Curbing Medical Debt and Surprise Billing
As of 2024, nearly 1 in 12 adults report having medical debt. When factoring in medical debts on credit cards or owed to family members, that figure rises to over 4 in 10.
Several states are now limiting or prohibiting the reporting of medical debt to consumer credit reporting agencies. For example, Virginia prohibited various health care providers and emergency medical services agencies from reporting medical debt to certain reporting agencies. Additionally, Delaware, New Jersey and Florida, restricted the sale of medical debt to third parties by implementing safeguards such as waiting periods or other requirements. New York has prohibited the sale of medical debt altogether.
Other states are addressing issues related to surprise medical bills —when patients are unknowingly charged the difference between what the provider bills and the insurer pays. These bills can often lead to consumers taking on medical debt. Arizona directed its Department of Insurance and Financial Institutions to create an arbitration process for surprise out-of-network bill disputes between enrollees, health plans and providers. Four states- Indiana, Mississippi, Oklahoma and Washington - passed consumer protections for surprise bills related to ground ambulance services in 2024.
Strengthening the Individual Market
In 2024, states considered legislation affecting consumer access and affordability for marketplace plans. Maryland requires the state Health Benefit Exchange to establish and implement the Qualified Resident Enrollment Program, allowing qualified residents to purchase qualified plans on the individual exchange. A qualified resident is any state resident who is not eligible for Medicaid, Medicare or employer-sponsored coverage. Washington mandated that its exchange create a worker health plan access program for individuals who lose coverage due to an active strike, lockout or other labor-related dispute.
Reforming Health Care Payment and Delivery
States are creating or modifying requirements related to rural emergency hospital to improve access to care, particularly in rural areas. Rural emergency hospital is a new Medicare provider designation established by Congress through the Consolidated Appropriations Act of 2021. Florida authorized qualifying hospitals to apply to the Agency for Health Care Administration for rural emergency hospital designation. Kansas expanded their designation to include hospitals that met the criteria between January 2015 and December 2020.
Policymakers are also examining their role in regulating prior authorization practices used by health plans. Prior authorizations are health plan approvals that may be required before coverage of certain services or medications. This session, at least 10 states enacted laws related to prior authorization. Minnesota reformed several aspects of their prior authorization process, including limiting prior authorization for chronic conditions to a one-time requirement. They also prohibited prior authorization for non-medication treatments for cancer, as well as outpatient mental health and substance use disorders. Wyoming established a "gold card" program that lets healthcare providers bypass prior authorization for certain procedures or medications if they meet a specific threshold of previously approved requests.
For more updates on legislative actions related to the commercial insurance market, see NCSL’s Health Care Costs, Coverage and Delivery Database.
For more information on legislative actions related to prescription drugs, see NCSL’s Prescription Drug Legislation Database and Voters Want Affordable Meds. Legislatures Are On It.