Home Providing Consumer Protection

Preventing Underinsurance and Medical Debt
Addressing the Rising Costs of Prescription Drugs
Pass Consumer Protections Against Hospital Overcharging
Reform the Individual Insurance Market
Controlling Health Care Costs
Support Additional HMO Consumer Protection
Supporting Other Consumer Health Care Legsilation
Ensuring Cultural and Linguistic Access to Care

Provide consumer protections for uninsured, underinsured, and insured families to protect them against overcharging and unfair pricing by hospitals, prescription drugs companies, and insurers.

Background

While we work toward the goal of quality, affordable health care for all, we need to provide consumer protections, particularly for the uninsured who are most vulnerable because they are left alone to fend for themselves in the health care market . While insurers are able to bargain with hospitals for reduced rates, the uninsured are often charged multiple times what an insurance company pays for exactly the same hospital procedure. Similarly, U.S. consumers pay more for prescription drugs than citizens of other countries, whose governments bargain on their behalf.

A solution is to use purchasing power of large pools of people to leverage better prices. Against hospital overcharging, we can allow the uninsured to get the same “public price” as government programs, rather than the often-inflated “sticker price.” To combat rising prescription drug prices, California can use its purchasing power, as well as the ability to import drugs at lower prices from other countries—which have used their own leverage effectively to bring down costs.

In addition, consumers protections are needed in the individual insurance market so that individuals and families can not be denied care due to “pre-existing conditions,” age, gender, or geography. Additional oversight is needed over out-of-pocket costs. Finally, the Department of Managed Health Care could adopt additional regulations to protect individuals and families that receive care through HMOs.

Recommended Actions

A. Pass consumer protections against hospital overcharging , and other aggressive billing and collections practices toward the uninsured and underinsured. Support AB774 (Chan), sponsored by Health Access California, to inform patients of their consumer rights and financial options; to prohibit sending patients to collections for 160 days; and to prohibit hospitals from collecting more than the Medicaid, Medicare, or worker’s compensation rate from low- and middle-income uninsured and underinsured families. While nothing in the legislation would guarantee free care, it would ensure that if a hospital bill was over a certain percentage of a person’s income, the patient would then be reduced to the “public” rate.

B. Support legislation to address the rising costs of prescription drugs by using the purchasing power of the state to leverage meaningful discounts for medicines for the millions of seniors, uninsured, and underinsured Californians. Support AB75 (Frommer) and the Cal Rx Plus ballot initiative sponsored by Health Access, as well as a full “OuRx” package of reforms on prescription drug issues.

C. Reform the individual insurance market, as in AB1111 (Frommer), to increase access to coverage for those with “pre-existing conditions,” and to prevent price discrimination based of age, gender, geography, or illness.

D. Provide oversight for high deductibles and other out-of-pocket costs. Support AB977 (Nava), sponsored by Health Access, which would require a public review and comment process for insurance company increases for out-of-pocket costs.

E. Support additional HMO consumer protections to ensure quality of care, including the implementation of strong consumer protection regulations at the Department of Managed Health Care (DMHC) regarding timely access to care, cultural and linguistic access to care, and other key measures. These consumer protections should also be applied to all health plans, including the new Medicare prescription drug plans, as proposed in AB1359 (Chan).

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