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Last night, the California Budget Conference Committee voted on a budget proposal that reflected a deal between the Governor and Legislature, including investments in health services with additional steps to universal coverage.

As a result of this budget, hundreds of thousands of Californians will get more help to access and afford health coverage, preventing premium increases for everyone and benefiting the health system we all rely on.

This budget deal builds on some of the Governor’s first-in-the-nation proposals with important next steps to a more affordable and universal health system. Many Californians will get more help with health care costs and coverage under this budget.

Beyond the Governor’s May Revise budget, health highlights that were sought by health and consumer advocates include:

  • Additional affordability assistance in Covered California beyond the revenue raised by a new state-level individual mandate, for around those under 138% of the poverty level (below around $16,800/year for an individual, benefiting around 35,000 Californians), and especially middle-income Californians between 400-600% of the poverty level ($48,000-$72,000/year for an individual, benefiting around 190,000 Californians).
  • The end of the “senior penalty” in Medi-Cal, raising the eligibility level for seniors and people with disabilities up to 138% of the poverty level, aligning with the rest of the Medi-Cal program.
  • The restoration of several Medi-Cal benefits, including optical, audiology, speech therapy, podiatry, and incontinence creams and washes, which were cut a decade ago during the Great Recession.
  • Funding for outreach and enrollment in Medi-Cal, and
  • An agreement to extend the Managed Care Organization (MCO) tax, although no revenues were allocated until federal approval.

For more, see our 2019 Health Access Budget Scorecard

Breaking new ground nationally, low- and middle-income Californians will get more help affording insurance through Covered California. A state-level individual mandate, paired with additional affordability assistance, will keep people covered and help lower premiums. This vital help for families to afford coverage will go beyond the revenue raised by re-instituting this key part of the ACA here in California. These new state subsidies make a real, tangible difference for those around or below poverty, and especially for those middle-income Californians who now don’t get any help under the federal law, despite the urgent need in our high-cost state. The ACA provides affordability assistance for folks up to four times the poverty level, but with this deal Covered California will now be the first to provide some subsidy to those up to six times the poverty level. This is a big deal to not just defray the high cost of health premiums, but to bring more Californians into coverage.

This budget improves Medi-Cal in multiple ways, including improving access and benefits for the 13 million Californians who depend on the crucial program, while also removing unfair exclusions from full Medi-Cal coverage for seniors and people with disabilities, undocumented young adults, and others. And, after a decade since they were cut in a recession, this budget finally restores key benefits like podiatry, audiology, and speech therapy.

Health and immigrant advocates are pleased that a key provision that we have sought for years will become a reality in California – expanding Medi-Cal coverage to not just all income-eligible children but young adults up to age 26 as well. While a handful of states cover all income-eligible children and pregnant women, California will become the first state to remove the exclusion for other adults, recognizing our health system is stronger when more people can get primary and preventive care. As we cheer this first-in-the-nation step, we were nonetheless disappointed as we were unable to make that same commitment to all California’s undocumented seniors this year.

Health Access’ push to include undocumented seniors, and ultimately to the goal of #Health4All, will continue in the months ahead. Additionally, we will continue to pursue steps in the near-term to achieve the Governor’s and Legislature’s shared goal of getting to universal coverage in the next few years, with greater affordability assistance in Covered California and further expansions of Medi-Cal.

Since 2017, the over 70 consumer and community groups of the #Care4AllCA campaign have advocated to take additional steps to move California towards universal coverage, including the investments needed to close the remaining gaps in our system. The campaign is proud to have successfully argued for more help in affordability assistance up and down the income spectrum, and those impacted by the “senior penalty” in Medi-Cal.

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The California State Assembly passed AB 1611 by Assemblymember David Chiu and Senator Scott Wiener to end surprise emergency room bills on a 48-9 vote. AB 1611 is a key patient protection that would also lower the costs of health care for California consumers. The bill faced opposition from industry lobbyists who argued that the status quo is working fine, but the patients who receive hospital ER bills of tens of thousands of dollars tell a different story. AB 1611 also gained an endorsement from the Los Angeles Times.

