The Remedy For Surprise Medical Bills May Lie In Stitching Up Federal Law When Drew Calver had a heart attack last year, his health plan paid nearly $56,000 for the 44-year-old’s four-day emergency hospital stay at St. David’s Medical Center in Austin, Texas, a hospital that was not in his insurance network. But the hospital charged Calver another $109,000. That sum — a socalled balance bill — was the difference between what the hospital and his insurer thought his care was worth. Though in-network hospitals must accept pre-contracted rates from health plans, out-ofnetwork hospitals can try to bill as they like. Calver’s bill eventually was reduced to $332 after Kaiser Health News and NPR published a story about
it last month. Yet his experience shines a light on an unintended consequence of a wide-ranging federal law, which potentially blindsides millions of consumers. The federal law — called ERISA, for the Employee Retirement Income Security Act of 1974 — regulates company and union health plans that are “self-funded,” like Calver’s. That means they pay claims out of their own funds, even though they may be administered by a major insurer such as Cigna or Aetna. And while states increasingly pass laws to protect patients from balance bills as more hospitals and doctors go after patients to collect, ERISA
law does not prohibit balance billing. Although Texas is one of nearly two dozen states that provide consumers with some degree of protection against surprise balance bills, those state laws don’t apply to self-funded plans. It’s a fairly common problem. About 60 percent of workers who get coverage through their job have selfinsured plans, and 18 percent of people with coverage through a large employer who were admitted to the hospital in 2016 received at least one bill from an out-of-network provider, according to an analysis by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program
of the foundation.) Health researchers and advocates have identified a number of potential solutions that could tackle the problem at the federal or state level. The courts are another option. Yet whether these efforts are politically feasible when health care is in play as a partisan football is another matter. Polarized views on appropriate reimbursement levels for medical services “limit stakeholders at both the federal and state level from making progress,” said Kevin Lucia, a research professor at Georgetown’s Center on Health Insurance Reforms, who has analyzed state laws that restrict balance billing….Read More
A stock-market bear signal is at a more-than-4-decade high, says Goldman A gauge of bullish and bearish momentum in the U.S. stock market is ringing alarms for strategists at Goldman Sachs. The investment bank’s so-called bull-bear indicator, which examines five market factors, indicates that the likelihood of a bear market occurring is at its highest point since around the mid-1970s (see chart on right). Goldman analysts led by Peter Oppenheimer, chief global equities strategist, said an unusual period for Wall Street, characterized by loose monetary policy and a recent spate of fiscal stimulus has resulted in an uncannily bullish cycle for markets that is likely to come to a screeching halt. ...Read More
Group Raises Nearly $1M for Susan Collins’ Nonexistent Opponent If She Votes to Confirm Brett Kavanaugh With the conclusion of three days of intense—even showboat-y—questioning of Supreme Court nominee Brett Kavanaugh by members of the Senate Judiciary Committee, public attention has shifted to one of the elected officials who actually holds the fate of Kavanaugh’s confirmation: Sen. Susan Collins of Maine. One group hopes to influence Collins’ vote with a small fortune in campaign
contributions to her next political opponent—whoever they may be. Two political action committees based in Collins’ home state, the Maine People’s Alliance and Mainers for Accountable Leadership, have joined forces with progressive activist Ady Barkan to crowdfund in support of the senator’s Democratic opponent in 2020, despite the Maine
Democratic primary not being scheduled for roughly 21 months. As of this writing, the campaign has raised a stunning $900,801, with every dollar earmarked for Collins’ eventual Democratic opponent if Collins fails, in the words of the campaign, “to stand up for the people of Maine and for Americans across the country” by voting against Kavanaugh’s
confirmation. By comparison, Collins’ Democratic opponent raised a mere $2.3 million during Maine’s most recent Senate campaign, making the nearly $1 million fund a jackpot for an ambitious Maine Democrat hoping to unseat the four-term senator. (Collins raised $6.2 million, and won re-election with nearly 70 percent of the vote.)...Read More
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