March 19, 2018: The Alaska ACEP team had a very productive three days in Juneau meeting with legislators and I wanted to bring you up to speed.
Back in the Fall we anticipated legislative connections in Juneau would be worthwhile and we organized joining ASHNA’s “Juneau Fly-in” conference (Alaska State Hospital and Nursing Home Association). This continues to be a productive relationship, but we ended up skipping most of the conference as our current legislative issues have taken precedence. Boots on the ground, walking through the Capitol, we developed personal connections with our legislators that I believe will pay good dividends in the future.
I cannot say enough how much I appreciate ACEP members’ involvement and how much I think their participation was meaningful. Our team included Anne Zink (MatSu), Meghan Lindstrom, (MatSu), Nick Papacostas (JBER), Sami Ali (Providence Anchorage), Nathan Peimann (Juneau) and myself. Nathan Peimann led us through his home town and really made the team feel welcome in Juneau.
HB193: Consumer Protection and Fairness
The House is considering the “Grenn Bill” that seeks to eliminate balance billing for emergency care. This bill was dropped into committee two weeks ago and Nate Peimann represented our interests testifying in committee. We expect this to go to committee with opportunity for oral testimony next week. Currently as written this bill is one that we can support. As written it includes the 80th percentile rule to maintain fair compensation in the case of out of network emergency care, and then eliminates “balance billing”. The risk of this bill is that with a stroke of a pen the 80th percentile component could be taken out, and what would therefore remain would be a system where the safety net of Alaska would be threatened. Healthcare providers would have no ability to fairly negotiate with insurance companies and maintain fair coverage. Reimbursement could be set at Medicare rates.
I would encourage everyone get on the same page about this bill and the way we communicate around it and related issues. I have seen in these meetings that word choices can really help steer the conversation. I encourage everyone who will be talking and writing for us to spend a minute and review this web page:
and watch this video: https://www.facebook.com/EndTheSurpriseInsuranceGap/
House Bill 193: Write that Letter
Key Points to put in your letter:
- HB 193 protects patients from getting a surprise bill in an emergency
- HB 193 preserves the 80th percentile rule which will preserve the emergency care safety net for the state
- These issues are linked and need to be discussed together
Letters should go to:
Please send a BCC: of your letters to me at email@example.com so that we can track progress. Please let me know if you have any questions or concerns.
We previously wrote to you about the Senate bill sponsored by Senator Giessel SB129. This bill has not yet moved in its committee. This bill is incredibly problematic for the maintenance of an emergency care safety net in this state. It annuls the patient protection measure Alaska has in the 80th percentile rule and then limits reimbursement from insurance companies to a percentage of Medicare. The original version of this bill that was rescinded included a ban on balance billing which was removed. As currently written this bill limits what insurance companies will be required to reimburse but shifts all the rest of the cost to the patient. It is a patient protection disaster.
There are many healthcare related bills circulating currently. We are supporting HB312, the workplace violence bill, which increases protections for healthcare staff when assaulted by patients. There are multiple “transparency in pricing” bills that target healthcare pricing but in current versions all exclude emergency medicine. There is an opioid education bill that seeks to mandate provider conversations on the risks of opioids. In theory we agree that the conversation is care we should be providing, but hesitate to support that our conversations be legislated. There are also bills on behavioral health funding, expanding scope of practice of naturopathic doctors, and on repealing the CON process.
Our current request of members is to please keep with the letter writing and phone calls. This issue is critical to maintaining access to emergency care in the state of Alaska. Please reach out to me if you have ideas and contacts. The 80th percentile rule needs to be maintained to protect patients from surprise insurance gaps and there is no percentage of Medicare that can replace it. This is a best practice in the lower 48 and is advocated by the National Association of Insurance Commissioners. New York and Connecticut also have this rule and 5 other States are looking at adopting it during this legislative season.
Thank you again for your participation in this issue.
Ben Shelton, MD, FACEP
Senate Bill 129:
We need to continue writing letters of OPPOSITION for SB 129. Letters should go to: