Policy Resolution HHS-15-31

WHEREAS, because disease, illness, and injury often occur unpredictably, health insurance is a means to protect individuals from unforeseen and high health care costs;

WHEREAS, services and treatments needed by people with illnesses are becoming less affordable even with insurance due to high and rising cost-sharing requirements that result in significant patient out-of-pocket costs (including deductibles, co-pays, and co-insurance);

WHEREAS, out-of-pocket costs for patients can exceed 30 percent of the cost of primary care, specialist visits, and some medications, while average deductibles have increased by 150 percent over the past five years;

WHEREAS, despite protections in the Patient Protection and Affordable Care Act (ACA), consumers are still exposed to significant cost-sharing;

WHEREAS, the ACA establishes a maximum annual limit on out-of-pocket spending; however, spending for individual services, treatments, and drugs is not capped, and 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;

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 not have to be counted towards the annual out-of-pocket maximum 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.

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

BE IT FURTHER RESOLVED, that the amount of patient cost-sharing should be limited to what patients can reasonably afford and that additional legislative provisions should be examined to safeguard affordable patient access to health care services and treatments; and

BE IT FINALLY RESOLVED, that a copy of this resolution be transmitted to the President of the United States, the Vice President of the United States, members of the United States House of Representatives and the United States Senate, and other federal and state government officials as appropriate.

• SPONSORS: Senator Constance N. Johnson (OK) and Senator David Haley (KS)
• Committee of Jurisdiction: Health and Human Services Policy Committee
• Certified by Committee Chair: Senator Willie Simmons (MS)
• Ratified in Plenary Session: Ratification Date is December 12, 2014
• Ratification is certified by: Representative Joe Armstrong (TN), President