After an emergency room visit, some California patients still receive a “balance bill” which is the difference between what the hospital charged for the service and what the insurer paid for the service. These unexpected medical bills can be huge, even after the patient’s insurance pays their portion. When experiencing an emergency, Californians are not able to choose where they are taken for their care. AB 1611 prevents patients from being on the hook for a bill incurred when receiving care at an emergency room in a hospital that ends up being out of network.

For the majority of consumers, California law requires a health plan to cover the cost of the emergency care a patient receives whether or not a hospital is in-network. However, there is still a giant gap in state law. Specifically, six million Californians with federally regulated health plans and one million Californians with coverage regulated by the California Department of Insurance are at risk for surprise emergency room bills because they are not covered by these important consumer protections.

In 2017, California enacted and implemented strong protections against surprise billing for patients in health facilities with AB 72. AB 1611 closes remaining gaps in state law and extends important consumer protections for those that get care in emergency rooms.

The bill is already prompting change. After high-profile stories and public pressure earlier this year, Zuckerberg San Francisco General Hospital (ZSFG) announced a proposal to end their egregious practice of keeping their ER out-of-network in order to charge insured patients higher rates. But ZSFG is not alone – many other hospitals also engage in this practice. AB 1611 would prevent balance billing and surprise emergency bills statewide.

Patients in an ambulance are in no position to choose what emergency room they end up at, and certainly should not get any extra or inflated charges if the hospital is out-of-network. AB 1611 is a key consumer protection that could help save Californians from crushing medical bills.

AB 1611 now moves to the State Senate for policy hearings in the coming weeks.

Read more on AB 1611:

Legislation prompted by huge SF General bills passes California Assembly

California hospitals are fighting a proposal to end surprise ER bills

Lawmakers Push to Stop Surprise ER Billing

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Last week the Assembly has voted on its proposed budget investments in health and human services, while last week, the Senate proposed to expand Medi-Cal and to help middle-income Californians better afford premiums in Covered California and the individual insurance market. Both build on Governor Newsom’s 2019-2020 May Revision that includes first-in-nation steps toward universal coverage.

After voters made health care such a priority in the next election, the health care debate in California’s budget is appropriately not just if we can take steps to increase access and affordability of coverage, but how many steps at what scale. The Senate’s budget proposal would make the most meaningful investments to help people to purchase coverage in Covered California and to expand Medi-Cal to all Californians regardless of age or immigration status. How much help Californians get accessing and affording health care is now up to the California budget negotiations between the Governor and legislative leaders. What’s at stake is the difference not just of dollars and cents but whether or not many Californians will get coverage and care. If the Senate prevails with the health budget priorities, tens of thousands of California seniors will have new access to full Medi-Cal coverage, and hundreds of thousands of families would get more affordability assistance in Covered California.

California is stronger when everyone has access to affordable health care. Too many low- and middle-income families are still living one emergency away from financial ruin, and need additional affordability assistance now. Additional investments proposed in the Governor and Legislative budgets can provide much-needed relief to Californians, and help bring our state closer to the goal of universal health care coverage, benefiting the health system. The work continues with policymakers to advocate for greater general fund investments, to have the most meaningful impact for those who don’t get ACA subsidies but still struggle with the cost of care given our high cost-of-living, and those that are locked out of care entirely due to age, income, or immigration status.

Over 70 consumer and community groups of the #Care4AllCA campaign will advocate to take additional steps to move California towards universal coverage, including the investments needed to close the remaining gaps in our system. Additional steps include providing more help in affordability assistance up and down the income spectrum, including to those under 200% of the poverty level, to undocumented seniors, and those impacted by the “senior penalty” in Medi-Cal.

According to the U.S. census, California has had the largest drop in the uninsured rate of all 50 states after the implementation of the Affordable Care Act (ACA), going from 6.5 million uninsured to 2.8 million, and a 7.2% uninsured rate. But a recent UC Berkeley/UCLA report found that due to the elimination of the ACA’s individual mandate by Congress, the uninsured rate could grow to 11.7% in 2020 (about 4 million people) and then to 12.9% in 2023 (or 4.4 million people). The largest groups of the remaining uninsured are undocumented Californians who are barred from accessing most health coverage options and Californians who struggle to afford their care.

