State appeals judge’s decision to block health price law

The state of Ohio is appealing a judge’s decision to block a health care transparency law, which called for sweeping changes to health care billing but has never gone into effect.

Attorney General David Yost’s office filed an appeal March 14, though his office said it doesn’t have more information to share about the decision to appeal.

The law required health care providers to give an up-front, good-faith estimate of the cost of care, unless it was an emergency. The bill had been supported by state Rep. Jim Butler, R-Oakwood, who said it provided consumers necessary information, but was opposed by medical industry groups that called the law burdensome and unworkable.

Billing transparency has become a hot policy topic at both the federal and state level.

MORE: Work rules approved for Ohio Medicaid expansion

Thomas Campanella, director of the health care MBA program at Baldwin Wallace University, said while he couldn’t weigh in on the specific lawsuit, in general both hospitals and the insurance industry could be doing more to make prices transparent.

While it might be cumbersome for providers to figure out how much a procedure costs after insurance, he said this same problem has been around for years and more could have been done by now to make costs transparent if the providers and insurers felt more pressure to do so.

“If you don’t do anything about it and you don’t adjust the systems, it will always be impractical,” Campanella said.

Hospitals and insurance companies typically agree to confidentiality clauses that prevent them from sharing the in-network prices they’ve negotiated, and while there are business reasons for confidentiality, it creates problems for patients wanting to understand their costs.

“In the middle of all this is the consumer and the employer being penalized,” Campanella said.

The law being appealed was passed in 2016 as part of a larger workers compensation bill. However, it never went into effect.

The Kasich administration did not create the rules needed to implement the law, and several health care industry groups, including the Ohio Hospital Association and Ohio State Medical Association, had also sued in Williams County Common Pleas Court and got a temporary restraining order blocking the law.

The Ohio Hospital Association said hospitals “wish to empower patients to fully understand cost obligations and, quite aside from any law or regulation, are providing more information to patients.”

“OHA remains committed to working with other providers, payers and policymakers on price transparency, but state policy must be attainable, provide meaningful information to patients and be written in a way that hospitals and other providers can comply with the law,” the association said.

In the February decision to approve a permanent injunction against the price transparency law, the judge noted that House Bill 52, where the price transparency language is found, was intended to make changes to the workers compensation law and to make appropriations for the Bureau of Workers Compensation.

MORE: CareSource denied 17 percent of in-network marketplace claims

He wrote that the entire legislative history of that bill had been about workers compensation, and when it passed both the House and Senate, it contained no reference to health care price transparency. Then on June 25, 2015, with no hearings or prior introduction, the amendment was added with the price transparency act. The judge’s decision only blocks the portion of House Bill 52 that added the price transparency act.

A different health care transparency bill has been re-introduced this session, this time with the support of the Ohio Hospital Association and several other provider groups.

Senate Bill 97 is sponsored by state Sen. Stephen Huffman, R-Tipp City, which would mean that if a patient requests a cost estimate for a scheduled services, then the health care provider would provide a reasonable, good-faith estimate.

Huffman, a physician, has said that it is important to have a bigger discussion on health care transparency.

About the Author