Kate Harveston* The last few thousand years have advanced our technology and our civility considerably. But there’s still plenty of work ahead for government, the law, and each of us, when it comes to expanding what it means to be a citizen. When we use our tools for the good of the many, we can bring about tangible improvements in our quality of living, our ability to participate in the economy, and our national competitiveness.
It is past time in America for its people to use its government and its laws to make sure all people have reliable health care. The good news is, states like Connecticut are helping change the legal climate as well as the public’s perception of what an acceptable health care system can look like.
Why the Legal Climate Needs to Change
Briefly, let’s explore why the current legal climate surrounding health care isn’t where it should be in the U.S. and why there’s lots of work left to do.
The goal of the Affordable Care Act was to turn uninsured Americans into health insurance customers. But its industry-centric approach left many millions behind by continuing to let insurers charge high premiums, letting pharmaceutical companies get away with price-gouging, and letting insurers turn away paying or prospective customers for pre-existing conditions.
The ACA was a half-measure that helped move the Overton Window on health care as a right of citizenship. But it preserved most of the biggest problems in the health insurance market, one of which was turning away would-be customers for maladies they have no control over.
But some of the other failures are still going under-talked-about as the public debate over health care rages on: mental health is still barely an afterthought in the U.S. health care market. This, despite the fact that health experts regularly tout mental wellness as absolutely vital for a person’s holistic health – and the fact that mental illness represents one-third of all adult disabilities across the globe.
The question cannot be “Why should government do something about this?” We know poor bodily and mental health affects the greater economy and erodes our productivity and our happiness. The question has to be, “What must government begin doing today to fix this?”
How Connecticut Helps Lead the Way
We are deep in a presidential election cycle and big ideas aren’t in short supply. In the meantime, states like Connecticut are using their legal systems to redress shortcomings in our existing health care laws, including the Affordable Care Act.
The governor of Connecticut, Ned Lamont, (left) recently signed a law that requires health insurance companies to provide “parity” for behavioral, mental health, and substance abuse conditions, alongside diseases and injuries of the body.
In other words: patients with health insurance can, by and large, already expect that conditions requiring emergency surgery are partially or fully covered under their plans. Now, in Connecticut, patients who require treatment for substance use disorder and other afflictions of the mind can expect equally ready access to treatment, without insurers placing artificial restrictions on mental health claims.
There are several positive steps forward within Connecticut’s Public Act 19-159 (“An Act Concerning Mental Health and Substance Use Disorder Benefits”). In addition to parity, insurers must also report each year on whether they are still in compliance and the measures they are taking to remain that way.
Connecticut’s new laws aren’t just about mental health, either. A second bill, Public Act 19-134 (“An Act Expanding Health Insurance Coverage for Pre-existing Conditions”), ends discrimination in Connecticut in the form of insurance companies excluding customers with pre-existing conditions. In 2015, that kind of discrimination would have barred 522,000 non-elderly patients from securing care in Connecticut before the Affordable Care Act, or nearly one-quarter of that same population.
Representatives Sean Scanlon (D) and Brenda Kupchick (R) and several others helped see these laws over the finish line. In Connecticut, these laws now serve as a hedge against the President’s and Congress’s attempts to neuter or remove the ACA’s existing protections.
Connecticut isn’t done expanding its bulwark against greed in its health care markets. Representative Scanlon has claimed drug prices as one of his marquee political issues, and in 2019 he hopes to make Connecticut one of the first in the U.S. to allow patients to import drugs from Canada.
As Connecticut fights that battle at the state level, presidential contenders like Senator Bernie Sanders (I, VT) are bringing the issue to the masses. In late July, 2019, Sanders took a bus filled with American diabetes patients over the border into Canada to buy insulin, where it’s not atypical for citizens to pay one-tenth the prices that American patients are accustomed to.
Connecticut Joins a Movement
There are health care companies, and medicine companies, and then there are companies that price-gouge sick human beings to death. Connecticut is calling out some of these companies in an enforceable way now, and helping make sure those who live with mental illnesses – those who often find themselves stigmatized and on the fringes already – have a place to turn, and financial support, when they need it.
We know a lot more about the body and the mind today than we ever did before, and we’re beginning to understand how badly we’ve failed some of our most vulnerable citizens. We must hold companies and institutions accountable now that we know addiction is a disease and that some human beings will never achieve financial solvency with drugs and surgery at their current unsustainable prices.
In passing these laws, Connecticut’s government and citizens are contributing to a movement, a moment, and, quite possibly, a revolution. Health care as a human right isn’t a new idea. But piece by piece, we’re codifying that idea in our laws from the bottom up.
*Kate Harveston is a young writer pursuing a career in journalism. She holds a Bachelors in English and minored in Criminal Justice, so she enjoys writing about anything related to politics, law and culture. If you would like to read more of her work, you can visit her blog, Only Slightly Biased
thanks for the excellent article. I praised the Connecticut laws in my recent article that appeared in The Health Care Blog…..
HEALTH REFORM JOB ONE:
STOP THE GOUGING!
WE NEED LEGAL ASSAULTS ON THE GREEDIEST PROVIDERS
By Bob Hertz
Editor, New Laws for America
Bob.Hertz@frontiernet.net
Assault Phase One: Outlaw surprise billing
This rule must become universal:
If a hospital is ‘in-network’, then any doctor who practices in that hospital is ‘in-network.’
To enforce this, we should adopt Connecticut’s law on surprise billing and balance billing for the entire nation.
Connecticut’s law No.15-146, which took effect July 1, 2016. states the following:
“If a patient receives a “surprise bill” from a health insurer for Out-of-Network services provided at an In-Network facility – the patient will only be responsible to pay the co-insurance, co-payment, deductible, or other out of pocket expense that would apply – if the services had been provided by an In-Network provider. The physician is reimbursed at the in-network rate, unless the patient and provider agree upon something else in advance.”
In addition:
• Patients who see Out-of-Network providers for emergency services can only be required to pay the equivalent of In-Network costs. This includes Out-of-Network hospitals, transportation services, and providers who are Out-of-Network practicing within In-Network facilities.
-1-
In addition:
• It is illegal in Connecticut for any provider to request extra payment from a patient who is covered by insurance — as the entire purpose of insurance is to negotiate prices for you.
• It is also an unfair trade practice for a health care provider to report a patient’s unpaid surprise medical bill to a credit reporting agency.
Other Connecticut rules include:
• A patient who still receives a surprise bill from an out of network provider in excess of what the patient would owe under the plan’s in-network rate can seek actual damages, punitive damages, and injunctive relief based on the Connecticut Unfair Trade practices Act.
• Connecticut also prohibits health plans from imposing a facility fee for outpatient visits at an off-campus site of a hospital. In fact, billing statements to patients must include a notice that the costs might have been less if they had had the procedure performed at a facility not owned or operated by the hospital or hospital system, and that the patient has the right to request a reduction in the fee.
• For uninsured patients, Connecticut providers may not charge more than the applicable Medicare rate.
Only six states have laws that are even close to this level of patient protection. Let’s establish the Connecticut standard nationwide.
Bob Hertz