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2014-5

Addressing Excessive Out-of-Pocket Costs for Patients

REPRESENTATIVE LOUIS RUIZ (KS) HEALTH CARE TASK FORCE

WHEREAS, because disease, illness, and injury often occur unpredictably, health insurance is a means to protect individuals from unforeseen and high health care costs. However, services and treatments needed by sick people are becoming less affordable even with insurance due to high cost-sharing requirements that result in significant patient out-of-pocket costs; and

WHEREAS, patient out-of-pocket costs for health care services and treatments, including deductibles, co-pays, and co-insurance, are on the rise. Out-of-pocket costs for patients can exceed 30 percent of the cost of primary care and specialist visits and some medications, while average deductibles have increased by 150 percent over the past five years; and

WHEREAS, despite protections in the Affordable Care Act (ACA), consumers are still exposed to significant cost-sharing. While the ACA establishes a maximum annual limit on out-of-pocket spending, spending for individual services, treatments and drugs is not capped. At the point of sale or service consumers can be faced with substantial out-of-pocket expenses in the form of deductibles, co-pays, and co-insurance; and

WHEREAS, not all utilization applies towards the annual limit on out-of-pocket spending. Out-of-network providers, services and drugs that are not covered, and non-essential health benefit services do ot need to count towards the annual out-of-pocket máximum established by the ACA; and

WHEREAS, cost-sharing requirements for health care services and treatments should not be so large as to inappropriately restrict or interfere with medical care, potentially resulting in a negative impact on health outcomes;

NOW THEREFORE BE IT RESOLVED, it is critical to promote, support, and encourage addressing
Excessive out-of-pocket costs for patients. Benefit design should support treatment decisions that are driven by clinical judgment and patient choice, not by costs, to promote long-term health; and

BE IT FINALLY RESOLVED, that the amount of patient cost-sharing should be limited and that additional legislative provisions may be needed to safeguard affordable patient access to health care services and treatments.

THIS RESOLUTION WAS ADOPTED ON OCTOBRE 03, 2014 AT THE NHCSL EXECUTIVE COMMITTEE & BUSINESS BOARD OF ADVISOR MEETING HELD IN WASHINGTON, D.C.RATIFIED ON DECEMBER 9, 2014 AT THE NHCSL ANNUAL MEETING HELD IN SAN JUAN, PUERTO RICO.