Education event

AB 1611 Member Forum
Originally presented June 25, 2019

Overview

CHA will host a call on June 25 at 7:30 a.m. (PT) to update members on proposed legislation that would protect patients from balance billing but includes a rate-setting provision that harms hospitals and helps insurance companies.

During the call, we’ll provide a brief overview of Assembly Bill (AB) 1611 (Chiu, D-San Francisco), its current status in the state Legislature, and our strategy and messaging to oppose the bill.

There is no fee for this CHA members-only forum; however, registration is required. 

Recommended for: Chief executive officers and government relations executives

AB 1611 Background

Protecting Patients, Avoiding Rate Setting

Among CHA’s priority issues is AB 1611, an Assembly bill nominally purported to eliminate the practice of hospital “surprise” billing (this issue is also getting attention at the federal level, with bipartisan proposals in the House and Senate to prevent surprise billing surfacing). That’s a goal that hospitals support; patients should not be worried about things like out-of-pocket costs, their network status, or prior authorization when they are ill or injured.

But a section of this bill proposes something else entirely: the insertion of a state-determined rate-setting mechanism into the health care financing system. Specifically, when medical bills are unpaid, this proposal would allow insurance companies to pay a “default” rate that, in most cases, does not cover the actual cost of care.

As stewards of your hospitals and the resources needed to care for patients and communities, you understand well the significant problems this would create, not only in terms of a direct reduction to resources, but also the long-term problem of generating an unfair advantage for insurance companies when negotiating rates with hospitals.

There are other concerns with this bill, namely that the ban on balance billing would apply to post-stabilization services and that it fails to address conflicts with federal law for patients covered by ERISA plans. While each of those creates its own set of problems, the greatest concern at this time is that establishing a “default” rate for certain unpaid bills is tantamount to state rate setting.

On May 16, AB 1611 passed a significant procedural step. That’s why our focus going forward will be on eliminating the “default” rate section of the bill while retaining the important patient protections it affords. In doing so, we aim to blend smart policy and savvy politics to find the path to the most favorable outcome for hospitals.

CHA Staff

Carmela Coyle began her tenure as President & CEO of the California Hospital Association, the statewide leader representing the interests of more than 400 hospitals and health systems in California, in October 2017.

Previously, Coyle led the Maryland Hospital Association for nine years, where she played a leading role in reframing the hospital payment system in Maryland and moving to a value-based methodology. Maryland is now considered a national leader in health care policy and innovation.

Prior to 2008, Coyle spent 20 years in senior policy positions with the American Hospital Association (AHA), including 11 years as the senior vice president of policy, where she served as a national media spokesperson and led AHA’s policy development and strategy planning activities. Earlier in her career, she worked for the Congressional Budget Office in Washington, D.C., advising members of Congress and their staff on the economic and budgetary implications of legislative policy.

Kathryn Austin Scott is the senior vice president for state relations and advocacy, serving as the association’s head lobbyist in Sacramento and directing the California lobbying team.

Ms. Scott has over 20 years of experience in public policy and has served as a contract lobbyist to CHA for 15 years. Scott has also represented the United Hospital Association and the District Hospital Leadership Forum among other health care and non-health care clients. 

Materials

Download Presentation

Infographic — Oppose AB 1611 – Let’s Protect Patients, Not Insurance Companies

AB 1611 Template Letter to Senate Health Committee

AB 1611 Talking Points

Commands