New Resource: Surprise Medical Billing Policy Playbook.

SiX has just released our Surprise Medical Billing Policy Playbook.

Surprise medical billing refers to when a consumer is unaware that health care services will be charged at out-of-network rates, whether by their insurer or by the out-of-network provider. For example, if a patient receives emergency care at an out-of-network hospital or care from an out-of network provider at an in-network hospital, they could receive a surprise medical bill.

As we face the first global pandemic of the 21st Century, our nation confronts a health care system that is not prepared to deal with an infectious disease at this scale. One of the many challenges we face will be patients who delay or defer care because they are unsure if their visit to a testing facility, urgent care center or emergency room will result in a surprise bill, not covered by their insurance.

These bills can be astronomical and show up despite the consumer's best efforts to obtain covered medical care. During the coronavirus outbreak and subsequent economic downturn, the last thing anyone needs is a surprise medical bill for thousands of dollars. Find out how you can protect your state from surprise medical bills here. 

North Carolinians Supported Economic Reform Even Before the COVID-19 Crisis

A recent poll commissioned by the State Innovation Exchange (SiX) shows North Carolina voters held deep concerns over pocketbook economic issues and support for progressive policy solutions even before the full impact of COVID-19 was felt. The poll showed that North Carolinians believe that the government should play a constructive role in people’s economic lives.  

The Role of Government in the Top Issues Facing North Carolina

When asked if the state government should play a role in some of the top issues facing working families, voters overwhelmingly supported government engagement. Voters’ top priorities include:  

Voters Support Action on Economic Policies

North Carolinians believe that a job should allow workers to earn a wage to support a family (82%), provide a steady consistent income (81%) and allow access to affordable health insurance (78%). North Carolinians overwhelmingly support these policies that help working families:  

These results showed that even before the economic dislocation from the current crisis, North Carolinians wanted economic policies to make life easier for families. Now more than ever, those policies are vitally important.

Click here to see the poll memo and here for the presentation.

April Update

In late April, SiX tested the same issues again to see whether the COVID-19 crisis has changed support for those policies. These recent results show that NC voters continue to strongly support progressive policies. The vast majority of voters believe that the government should have a role in enacting progressive policy changes that would provide economic fairness, more access to affordable health care, and investments in public education. More information here.  

Legislating in a Pandemic: Transparent & Remote Governance

Contents


As a consequence of the COVID-19 pandemic, a growing list of state legislatures have postponed session and legislators themselves have started testing positive for the virus. While some states quickly moved to remote sessions and amended open meeting laws to prevent crowds at state capitols, many are struggling to make this transition in a transparent and accessible manner. Other states have limited or no government continuity plans in place, and some are grappling with constitutions or state laws that appear to prohibit remote governance and voting altogether.

While this is an unprecedented time in American history, where preserving the public health and the continuity of government collide, it will not be the last time that legislatures must shift how they do business. At extraordinary moments like today, state legislatures must adopt methods of flexible, remote governance while prioritizing transparency and public access.

State legislatures adapting to the new reality of governance can learn from early experiences, challenges, and critiques that other state and local governments have faced in the early weeks of the COVID-19 pandemic. We recognize that shifting your state’s approach to governance will not be easy and that there will be hiccups and mistakes along the way. To anticipate and overcome these challenges and to find viable solutions to keep government working and accessible, we encourage state legislators to work with their executive branch counterparts, state technology officers, local officials, state/local advocates, peer legislators from across the country, and of course, SiX.

After reading this blog, email democracy@stateinnovation.org with your remaining questions and your asks for direct support. We are all taking this transition one step at a time, and we want to meet you and your state where you are.


Considerations for Transparent & Accessible Governance in Emergencies

Common Cause released a strong set of transparency recommendations for national, state, and local officials to follow when transitioning to remote forms of governance and adjusting open meeting laws. SiX strongly recommends that state legislatures consider these guidelines when setting up new, emergency governance structures: 

SiX also recognizes that, even by following the above principles, a rapid transition to remote governance can and will exacerbate barriers to participation in governance for many community members. While continuity of governance through remote voting and committee hearings is key as this crisis evolves, legislators must consider how this transition will impact equitable access for marginalized constituents and work to find creative solutions. This includes (but is not limited to) ensuring access for people with:


Examples of Remote Governance Transitions

Below we highlight several examples of rule changes, statutory changes, and executive orders that have enabled states to adapt and govern flexibly during the COVID-19 pandemic. Note that these are not perfect examples and many could benefit from stronger or clearer transparency provisions in line with the above guidance from Common Cause. That said, we hope sharing these examples offers a helpful base of information for other states to analyze and build on.

