholders, and taking advantage of the media’s interest in the issue helped move this legislation from a bill into a law that will protect 11.5 million Floridians with private insurance from the financial distress of unfair surprise medical bills.