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A new brief by the UC Berkeley Labor Center and UCLA Center for Health Policy Research is the first of its kind to model the health coverage impacts of pending legislation in the California State Legislature. The report finds that under the current legislative and budget proposals 1.7 million Californians would be enrolled in coverage instead of being uninsured in 2023. In addition, it would lower health insurance costs by 35% for 2.3 million people enrolled in the individual market. They would either receive state assistance with health care costs or experience lower premiums. The largest group gaining coverage would be low-income undocumented adults who would become eligible for full-scope Medi-Cal coverage. The new report analyzes three policy proposals that, taken together, would benefit 3.6 million Californians:

  • Expanding Medi-Cal to all income-eligible adults regardless of immigration status as proposed in AB 4 by Assemblymembers Bonta, Chiu, and Santiago, and SB 29 by Senator Durazo
  • Providing greater affordability assistance to low- and middle-income Californians who purchase coverage in Covered California as proposed in SB 65 by Senator Pan and AB 174 by Assemblymember Wood
  • Implementing a state-level individual mandate as proposed in SB 175 by Senator Pan and AB 414 by Assemblymember Bonta.

These proposals are also being discussed as state budget items. They are actively supported by the #Care4AllCA campaign of over 70 health, immigrant, labor, senior, children, LGBTQ, and community groups who are advocating for legislators and Governor Newsom to take these steps that could move our state closer to universal coverage, without the need for federal approvals. Governor Newsom has already included parts of each of these proposals in his first state budget.

Due to it’s aggressive implementation and improvement on the Affordable Care Act (ACA), California has seen the largest drop in uninsured of all 50 states, from 20% to nearly 7% uninsured (from 7 million to 3 million uninsured). Researchers of the new brief found that if the state takes no action, the number of uninsured Californians is projected to increase to 4.4 million in 2023. This is due to actions by the Trump Administration and Congress like the elimination of the individual mandate, as well as trends such as premium increases that makes health care increasingly unaffordable (especially in our high cost-of-living state) and wage increases that move people out of Medi-Cal eligibility windows.

While California made historic gains in health care coverage under the ACA, we must take additional steps to help those who struggle to access care due to exclusions or affordability barriers. California can counter the attacks by the Trump Administration to our health system, but also provide additional access and financial assistance for millions in California who find it hard to make ends meet in our high cost-of-living state.

If California does not counter these federal attacks, more people will become uninsured, living sicker, dying young, and being one emergency away from financial ruin. It would be a shame to allow more Californians to lose coverage when there are tangible, achievable actions to prevent this backslide and make our health system stronger for everyone. After a historic health care election, Governor Newsom and the Legislature have the opportunity to craft a state budget that includes a major down payment to increase health care access and affordability and ever closer towards the goal of universal coverage in California.

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This week the Assembly voted on its proposed budget investments in health and human services, while last week, the Senate proposed to expand Medi-Cal and to help middle-income Californians better afford premiums in Covered California and the individual insurance market. Both build on Governor Newsom’s 2019-2020 May Revision that includes first-in-nation steps toward universal coverage.

See Health Access’ updated Budget Scorecard to keep track of the health issues at play in the state budget

After voters made health care such a priority in the next election, the health care debate in California’s budget is appropriately not just if we can take steps to increase access and affordability of coverage, but how many steps at what scale. The Senate’s budget proposal would make the most meaningful investments to help people to purchase coverage in Covered California and to expand Medi-Cal to all Californians regardless of age or immigration status.

How much help Californians get accessing and affording health care is now up to the budget negotiations between the Governor and legislative leaders. What’s at stake is the difference not just of dollars and cents but whether or not many Californians will get the coverage and care they need. If the Senate prevails with the health budget priorities, tens of thousands of California seniors will have new access to full Medi-Cal coverage, and hundreds of thousands of families would get more affordability assistance in Covered California.

California is stronger when everyone has access to affordable health care. Too many low- and middle-income families are still living one emergency away from financial ruin, and need additional affordability assistance now. Additional investments proposed in the Governor and Legislative budgets can provide much-needed relief to Californians, and help bring our state closer to the goal of universal health care coverage, benefiting the health system.

The work continues with policymakers to advocate for greater general fund investments, to have the most meaningful impact for those who don’t get ACA subsidies but still struggle with the cost of care given our high cost-of-living, and those that are locked out of care entirely due to age, income, or immigration status.

