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Health Care Bills in 2022 Took On Costs, Coverage and Delivery

By Jack Pitsor  |  December 19, 2022

State legislators and their constituents continue to grapple with rising health care costs and the challenge of ensuring access to quality care.

NCSL tracked 127 bills enacted in 38 states in 2022 as lawmakers aimed to transform health costs, coverage and delivery in the commercial market. The bills touched on surprise billing, medical debt, health cost increases, primary care and much more.

Addressing Surprise Billing and Medical Debt

At least 10 states enacted legislation modifying surprise billing laws, largely in response to the federal No Surprises Act. The act, which took effect this year, prohibited providers from billing a patient who unknowingly receives out-of-network services more than what that patient would pay in-network.

Washington amended its state law to mirror federal requirements, including applying protections to post-stabilization services and emergency behavioral health services. Georgia also added emergency mental health and substance use care to its surprise billing law.

Beyond surprise billing, some states focused on hospital financial assistance policies and medical debt protections. Virginia required hospitals to screen patients for public insurance or financial assistance eligibility before engaging in debt collections. Kentucky prohibited its revenue department from collecting consumer debts for health goods or services, and New York protected patients from certain penalties (such as liens or wage garnishment) due to actions brought by hospitals or health care professionals.

Assessing Cost Increases and Price Transparency

States also considered legislation to evaluate health spending trends and improve price transparency. California became the ninth state to establish a cost-growth benchmark, which allows a state to measure and limit health cost growth to a certain rate. The legislation created the Office of Health Care Affordability, which has the authority to issue financial penalties to entities exceeding the benchmark. Connecticut codified its cost-growth benchmark, which was originally established through executive order.

Louisiana created an all-payer claims database task force, which will recommend ways to implement the database in the state. These tools can use health insurance claims data to measure spending trends and inform policymakers, regulators and individual consumers on health care markets and costs in their states.

Also on the price transparency front, Oklahoma initiated a “right to shop” program, which lets insurers offer incentives to patients for choosing lower-cost providers. Colorado prohibited hospitals from engaging in medical debt collection practices if they are not in compliance with federal price transparency rules.

Leveraging High-Value Primary Care

Some states focused on bolstering access to primary care through investments and reimbursements. For example, Nebraska established a Primary Care Investment Council to analyze primary care spending, barriers to care, alternative payment models and other primary care measures in the state. Colorado required the division of insurance to develop primary care alternative payment model parameters for commercial insurers. Maryland required its health commission to examine trends in primary care spending and recommend ways to improve health care quality and access.  

Overseeing Market Concentration

A few states focused on hospital consolidation with the aim of mitigating adverse effects of mergers on health care costs and quality. Indiana amended its certificate of public advantage, or COPA, law, which allows the state to approve certain mergers that might threaten market competition and would otherwise trigger federal antitrust enforcement in exchange for increased state oversight. The legislation required merging entities to incur the costs of reviewing proposed mergers and established processes for analyzing the effects of an approved COPA.

Connecticut task force will consider instituting a price increase cap after consolidation occurs through its certificate of need program. California authorized the newly created Office of Health Care Affordability to conduct market impact reviews of mergers, acquisitions or corporate affiliations.

Bolstering Enrollment in the Individual Marketplace

States turned to novel approaches for improving health insurance outreach and enrollment. At least four states—CaliforniaMaineNew Jersey and New Mexico—created programs to simplify enrollment processes. These programs allow individuals to mark on their tax returns whether they want to receive eligibility information for public insurance or subsidized marketplace plans.

Oregon required the state to develop a “bridge plan” that would help people at risk of losing Medicaid coverage to find marketplace health plans by engaging community partners. Rhode Island will allow pregnant people to enroll in health insurance outside of the normal open enrollment period.

Health Benefits and Other Insurance Mandates

At least 22 states enacted legislation bolstering health insurance mandates, with many bills focused on behavioral and mental health services. Georgia mandated that state-regulated private insurance plans comply with federal mental health parity requirements and required the state to regularly monitor compliance. Oklahoma aligned federal and state mental health parity reporting requirements. ConnecticutDelaware and Massachusetts established private insurance coverage for mental health wellness exams.

Beyond mental health mandates, Tennessee enhanced coverage requirements for breast cancer screenings. Minnesota mandated private insurance coverage for comprehensive postnatal care. Colorado required the state to provide actuarial assessments for future legislation proposing health insurance mandates.

States will likely continue to explore policy options on health care costs, coverage and delivery in 2023.

Jack Pitsor was a research analyst in NCSL’s Health Program; for questions about this story, please contact Samantha Scotti.

NCSL acknowledges Arnold Ventures for its support of this resource. Please note that NCSL takes no position on state legislation or laws mentioned in linked material, nor does NCSL endorse any third-party publications; resources are cited for informational purposes only.


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