As an advocate for consumers, CQC works to ensure that patients – and their right to high-quality and affordable health care – remain at the forefront of the health care debate.
Consumers for Quality Care (CQC)-Ipsos research shows that two in three Americans struggle with predicting how much they will have to pay for health care when they need it. They fear health care costs even more than they worry about costs associated with retirement, college, housing or childcare.
CQC aims to provide a voice for consumers and a platform to tell their stories and remind policymakers of the importance of quality comprehensive and affordable care, focusing on health care policies including:
- Surprise medical bills: Hospital care is the single largest component of national health care spending. We expect that our health care premiums will cover most of our hospital costs, but over half of all Americans have received a surprise medical bill in the past year for a cost they thought was covered by their health insurance. Many surprise hospital bills result from “balance billing” for treatment at in-network facilities by out-of-network providers. Others result from a lack of customer understanding of complex health benefits and opaque pricing and still others are a result of billing errors.
- Junk insurance plans: Short-term limited-duration insurance (STLDI) plans that pass unanticipated costs along to consumers are proliferating due to Trump administration rules that allow these plans to continue for 12 months or longer. STLDI plans are exempt from many Affordable Care Act (ACA) requirements and can exclude coverage for preexisting conditions, have dollar value limits on covered services and are not required to cover preventive services, and have a host of other substantial risks for consumers. These plans raise even more problems during the coronavirus pandemic since they are exempt from provisions in the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act, such as the requirement for insurers to cover telehealth visits, which are a valuable tool to protect people during a pandemic while still ensuring access to care.
- Protecting Medicaid: Medicaid is critical for millions of Americans. While 35 states and DC continue to expand Medicaid to its residents, others – including Oklahoma, Arkansas and New Hampshire – have opted instead to roll out dangerous and abusive attempts at limiting coverage for the people who need it, such as embracing the use of a Medicaid block grant proposal, implementing Medicaid work requirements and cutting prescription drug coverage. The COVID-19 pandemic has laid bare the inequalities in our health care system, highlighting gaps in insurance coverage for large swaths of our population. We must embrace the national expansion of Medicaid as a remedy to these problems and a necessary step in building a healthier and more resilient population that is better able to fight the next pandemic.
- Accumulator adjustment programs: The cost of medicines at the pharmacy counter are being forced up by policies by health plans and pharmacy benefit managers (PBMs)that prevent consumers from using copay coupons to bring down the out of pocket price they pay for the prescription drugs they need. Many Americans, particularly those with chronic diseases, rely on medicines to manage their conditions. With copay adjustment – or accumulator adjustment – programs, insurers no longer allow drug cost sharing coupons to count towards patients’ deductibles or caps on total out-of-pocket costs. For some patients, their coupons run out before the end of the year—leaving them with unexpected amounts they can’t afford to pay when they try to fill a prescription at the pharmacy.
- Emergency department policies: Some insurers have instituted policies that would force policy holders to pay for an emergency room visit if the insurer later deems it a non-emergency, jeopardizing patients’ health and their finances. These policies, which essentially require patients to diagnose themselves in order to ensure their condition is serious enough to be deemed an emergency by their health insurer — are harming customers while reducing costs for the insurers implementing them. The only recourse for consumers who have an emergency department visit denied after the fact is a burdensome and bureaucratic appeals process or being forced to pay unexpected out-of-pocket fees.
- Prior authorization of medical treatments: Prior authorization – which requires physicians to secure approval from insurers for needed procedures or medications – is a common fixture in modern health insurance plans. Unfortunately, significant delays and dangerous denials in these prior authorizations are also all too common, forcing patients to appeal and delay important tests and treatments or attempt to pay for expensive procedures and medications out-of-pocket. An American Medical Association (AMA) survey of 1,000 physicians found that 9 in 10 reported prior authorizations delayed access to necessary care and more than 25 percent said the delays had led to a serious adverse event.
- Lack of transparency in hospital pricing: Consumers have long grappled with the fact that prices for hospital services vary widely and hospital pricing in general is opaque, making it more nearly impossible to figure out what they might have to pay. In fact, sixty-five percent of Americans report it is difficult to understand the cost of care received at a hospital, according to Ipsos/CQC research. In an attempt to address this problem, hospitals are now required to post list prices online. Unfortunately, consumers are finding that despite these “chargemasters” being public, it can still be difficult to know where to find them, how to read them and to how determine which charges they would be responsible for in any given treatment scenario, setting the stage for unexpected charges and surprise bills.