Cost Containment and Accountability Act Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act The Fight To Protect New Jersey Consumers

Existing NJ Protections Members in: - Large group - Individual - Small group plans - State Health Benefit Plan Are held harmless for the balance of any out of network charges in emergency situations.

SO WHAT’S THE PROBLEM?

THE NJ SOLUTION Creating a Comprehensive Consumer Protection Bill

PRINCIPLES ESSENTIAL TO ANY SOLUTION Hold Consumers Harmless for any “inadvertent” out-of-network charge In-network cost sharing will apply for “inadvertent” charges Require providers to disclose network status and estimated cost of care Ban balance billing of consumers for emergency and inadvertent out-of-network charges Notify consumers of the ban and how to report violations Remove consumers from the dispute Establish an independent dispute resolution process for providers and payers to resolve disputed charges Expanding protections to ERISA plan members (opt-in)

Navigating the Landmines Political and Regional Divides: North v. South Push back from powerful stakeholders Building consensus through a unified coalition Emphasizing consumer protection and cost savings

THE PROCESS POLICY PUBLIC MESSAGING Stakeholder meetings with bill sponsors Building a coalition of diverse allies Engaging outside experts and national partners Lobbying legislators Sounding the alarm Mobilizing partners & consumers Story collection Galvanizing media attention

Surprise Medical Bills What they are and how to stop them, while ensuring access to needed services and adequate payment to providers Educating policy makers on the problem, its impact and the solution needed in order to truly protect consumers. Combining research with reality – stories of real consumers impacted all across NJ A REPORT BY

SOUNDING THE ALARM ON COST

“Surprise out-of-network med bills cost NJ $1B” Michael Diamond, Asbury Park Press, June 16, 2016 “Report: Out-of-network care drives premiums in N.J. up by nearly $200” Lindy Washburn, The Record, June 16, 2016

Story Collection "I honestly felt sick to my stomach," Ambos said. "I know I have a co-pay but I never thought in a million years that taking my daughter for an emergency room visit would cost me $3,251 when I was in network.“ Asbury Park Press, June 16, 2016

COALITION OF SUPPORTERS New Jersey Appleseed Public Interest Law Center New Jersey Citizen Action New Jersey Firefighters' Mutual Benevolent Association New Jersey Policy Perspective New Jersey State Pipe Trades Association New Jersey State Policemen's Benevolent Association, Inc. New Jersey Public Health Institute NJ Association of Mental Health & Addiction Agencies, Inc. NJ Business & Industry Association NJ Superior Officers Association NJEA Professional Firefighters Association of NJ Rutgers AAUP-AFT State Trooper Fraternal Association South Jersey NOW, the Alice Paul Chapter State Troopers Fraternal Association Statewide Parent Advocacy Network Union of Rutgers Administrators  AARP – NJ AAUP Biomedical & Health Sciences of NJ AFSCME New Jersey AFL-CIO AFT Local 1904, Montclair State University AFT New Jersey American Federation of Teachers Anti-Poverty Network Association of Counties-NJ Consumers Union Council of New Jersey State College Locals CWA District 1 CWA Local 1014 CWA Local 1081 CWA New Jersey Area (Local 1032) Employers Association of New Jersey Faith in New Jersey Family Voices HPAE Local 1766 National Association of Social Workers – NJ National Multiple Sclerosis Society, New Jersey Chapters National Patient Advocate Foundation New Jersey AFL-CIO 42 Groups in total - Leveraging the support and influence of these groups to move the legislative process and build support

The Power of National Partners The Facts on Out-Of-Network Surprise Bills “To put it in very, very blunt terms: This is the health equivalent of a carjacking.” Zack Cooper, Assistant Prof., Health Policy & Economics, Yale University

New Jersey Consumers and Pass Cost Containment and Accountability Act The Fight To Protect New Jersey Consumers and Pass A1952/S1285 The Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act CONTINUES….. Maura Collinsgru Health Care Program Director New Jersey Citizen Action 732-246-4772 maura@njcitizenaction.org