We will continue to update this list with new examples as more states make this transition and learn from each other.

Vermont

Vermont legislators and other public bodies must now convene electronically and provide virtual public access to all meetings. Legislators are primarily using Zoom to convene and deliberate. (This Tweet from a Vermont government reporter offers a taste of what remote legislating looks like!)

2020 Vermont H 681

Sec. 5. LEGISLATIVE INTENT; COVID-19 RESPONSE AND OPEN MEETINGS BILL AS PASSED BY THE HOUSE AND THE SENATE

It is the intent of the General Assembly that during the continued spread of coronavirus disease 2019 (COVID-19) in the State of Vermont public bodies should organize and hold open meetings in a manner that will protect the health and welfare of the public while providing access to the operations of government. Public bodies should meet electronically and provide the public with electronic access to meetings in lieu of a designated physical location. Accordingly, this act sets forth temporary Open Meeting Law procedures in response to COVID-19.

Sec. 6. OPEN MEETING LAW; TEMPORARY SUSPENSION OF DESIGNATED PHYSICAL MEETING LOCATION REQUIREMENTS

(a) Notwithstanding 1 V.S.A. § 312(a), during a declared state of emergency under 20 V.S.A. chapter 1 due to COVID-19:

(1) a quorum or more of the members of a public body may attend a regular, special, or emergency meeting by electronic or other means without being physically present at a designated meeting location;

(2) the public body shall not be required to designate a physical meeting location where the public may attend; and

(3) the members and staff of the public body shall not be required to be physically present at a designated meeting location.

(b) When the public body meets electronically under subsection (a) of this section, the public body shall use technology that permits the attendance of the public through electronic or other means. The public body shall allow the public to access the meeting by telephone whenever feasible. The public body shall post information on how the public may access meetings electronically and shall include this information in the published agenda for each meeting. Unless unusual circumstances make it impossible for them to do so, the legislative body of each municipality and each school board shall record its meetings held pursuant to this section.

(c) In the event of a staffing shortage during a declared state of emergency under 20 V.S.A. chapter 1 due to COVID-19, a public body may extend the time limit for the posting of minutes prescribed in 1 V.S.A. § 312(b)(2) to not more than 10 days from the date of the meeting.


Rhode Island

On March 16, Rhode Island Governor Gina Raimondo issued Executive Order 20-05 which relieved state/local officials from open meeting law prohibitions on the “use of telephonic or electronic communication to conduct meetings.” Though the Executive Order provided for virtual public access to government meetings, technical challenges and ambiguities to these rules became apparent in just the first week. Common Cause Rhode Island and the American Civil Liberties Union (ACLU) of Rhode Island quickly sent a letter to state officials urging modifications to the Executive Order including: clarifications to transparency requirements for government bodies that continue to meet in person but are no longer accessible to the public (i.e. because of closed capitols) and protocols to safeguard public participation in the event of technological glitches or connectivity issues (i.e. dropped video conference or conference call lines). Other states can anticipate and learn from the Rhode Island experience.


Pennsylvania

Pennsylvania lawmakers enacted multiple pieces of legislation to enable remote governance. Legislators in both the House and Senate are now able to vote on legislation and participate in committee hearings remotely. As of March 26, 2020, the State Capitol remained open for (in-person) session but a large portion of legislators intentionally participated remotely via video chat to enable social distancing.

2020 Pennsylvania HR 834 RESOLVED, That a member who is not present in the Hall of the House may designate either the Majority or Minority Whip to cast the member's vote on any question as to which there has been consultation between the Majority Leader and the Minority Leader; and be it further
RESOLVED, That, after consultation between the Majority Leader and the Minority Leader, if the process permitted for designated voting under this temporary rule is not agreed upon, the vote shall be cast pursuant to the Rules of the House of Representatives in existence on March 15, 2020; and be it further
RESOLVED, That a designation shall be accomplished by filing an attestation with the Chief Clerk which affirms that the member will not be present in the Hall of the House and identifies either the Majority or Minority Whip as the designee; and be it further [...]
RESOLVED, That, unless amended or revoked by the House, the temporary rules adopted in this resolution shall expire when the declaration of disaster emergency issued by the Governor on March 6, 2020, is terminated by executive order, proclamation or operation of law.