Over 70 consumer and community groups of the #Care4AllCA campaign will advocate to take additional steps to move California towards universal coverage, including the investments needed to close the remaining gaps in our system. Additional steps include providing more help in affordability assistance up and down the income spectrum, including to those under 200% of the poverty level, to undocumented seniors, and those impacted by the “senior penalty” in Medi-Cal.

According to the U.S. census, California has had the largest drop in the uninsured rate of all 50 states after the implementation of the Affordable Care Act (ACA), going from 6.5 million uninsured to 2.8 million, and a 7.2% uninsured rate. But a recent UC Berkeley/UCLA report found that due to the elimination of the ACA’s individual mandate by Congress, the uninsured rate could grow to 11.7% in 2020 (about 4 million people) and then to 12.9% in 2023 (or 4.4 million people). The largest groups of the remaining uninsured are undocumented Californians who are barred from accessing most health coverage options and Californians who struggle to afford their care.

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Key legislation to make health care more affordable passed fiscal committees in the California Legislature, setting up high-stakes floor votes and budget negotiations in the next few weeks. The proposals would expand health coverage, increase affordability for hundreds of thousands of Californians, and reduce health care costs overall, and are all supported by the #Care4AllCA campaign made up of 70 consumer and community groups.

The Assembly Appropriations Committee passed key bills that could save California consumers hundreds of millions of dollars a year, including AB 1611(Chiu) to stop “surprise” emergency room bills, and AB 731 (Kalra) to expand and improve rate review and oversight of premiums increases. Both bills, co-sponsored by Health Access California and the California Labor Federation with strong support from consumer, labor, and community organizations, face industry opposition, by hospitals and health plans respectively, as they need to pass floor votes in the next two weeks in order to proceed this year.

Californians can save hundreds of millions of dollars a year if these key health reforms pass, despite industry opposition by hospitals and health plans. In the next few days, California legislators can close the loopholes in our law to stop surprise medical bills that are causing many Californians financial stress even after the actual stress of an emergency has passed. When Californians go to the emergency room, they should focus on getting care and getting well, not getting a bill. With these upcoming votes, California Assemblymembers have the opportunity to save consumers millions by preventing outrageous ER bills and expand a proven practice that has successfully gotten health plans to roll back or retract unreasonable rate increases. California voters have been clear about needing relief from high health costs, and legislators now have a clear opportunity to side with their constituents, even in the face of industry opposition.

The Assembly and Senate Appropriations Committees passed out several bills, including SB 65 (Pan) and AB 174 (Wood) to increase affordability assistance to Californians buying coverage on their own through Covered California. Other proposals would expand Medi-Cal, including for low-income undocumented immigrants as in SB 29 (Durazo) and AB 4 (Bonta, Chiu, Santiago), and for low-income seniors in AB 715 (Wood).

On the separate track of the budget, the Senate Budget Subcommittee on Health and Human Services voted to include specific investments towards these goals. This includes $300 million more in affordability assistance for those purchasing coverage in Covered California than what Governor Newsom proposed in his budget. The Senate Subcommittee also voted to go beyond the Governor’s budget proposal in expanding Medi-Cal to more seniors, including those excluded by the so-called “senior penalty” and those excluded due to immigration status. Health Access California has a budget scorecard to track these health investment proposals, at: www.health-access.org/budgetscorecard2019

Especially in our high cost of living state, millions of Californians still struggle to made ends meet and pay their health care premiums and cost-sharing. The state budget must include more meaningful affordability assistance and help more low- and middle-income Californians to get into coverage, which would strengthen the system and help bring down premiums for everyone. The Senate has take several steps to include more low-income seniors in Medi-Cal, who are now unfairly excluded for income or immigration status. Californian seniors have significant health care needs, and this will make sure our Medi-Cal program can address these issues that impact our entire community. Our health care system works better and benefits all Californians when everyone is covered.

These bold proposals — to invest in greater affordability assistance, to continue the individual requirement to have coverage at the state level, and to expand Medi-Cal — will work together to help Californians with accessing and affording health care in multiple ways. Listening to the voters in the recent health care election, the Legislature is right to go beyond the significant steps the Governor has laid out in order to get to a real down-payment towards the goal of universal health care this year. Low- and middle-income Californians across the state need the help as soon as possible, to be able to afford care and coverage.

