Health Insurance Industry Issues and Legislation

The No Surprise Act ("Act"), part of the stimulus bill, was signed into law at the end of 2020. The Act applies to the 135 million Americans with self-funded coverage, as well as those in fully-insured plans. Patients are the major beneficiaries of the Act. Patients will be responsible for only the cost-sharing amounts that they would pay to in-network providers in either an emergency or non-emergency setting when they utilize an out-of-network provider.

The U.S. spends 50% more per capita than other industrialized nations for hospital care and that percentage is even higher for commercial insurers who pay for 40% of the hospital bills. A recent RAND study explores options for significantly reducing those costs.

Healthcare provider consolidation continues unabated and prices just keep rising but not patient quality of care. Hospital same service prices increased 14% for mergers and acquisitions in markets, in states, or even between states. Physician practice consolidation has led to 14%-30% higher prices.

Self-fund employers constantly face the risks associated with a high-cost, adverse health event. Specialty drugs like Harvoni make up only 2.2% of all written prescriptions, but they account for 50% of all drug expenditures, and according to Express Scripts, they cost the U.S. health system as much as $100 billion per year.