2020 Pennsylvania S.R. 318 RESOLVED, That, notwithstanding Rule 14(h) of the Senate, members may remotely participate in committee meetings as follows: remote participation means simultaneous, interactive participation in a committee meeting by committee members not physically present at the location of the meeting, through means of communication technologies designed to accommodate and facilitate such simultaneous, interactive participation; committee members participating remotely shall be counted for the purpose of determining a quorum; a quorum shall be established through a roll call; and technology employed for remote committee meetings must safeguard the integrity of the legislative process and maintain the deliberative character of the meeting by providing for simultaneous, aural and verbal communication among all participants.

Maine

Before adjourning early for 2020, Maine lawmakers enacted legislation to allow public bodies covered by the state’s open meeting law to conduct business remotely provided that the public is given advance notice, all participating members are able to hear and speak to one another, there is a clear method of electronic public participation, and all official votes are taken by roll call.

2020 Maine LD 2167 §403-A. Public proceedings through remote access during declaration of state of emergency due to COVID-19

1. Remote access. Notwithstanding any provision of law or municipal charter provision or ordinance to the contrary, during a state of emergency declared by the Governor in accordance with Title 37-B, section 742 due to the outbreak of COVID-19, a body subject to this subchapter may conduct a public proceeding through telephonic, video, electronic or other similar means of remote participation under the following conditions:

A. Notice of the public proceeding has been given in accordance with section 406, and the notice includes the method by which the public may attend in accordance with paragraph C;

B. Each member of the body who is participating in the public proceeding is able to hear and speak to all the other members during the public proceeding and members of the public attending the public proceeding in the location identified in the notice given pursuant to paragraph A are able to hear all members participating at other locations;

C. The body determines that participation by the public is through telephonic, video, electronic or other similar means of remote participation; and

D. All votes taken during the public proceeding are taken by roll call vote.

2. Application to legislative proceedings. This section does not apply to public proceedings of the Legislature, a legislative committee or the Legislative Council, except that while the state of emergency as set out in subsection 1 is in effect, the Legislature, a legislative committee or the Legislative Council may restrict attendance by the public to remote access by telephonic, video, electronic or other similar means. This section also does not apply to town meetings held pursuant to Title 30-A, section 2524 or regional school unit budget meetings pursuant to Title 20-A, section 1483.

3. Repeal. This section is repealed 30 days after the termination of the state of emergency as set out in subsection 1.

Nebraska

On March 17, 2020, “Governor Pete Ricketts issued an executive order [(Executive Order No. 20-03)] to permit state and local governmental boards, commissions, and other public bodies to meet by videoconference, teleconference, or other electronic means through May 31, 2020. The Governor’s order stipulated that all such virtual meetings must be available to members of the public, including media, to give citizens the opportunity to participate as well as to be duly informed of the meetings’ proceedings. The Governor’s order did not waive the advanced publicized notice and the agenda requirements for public meetings [(set forth in (Neb. Rev. Stat. § 84-1411)].”


New Jersey

The New Jersey legislature enacted a fairly simple statute to allow lawmakers to use technology or electronic means to conduct business if the Governor has declared a state of emergency. It does specifically outline transparency requirements. Lawmakers simultaneously enacted a law that allows local government bodies to govern remotely as well (see 2020 New Jersey A 3850).

2020 New Jersey A 3852
b. All sessions of the Legislature shall be held at Trenton or, on a temporary basis, for ceremonial or commemorative purposes or, notwithstanding section 1 of P.L.1963, c.118 (C.52:1-1.1), by reason of emergency or other exigency, at such other locations in the State as shall be designated by the Legislature by concurrent resolution.
c. During a period of emergency or exigency, as determined by the Governor pursuant to the laws of this State or by the Legislature pursuant to concurrent resolution, the Legislature may use any technology or electronic means to conduct its business or otherwise carry out its purposes, or to comply with the requirements of paragraph 6 of Section IV of Article IV or, for the purpose of ensuring the continuity of governmental operations, of paragraph 4 of Section VI of Article IV of the Constitution of the State of New Jersey.