The Care4All California campaign of over 70 health, consumer, and community organizations proposed many parts of this agenda last year, and are backing over 20 bills and budget items this year, many aligned with and building on Governor Newsom’s goals. Last year, the campaign advanced 20 bills and budget items last year, and had eight pieces of legislation signed into law.

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Today Governor Gavin Newsom unveiled the May Revision of his proposed 2019-2020 budget continues to include first-in-nation steps toward universal coverage including enhanced affordability assistance in Covered California, continuing the ACA’s individual requirement for coverage at the state level, and $200 million general fund investment to expand Medi-Cal to low-income  young adults up to age 26 regardless of immigration status.

See Health Access 2019 Budget Scorecard for a break down of Governor Newsom’s proposals and what additional steps we can take towards universal coverage.

As opposed to the debate in DC about rolling back and repealing reforms, the health care debate in California’s budget will be about the scale and amount of help we can provide in accessing and affording coverage. The Governor laid out initial steps to universal coverage, now the budget debate in the next few weeks will be about how far California will go down that path this year, to cover everyone regardless of age, income, or immigration status.

The May Revision provides an up-front investment to start affordability assistance in 2020 to middle-income Californians, now from 200-600% of the poverty level, from money raised by instituting the state-level ACA-like individual requirement to have coverage. Patient advocates will urge more help, especially for those lower on the income scale, and additional general fund dollars.

These upfront investments to start this help for consumers next year are appreciated, but Californians need ongoing general fund investments to get to the scale and consistency to make this meaningful for middle-income California families in this high-cost state.

Over 70 consumer and community groups of the #Care4AllCA campaign will continue to work with legislators to take additional steps to move California towards universal coverage, including the investments needed to close the remaining gaps in our system. Additional steps include providing help to those under 200% of the poverty level, to undocumented adults age 26 and older, and those impacted by the “senior penalty” in Medi-Cal. For lower-income Californians, a little help can go a long way in getting more consumers covered and making the system stronger for everyone.

According to the U.S. census, California has had the largest drop in the uninsured rate of all 50 states after the implementation of the Affordable Care Act (ACA), going from 6.5 million uninsured to 2.8 million, and a 7.2% uninsured rate. But a recent UC Berkeley/UCLA report found that due to the elimination of the ACA’s individual mandate by Congress, the uninsurance rate could grow to 11.7% in 2020 (about 4 million people) and then to 12.9% in 2023 (or 4.4 million people). The largest groups of the remaining uninsured are undocumented Californians who are barred from accessing most health coverage options and Californians who struggle to afford their care.

The ongoing federal and judicial attacks to our health care continue to threaten to undo much of this progress made under the ACA unless the states takes bold action to prevent more people becoming uninsured in our state. Above all, it is encouraging that Governor Newsom and legislators are heeding the call of the California voters in the most recent election, making the debate not about whether we should expand access and affordability to coverage and care, but by how much.

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The California State Assembly Health Committee yesterday passed AB 1611 by Assemblymember David Chiu and Senator Scott Wiener to end surprise emergency room bills on a 11-0 vote. After an emergency room visit, some California patients still receive a “balance bill” which is the difference between what the hospital charged for the service and what the insurer paid for the service. These unexpected medical bills can amount to tens of thousands of dollars even after the patient’s insurance pays their portion.

When experiencing an emergency, Californians are not able to choose where they are taken for their care. Since patients lack choice, then they should never be faced with an outrageous bill that can cause them financial ruin and bankruptcy. AB 1611 prevents patients from being on the hook for a bill incurred when receiving care at an emergency room in a hospital that ends up being out of network.

For the majority of consumers, California law requires a health plan to cover the cost of the emergency care a patient receives whether or not a hospital is in-network. However, there is still a giant gap in state law. Specifically, six million Californians with federally regulated health plans and one million Californians with coverage regulated by the California Department of Insurance are at risk for surprise emergency room bills because they are not covered by these important consumer protections.

In 2017, California enacted and implemented strong protections against surprise billing for patients in health facilities with AB 72. AB 1611 closes remaining gaps in state law and extends important consumer protections for those that get care in emergency rooms.

