|Health Care Cost Institute, 2017 Healthcare Cost and Utilization Report, February 2019
Hospital care accounts for 44% of all personal health care spending. A study released by the RAND Corporation in May 2019 demonstrated that Indiana’s hospital costs relative to Medicare were the highest of any of the 25 states measured. On average, Hoosiers’ hospital costs are 311% higher than Medicare costs. That compares unfavorably to neighboring states like Michigan (156% of Medicare), and even Illinois (225% of Medicare).
If hospital costs in Indiana were lowered to match those in the 24 other states studied, Hoosier families would have an additional $2,600 to spend on gas, groceries and housing. If they equaled those in Michigan alone, the number would be $3,150.
Following the release of the RAND Corporation’s report, Hoosiers For Affordable Health Care assembled a group of distinguished economists and health policy experts to develop recommendations to address high hospital prices in Indiana (Biographies attached). The working group conducted 59 meetings with stakeholder groups representing hospitals, insurance companies, employers, and state health policy officials. After months of study, the team developed recommendations for policy makers to consider. The common thread that weaves the recommendations together can be summed up in a single word: TRANSPARENCY.
Hoosiers for Affordable Health Care is writing you today to ask for your support of a series of commonsense, non-partisan, and popular policy proposals to help consumers and employers navigate the health care system and make better, more informed choices. The legislation we are supporting is rooted in free market principles and would rely on competition, choice and transparency to curb costs. Under our proposals, the government’s role would be to require that consumers and employers be totally informed about pricing.
Last week, Governor Eric Holcomb made addressing the high cost of hospital care a priority in his State of the State Address. As he laid out his vision for 2020, he stated:
“We’re also coming after high health care costs. That’s why we’ll establish an all-payer claims database as a first step to improve information about hospital pricing and insurance reimbursement, giving Hoosiers more transparency to make better choices. We’ll also require that providers give a good-faith cost estimate five days before the care is provided, and we’ll require in-network facilities to ensure their patients receive care at the network cost. Because when you’re injured or ill, the last thing you need is a surprise when you receive a medical bill.”
-Indiana Governor Eric Holcomb’s 4th State of the State Address, January 14, 2020
The specific proposals endorsed by Hoosiers For Affordable Health Care include:
Senate Bill 3, Health Care Provider Billing (Sen. Ed Charbonneau, R-Valparaiso): This is the Senate’s anti-surprise billing measure. The bill prohibits billing a patient who receives services from an out-of- network service provider at in-network facility for amounts in excess of the cost paid by the patient’s insurance plus any deductibles, copays, and coinsurance amounts.
Senate Bill 4, All Payer Claims Database (Charbonneau): The bill creates an All Payers Claim Database (APCD) Committee to assist the Department of Insurance with the creation and implementation of an APCD. Twenty-five states have established APCD’s as a tool to identify trends in health care costs and courses of treatment.
Senate Bill 5, Health Provider Contracts and Pricing (Charbonneau): The bill prohibits health provider contracts from including provisions that do not disclose pricing for health care services and requires providers to disclose health care service claims data to employers providing coverage consistent with HIPAA and all health privacy laws.
House Bill 1004, Out of Network Billing (Rep. Ben Smaltz, R-Auburn): This is the House version of anti-surprise billing. The bill prohibits health care providers from billing a patient for amounts that exceed in-network rates plus any deductibles, copayments, and coinsurance amounts unless the patient is notified in advance of a procedure, verbally and in writing, of the increased network charges in the form of a good faith estimate, the patient signs the good faith estimate, and the increased rate does not violate the in-network provider agreement between the health plan and the hospital or ambulatory outpatient surgical center.
House Bill 1005, Health and Insurance Matters (Rep. Donna Schaibley, R-Carmel): This is the House transparency bill. The bill:
- Stipulates that a patient may request a good faith estimate of cost at any time and requires a hospital to provide a good faith estimate of cost within 72 hours of the receipt of such a request. The bill states that the good faith estimate is not binding.
- Requires that notice be posted in each waiting room and on its website informing patients of their right to a good faith estimate.
- Requires any off-campus medical location have a unique identifier and requires that any such facility use its unique identifier on all claims for reimbursement (rather than using the unique identifier of the hospital which owns the off-campus facility.)
- Requires insurance brokers to disclose their fees and commissions
- Prohibits the use of gag clauses and requires providers to disclose health care service claims data to employers providing coverage consistent with HIPAA and all health privacy laws
- Establishes an APCD
Indiana’s health care system is vast and complicated. Reforming it is daunting. It is crucial, though, that Hoosier legislators begin the process of injecting transparency into the system. Only seven weeks remain in the 2020 Indiana legislative session. Time is of the essence.
We are asking you to join companies like Cummins, Inc. and the Employers’ Forum of Indiana in the growing Hoosiers For Affordable Health Care Coalition. We will arm you with the information you need to advocate for policies that will result in a more transparent, customer-focused, and market responsive health care system in Indiana. Together, we must help legislators from every corner of our state understand the urgent need for healthcare reform in Indiana.
We encourage you to reach out to our team with any questions you might have. Our effort in the Statehouse is being led by Matt Bell and Tony Mitson, the Principals at Catalyst Public Affairs Group. Matt can be reached at 317-910-7572 or by email at firstname.lastname@example.org. Tony can be reached at (260) 433-4680 or by email at email@example.com.
Thank you for your consideration and I hope we can count on your participation.