Texas

On March 16, 2020, Texas Governor Greg Abbott suspended provisions of the state’s open meeting law that requires “government officials and members of the public to be physically present at a specified meeting location,” while emphasizing key transparency provisions for remote meetings. According to the Governor’s office:

The directive also allows state and local officials to contact the Texas Department of Information Resources for information and support setting up teleconferences and video conferences. Governor Abbott invoked emergency authority under Texas Gov. Code § 418.016 to change these requirements.


Reads & Resources

COVID-19 Repro Resources

In this urgent global health pandemic, anti-abortion lawmakers are once again playing politics with people's lives and health, and there are very real reproductive health impacts and needs this moment presents.
 

Click here for general RFLC talking points on the coronavirus.


Important: Here are some issues that you should talk to your repro coalition and abortion and family planning providers about. In some states, they may want public support and in other places, it may be harmful to raise these issues at all, even within the administration or with other, less friendly, legislators or officials. Your support of reproductive health care is crucial at this time. Please check in with the state coalition organizations and reproductive health care providers to see how best you can support them during this difficult time, and we encourage you to reach out to us to connect you if you don’t already have an existing relationship.
 

Coronavirus Response: Resources for State Legislators

As the coronavirus situation continues to unfold, we’re compiling resources here to help you navigate the many challenges this presents to your community.  We will use this space to share policy, communication, and organizing resources that you can use to respond to the health, economic, and social impacts this is having on your communities.  

We know that crises like these have disproportionate impacts on vulnerable and low-income communities and want to make sure we stand up for those most at risk. As legislators, you are uniquely positioned to find solutions that mitigate the harm for at-risk medical populations (people with chronic health conditions, people with disabilities, the elderly), hourly workers, the millions of Americans without access to health care or paid sick days, and everyone who is one health emergency away from financial ruin.

The resources below can help you use your platform to provide clear, scientifically-based information to the public and advocate for better policies.

If you have actions or new policies that are happening in your states, please share them so we can provide them to other legislators across the country. Please email helpdesk@stateinnovation.org.




The Basics


Legislative Sessions and Operating Remotely


Race and the Virus: Bias, Data, Testing, and Impact

Structural racism puts people of color at greater risk to both the health and economic impacts of COVID-19.

Racial data
Coronavirus data released from the CDC does not yet include breakdowns by race. We cannot continue to fight this pandemic blindly.

Impacts
The Coronavirus Pandemic and the Racial Wealth Gap
Coronavirus Compounds Inequality and Endangers Communities of Color
On the Frontlines at Work and at Home: The Disproportionate Economic Effects of the Coronavirus Pandemic on Women of Color


Health Care


Unemployment and Protecting Stimulus Paychecks


See SiX’s Paid Family and Medical Leave Policy playbook here.

Policy Recommendations:

Examples of States’ Paid Leave Legislation in response to COVID-19

Additional Resources


Preventing Evictions


Preventing Utility Shut Offs and Payment Deferment


Democracy and Voting

2020 Census 

Voting & Elections


Reproductive Rights

Medical and Research Resources


Education


Rural Communities and Agriculture

See SiX's talking points and policy solutions for rural communities and local agriculture and our memo outlining how stimulus money is expected to come into states to aid agriculture and rural communities. There are still a number of unknowns and we are continuing to monitor the situation closely.

The $2 trillion stimulus package included $9.5 billion dollars for agricultural producers impacted by coronavirus, including producers of specialty crops, producers that supply local food systems, including farmers markets, restaurants, and schools, and livestock producers, including dairy producers. You can read a summary compiled by the National Farmers Union here. Here is an analysis from the National Sustainable Agriculture Coalition.

The United States Senate Committee on Finance has a breakdown on their website of the rural healthcare resources in the recent Stimulus package. You can read it here.

Resources for Farmers in Your District

Resources for Farm Workers

Here is a guidance from NC Health & Human Services for migrant farm workers and their employers (only in English)


Immigration


Other Policies to Consider

Child Care

Consumer Protection

Criminal Justice

Economic Development

Judicial

Social Services

Hate Crime Prevention

Broadband Access

Quarantined Individuals

Miscellaneous


State Budgets


Messaging and Connecting with Constituents during Social Distancing

Messaging

Connecting with Constituents

Here are some ideas and examples to help you connect with your constituents remotely:

Reach out if we can help you plan or execute any of these ideas.


