A Busy Season at the Statehouse
Budget time — the every-other-year process of hashing out a massive bill with the state’s spending priorities for the next two years — is always hectic, but this year in addition to the budget we’re following a larger-than-usual crop of bills that could help or hurt access to health insurance for Ohioans. Read on for a quick update of where we stand:
First, we’re excited about two bills that would increase access by making it easier for businesses both large and small to offer their employees coverage:
HB 133 — Small employer tax credit
For small employers that aren’t currently offering coverage, the bill would create a tax incentive for those that opt to offer their workers Individual Coverage Health Reimbursement Arrangement (ICHRA) plans. In addition to the financial boost of $400 per covered employee, the existence of the tax credit would raise awareness of this innovative solution among employers.
SB 129 — Tax credit for group health plans
Increasing healthcare costs are a significant burden on businesses offering group insurance plans; a tax credit would offer welcome relief.
Second, a raft of bills introduced in recent weeks raise a number of concerns for their potential to make healthcare more expensive:
HB 214 — Prior authorization “gold card”
The bill would require insurers to have “gold card” programs exempting some providers from prior authorization requirements based on their history of approving medically necessary treatments. While some insurers in Ohio’s competitive marketplace have initiated their own gold carding programs as a way to attract the highest-performing providers to their networks, OAHP is concerned that gold carding isn’t right for every situation. It works better for services that have clear, consistent clinical standards of care and for which there are frequent provider reviews. Insurers prefer to offer gold carding selectively as a competitive tactic.
The bill would prohibit insurers from making midyear drug formulary changes. OAHP opposes this restriction on insurers’ ability to control healthcare costs by encouraging the use of lower cost or more cost-effective alternatives. Effective formulary management enables insurers to negotiate better prices with drug manufacturers.
The bill would prohibit insurers from changing a provider’s billing code to a lower-paying code. OAHP opposes this prohibition, believing that insurers need the ability to correct inaccurate or inappropriate coding when it’s based on clear documentation and clinical guidelines. Accurate coding is an important tool for containing costs and preventing fraud.
The bill would direct the Ohio Department of Insurance to create network adequacy standards for commercial plans. OAHP generally supports network adequacy standards but opposes strict, one-size-fits-all mandates that could drive up costs and inhibit insurers’ ability to design efficient networks. Overly broad standards, especially those forcing insurers to contract with every willing provider, would limit insurers’ ability to negotiate lower prices and maintain high quality.
SB 162 — Recoupment timeframes
The bill would reduce the timeframe in which insurers can take back payment and prohibit them from changing that timeframe during a contract period, as well as prohibiting insurers from charging providers a fee for appealing a determination of overpayment. OAHP opposes strict limits on the time required to audit claims and recoup overpayments. Takebacks are necessary to correct billing errors and prevent systemic fraud and abuse.
SB 166 — Provider payment fees
The bill would prohibit insurers from imposing any charge on providers for electronic fund transfers or remittance advice transactions. OAHP opposes the bill because processing electronic payments incurs costs that insurers should be permitted to offset. Further, mandating free EFT payments could discourage investment in digital payment infrastructure, shifting costs elsewhere in the system.
The bill would add a number of restrictions and mandates to prior authorization. OAHP considers prior authorization a necessary tool for containing costs and ensuring medically appropriate treatment and opposes arbitrary, blanket restrictions that could inhibit insurers’ flexibility to manage costs and ensure medically appropriate treatment.
OAHP supports transparency but opposes broad and overly prescriptive mandates, such as disclosure of proprietary algorithms, that could stifle innovation and impose unnecessary administrative burden.
Finally, we’re continuing to oppose three bills that, while well intentioned, would make healthcare more expensive, at the risk of making it hard for many people to afford any coverage at all:
HB 8 — Mandating coverage of biomarker testing
HB 33 — Mandating coverage of prostate screening
Both are examples of coverage mandates that, while well intentioned, risk making it hard for many people to afford any insurance coverage at all.
HB 24 — Additional mandates involving Medigap
This bill raises concerns for two reasons: First, having an annual enrollment period for Medicare supplement (Medigap) plans could lead to more people making less-than-ideal choices among plans, simply by incentivizing them to delay the choice. Second, the bill would mandate that Medigap plans be offered to people who are under 65 but nonetheless qualify for Medicare because they are disabled or have end-stage renal disease. Shifting the cost of care for this population to the broader Medigap pool could destabilize the Medigap market, adding a significant cost burden for existing Medigap enrollees, many of whom are vulnerable seniors on fixed incomes.
We know it’s a lot, and we’re here to help folks make sense of it all. Being a voice for healthcare accessibility and affordability when laws and policy are made is at the center of our mission. If you need more information about these bills or other healthcare policy issues, feel free to contact me, our CEO Kelly O’Reilly or Angela Weaver, our director of regulatory affairs.
