Bill Description: House Bill 529 would impose new regulations on health carriers and require them to apply out-of-pocket payments for healthcare purchased outside of insurance toward policy deductibles.
Rating: -1
Does it give government any new, additional, or expanded power to prohibit, restrict, or regulate activities in the free market? Conversely, does it eliminate or reduce government intervention in the market?
House Bill 529 would create Section 41-1854, Idaho Code, to say, “A health carrier may not prohibit a health care provider from offering a covered person the option of paying the provider's discounted cash price for health care services.”
It further says, “A covered person may choose to pay out of pocket for a health care service from a health care provider instead of submitting a claim to insurance.”
These regulations would limit the terms that could be contained within contractual agreements between and among health carriers, health care providers, and covered persons.
The bill goes beyond these regulations by restructuring how deductibles are calculated. It says, “If a covered person obtains a medically necessary health care service covered by such person's health benefit plan and negotiates for a price lower than the average allowed amount established by the benefit plan, as provided to the covered person upon request, and the covered person pays out of pocket for the health care service, the amount of the out-of-pocket cost shall be counted toward the covered person's out-of-pocket deductible and annual maximum out-of-pocket expense if the requirements of this section are met.”
It further requires that, in most cases, a health carrier “count the full amount that the covered person paid out of pocket toward the deductible and annual maximum out-of-pocket expense.”
The bill contains a list of exceptions for the deductible components of the law for certain types of plans and providers, including a plan that provides coverage “only for a specified disease or diseases; only for accidental death or dismemberment; only for dental or vision care; under an individual limited benefit policy; for a hospital confinement indemnity policy; for disability income insurance or a combination of accident-only and disability income insurance; or as a supplement to liability insurance.”
It further excludes Medicaid; Medicare supplemental policies; workers’ compensation insurance coverage; medical payment insurance issued as part of a motor vehicle insurance policy; a long-term care policy, including a nursing home fixed indemnity policy (in most cases); and short-term health insurance issued on a nonrenewable basis with a duration of six (6) months or less.
The breadth of the exceptions only underscores the problems with the policy.
Medical care paid out-of-pocket is separate from insurance by design, but this law would force insurance companies to count these expenses against one’s deductible, which significantly restructures the entire concept of medical insurance.
While a health carrier could certainly choose to adopt such policies within a market framework, mandating their adoption significantly undermines the free market.
(-1)