The bill is already prompting change. Last week Zuckerberg San Francisco General Hospital (ZSFG) announced a proposal to end their practice of “balance billing” after making headlines earlier this year for their egregious practice of keeping their ER out-of-network in order to charge insured patients higher rates. But ZSFG is not alone – many other hospitals also engage in this practice. AB 1611 would prevent balance billing and surprise emergency bills statewide. The bill is co-sponsored by Health Access California and the California Labor Federation.

AB 1611 is a statewide solution to unfair and outrageous surprise emergency room bills. Patients in an ambulance are in no position to choose what emergency room they end up at, and certainly should not get any extra or inflated charges if the hospital is out-of-network. This legislation closes loopholes in California’s otherwise strong consumer protections against surprise medical bills, taking the patient out of the middle of billing disputes between hospitals and insurers.

AB 1611 now moves to the Assembly Appropriations Committee for a vote in the coming weeks with a floor vote potentially in mid-May.

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On his 100th day in office, Governor Gavin Newsom announced a partnership with Los Angeles County on prescription drug purchasing, putting together the power of the country’s biggest state and county for the biggest discounts and lower prices needed for medications. The State of California and Los Angeles County buy drugs for similar purposes and populations and can leverage their power against the price-gouging of the pharmaceutical companies.

Consumer groups see a lot of great potential in this new purchasing pool proposal savings for these state and county programs and the public in general. Californians now have a bigger leverage to get better deals. The biggest state and the biggest county in the nation should be able to get bigger discounts on prescription drugs.

Consumer and community groups will continue to pursue other ways to bring down prescription drug prices, as well as other health care costs. The Legislature is advancing bills to stop pay-for-delay practices that inflate the price of medications, as well as greater oversight on insurance premiums and hospital emergency room bills. Californians need help with health care affordability urgently, policymakers are listening to voters to make progress on prescription drug prices and more.

Governor Newsom made major moves in health care not just in his first 100 days, but in his first day and his first week, with first-in-the-nation proposals to expand health coverage and increase affordability, quality and equity.

These major health care priorities are proceeding on schedule, moving ahead at this midpoint in California’s budget and legislative processes, even if there is more work to do to advance and improve these proposals.

The Governor’s proposals to expand coverage and increase affordability, by extending Medi-Cal to young adults regardless of immigration status, and increase financial assistance to more middle-class Californians through a state-level individual mandate were discussed and debated in the California Legislature last week. Many legislators showed support even going beyond these steps and covering all adults, regardless of immigration status, and further extending financial subsidies in the individual market. The #Care4AllCA campaign of 70 consumer and community groups have championed a number of these legislative and budget proposals while also seeking to take additional steps to help more Californians and cut the uninsured rate.

California’s positive progress over the last 100 days is in stark contrast to the federal government’s continued efforts to sabotage our health system, through regulation or litigation. The California electorate clearly expects to not just keep us where we are, but to improve the system and make it work better for more people. Governor Newsom’s efforts on prescription drug prices or other health priorities are not just protect California’s progress, but take further steps to guaranteed, affordable, quality, health care coverage for all.

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On Tuesday, April 16th  Zuckerberg San Francisco General Hospital announced a proposal to be considered by the San Francisco Health Commission to end the practice of “balance billing,” where insured patients get billed the remaining balance after insurer payment of an emergency room bill. This practice can leave patients with bills in the tens of thousands of dollars. The California Legislature this year introduced AB 1611 (Chiu) to end this practice and it is set for it’s first hearing in the Assembly Health Committee on Tuesday, April 23rd. This bill builds on 2016’s AB 72, which prevented this practice in other health facilities. The issue of surprise medical bills is much bigger than one hospital or one city.

AB 1611 (Chiu), would end surprise emergency room bills that are not just unfair, but can send a family’s finances into a free-fall. Patients are doing everything right in seeking care during an emergency. When you or a loved are on a gurney in an ambulance, you are in no position to choose what emergency room you end up at, and you certainly should not get any extra or inflated charges if the hospital happens to be out-of-network. The bill closes loopholes in California’s otherwise strong consumer protections against surprise medical bills, taking the patient out of the middle of billing disputes between hospitals and insurers. After experiencing the trauma of an emergency, this bill helps ensure that patients and their families don’t face the additional trauma of an outrageous and unfair hospital bill.

With backing from patient, consumer, community, labor, and other organizations, AB 1611 (Chiu) will be heard next Tuesday, April 23rd in the Assembly Health Committee.

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