State Update: Surprise Medical Bills, New States Sign On to Death With Dignity, & More!

Recently, there have been many news stories related to changes to our health care system that have a significant potential impact on the cancer community.  Here are a few highlights . . .


California’s state legislature just approved a budget, which includes reinstating the individual mandate penalty. Starting in 2020, individuals who reside in California and opt not to have health coverage can face a $695 state penalty or 2.5% of their household income, whichever is more – a fine that will increase each year with inflation.

This penalty will actually raise funds to provide more financial assistance for people buying health insurance coverage in the state Health Insurance Marketplace, called Covered California.  Currently, under the Affordable Care Act (ACA) people with household incomes up to 400% of the federal poverty level can get financial assistance to buy their health insurance through the Marketplace.  In California, people up to 600% of the FPL will be able to get financial help.Enrollment will begin in the fall and the plans will go into effect on Jan. 1, 2020.

California also expanded Medi-Cal, the state’s Medicaid program for low-income people, to cover all young adults ages 19-25, regardless of immigration status. California already makes Medi-Cal available to children regardless of immigration status.

Maine & New Jersey:

Maine and New Jersey have joined eight other states and Washington, D.C., to allow for medically assisted suicide. These new laws allow terminally ill patients to obtain life-ending medication that they must self-administer. Read our Death with Dignity blog for more information about these types of laws.


Maryland Gov. Larry Hogan signed a bill to allow those who are uninsured to receive assistance in finding out if they qualify for low-cost insurance after they file their income taxes. In efforts to improve access to health care, this law will provide a box for individuals to check on their income tax returns for the state’s health care exchange to see if they qualify for Medicaid. If so, they will be enrolled automatically.

South Carolina:

On June 9th, the state officially submitted a request to the Trump Administration to impose a requirement for Medicaid recipients to work, be enrolled in job training, or be in school an average of 80 hours a month. In this proposed law, Medicaid recipients who don’t meet the requirements for three consecutive months will have their benefits suspended for three months, or until the work requirements are met, whichever comes first.


Texas Gov. Greg Abbott signed legislation to protect patients from surprise medical bills when a member of their health care team is not an in-network provider, or they visit an out-of-network emergency room. Sometimes insurance companies and medical providers do not agree on a fair price for that care and patients end up with a hefty medical bill. Under the new law, insurance companies and medical providers can enter into arbitration to negotiate a payment — and state officials would oversee that process. Similar proposals are being debated in other states and at the federal level. Colorado and New Mexico also passed legislation in 2019 to address surprise bills. A recent report found about half of states offer some legal protections from surprise bills, but only six states had laws that provide “comprehensive” consumer protections similar to those just passed in Texas. Texas’ new law takes effect September 1, 2020.


Washington is the first state to move forward with offering a public health insurance options that would be sold in the health insurance marketplace, beginning in 2021. People can choose the public option plan during open enrollment in the fall of 2020. Monthly premiums for the public plan are estimated to be 5 to 10 percent lower than plans currently available. Provider reimbursement is capped at 160% of Medicare rates, and primary care providers must be paid at least 135% of Medicare rates. Efforts to create a similar plan have mostly stalled in other states this year. Colorado approved a public option study bill this year. Connecticut, Illinois, and Nevada have all pitched versions of public options.

Also in Washington state, the Governor signed legislation to give for eligible residents a $100-per-day allowance for a variety of long-term care services, which will last up to a year. This new legislation begins in 2025 and will come from a payroll tax beginning in 2022.

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