National Resources on Economic Impact


Overview of the Federal Response Package

Overview of the Federal Response Package


Defend Against Harmful Policies

Opportunistic Abortion Bans

Elected officials in numerous states --including West Virginia, Alaska, Texas, Mississippi, Ohio, Oklahoma, Iowa and Indiana-- have taken steps to restrict abortions under the pretense of preserving medical supplies and hospital beds, claiming abortions are not “nonessential” procedures that can delayed till the end of the epidemic and most abortions do not take place in hospitals. See the Reproductive Health Care section on this page for more.

Reopening Too Soon?

Elected officials in Pennsylvania, Minnsota, Michigan, Idaho, and Florida have pushed back against stay-at-home orders, non-essential work bans, and school closures. The premature calls for returning to ‘business as usual’ threaten the safety and lives of communities.

Check out the LSSC Virtual Training on What Local Governments Can and Should Do to Respond to the Public Health Crisis for further guidance on the importance of local and state governments using their authority to protect communities from the virus.

Also check out the CAP tracker on how states and localities are enforcing stay-at-home orders

Limits to Voting Expansions

As states grapple with how to prepare their electoral systems to handle the pandemic’s unique challenges, legislators across the country have pushed for reforms (mail-in-ballots, absentee voting, deadline extensions, etc.) as a safe, secure, and accessible way for voters to participate without risking their health. However, opposition to such expansions, in states like Minnesota, Arizona, and Wisconsin, jeopardize citizens’ abilities to safely vote. See the Democracy and Voting section on this page for more.

Become a part of CROP: SiX's Agriculture Cohort

We wondered: Do SiX legislators want or need program-specific resources to help engage in rural, agricultural or local foods policy?

Our staff criss-crossed the country, traveled to your states, spoke with some of you over the phone, connected with your colleagues, reached out to your partners and the verdict is in:

SiX legislators not only need, but are EAGER to have resources developed specifically to support you as a progressive champion to engage in rural and agriculture policy-making.  

So we created CROP: the Cohort for Rural Opportunity and Prosperity, and we're providing you with those resources. Whether you are a policy maker who is an expert and passionate about rural and agricultural issues or if you are brand new to these topics looking to learn more and connect with others working in the same space, we invite you to join the Cohort for Rural Opportunity and Prosperity (CROP).

Join CROP: SiX's Agricultural Cohort

CROP is an internal group that is being developed in coordination with steering committee of amazing legislators (who you'll hear more about in coming days!) to ensure that the resources developed meet the needs on the ground in states. This Cohort is intended to be a safe space for you to learn, connect and get the support you need to be a progressive champion for regenerative agriculture, soil health, local food economies, family farms and everything food and "farmy" in between! 

By joining this new and growing cohort, you will have access to issue-specific resources, information about happenings in other states, the opportunity to connect with elected officials in other areas doing similar work, and you will have the opportunity to connect with farmers, ranchers and partner organizations who you likely are not always hearing from.  We will also be hosting opportunities that bring together partners and legislators for shared-learning and deeper strategic collaboration. 

Join us!

New Resource: Paid Family and Medical Leave Playbook

Ultimately, nearly all workers need to take time away at some point to deal with a serious personal or family illness or to care for a new child. Laws providing paid family and medical leave allow workers to meet these needs without jeopardizing their economic security, which strengthens working families and thereby grows the economy. 

Our Paid Family and Medical Leave Policy Playbook is a summary of resources that we have compiled from state and national advocates, organizers, and leading policy organizations across the country. You will find communications and messaging guidance, a menu of policy solutions, example legislative language, and national organizations and experts who can support your efforts.

Screen Shot 2020 03 12 at 4.04.54 PM

State Innovation Exchange's own polling in six states shows strong support for paid family and medical leave programs:

Census Get Out the Count Toolkit for State Legislators

The 2020 Census officially kicks off March 12th, when households across the country have started receiving mailed invitations with instructions to respond to the census.

State legislators have a uniquely strong platform and a responsibility to get out the count in communities all across the country. And SiX is here to help.

Check out our Census Get Out the Count Toolkit for State Legislators, which:

Feel free to email the SiX Democracy Team with any questions or for support. 

Quick action step! Post SiX's census graphic and use this link to update your Facebook profile frame showing your support for the census!

190325 SiX census progressive
First Revision SiX Facebook Frame census

Paid Family and Medical Leave Playbook

The Family and Medical Leave Act of 1993 (FMLA) was a momentous piece of federal legislation that secured the right of working Americans to take up to 12 unpaid weeks off of work for the birth of their child, to care for their newborn or newly adopted child, to care for a loved one with a serious illness, or to respond to their own serious illness. Its passage represented a consensus that hardworking individuals should not lose their jobs if they become seriously ill, and new parents should be given time to recover from pregnancy and bond with their new child. 

However, nearly 30 years later, our country has fallen behind the rest of the world in paid leave protections. Approximately 40% of Americans do not qualify for leave under the FMLA at all, and many of those who are covered cannot afford to take unpaid leave without falling into financial distress. The United States remains the only wealthy nation in the world that does not guarantee any form of paid leave.

For working families who are living paycheck to paycheck, lack of access to paid family and medical leave policies can have dramatic effects. For example, in the year following a child’s birth, women who are able to take paid leave are 39% less likely to need public assistance than those who did not take leave. And a study on the impact of California’s paid family leave program found that paid family and medical leave decreased the risk of poverty for new mothers by just over 10%. Ultimately, nearly all workers need to take time away at some point to deal with a serious personal or family illness or to care for a new child.

Laws providing paid family and medical leave allow workers to meet these needs without jeopardizing their economic security, which strengthens working families and thereby grows the economy. 

Our Policy Playbook is a summary of resources that we have compiled from state and national advocates, organizers, and leading policy organizations across the country. Here you will find communications and messaging guidance, a menu of policy solutions, legislative language, and national organizations and experts who can support your efforts.


Ending Prison Gerrymandering

During the decennial census, the Census Bureau, state, and local governments have traditionally counted incarcerated individuals as residents of the areas where they are imprisoned, rather than in their home communities. This data is then used for redistricting—resulting in distorted local and state representation and hidden transfers of political power to communities that host prisons. By inflating the apparent size and therefore the political influence of areas with incarceration facilities, prison gerrymandering violates our constitutional right to equal political power based on population size. This problem is especially urgent and harmful in today’s era of mass incarceration and limits the voices and power of communities of color. 

Despite advocacy to the change the practice, the 2020 Census will once again count prisoners where they are incarcerated. While the Census Bureau is best positioned to end prison gerrymandering permanently and on a national scale, state action is needed to address this problem in the meantime— particularly ahead of the next redistricting cycle. 

As of January 2020, seven states had enacted legislation to prohibit prison gerrymandering and count incarcerated individuals at their last known home address in the state: California (2011), Delaware (2010), Maryland (2010), Nevada (2019), New Jersey (2020), New York (2010), and Washington (2019). Colorado, Michigan, Tennessee, and Virginia have addressed prison gerrymandering at the local level, either by barring or discouraging county and local governments from counting prison populations when drawing local districts (e.g., for town or school board elections). 

State legislators have a crucial role in advancing accurate and equitable redistricting that strengthens the voices of marginalized black, white, and brown communities. To help end the harmful practice of prison gerrymandering, the State Innovation Exchange (SiX) and Prison Policy Initiative have put together the following brief with messaging guidance, policy design considerations, practical lessons on bill drafting, coalition building, and implementation, and example legislation.

Download the full report to read more.

Surprise Medical Billing Research Brief

Surprise medical billing refers to when a consumer is unaware that health care services will be charged at out-of-network rates, whether by their insurer or by the out-of-network provider. For example, if a patient receives emergency care at an out-of-network hospital or care from an out-of-network provider at an in-network hospital, they could receive a surprise medical bill.

As we face the first global pandemic of the 21st Century, our nation confronts a health care system that is not prepared to deal with an infectious disease at this scale. One of the many challenges we face will be patients who delay or defer care because they are unsure if their visit to a testing facility, urgent care center or emergency room will result in a surprise bill, not covered by their insurance.

57% of patients have experienced a surprise medical bill

2018 University of Chicago survey 

Surprise medical bills have two main components, according to a 2019 Health System Tracker brief from Peterson Center on Healthcare and the Kaiser Family Foundation:

  1. The higher amount a patient owes due to the difference in cost-sharing levels between in-network and out-of-network services. “For example, a preferred provider health plan (PPO) might require a patient to pay 20% of allowed charges for in-network services and 40% of allowed charges for out-of-network services. In an HMO or other closed-network plan, the out-of-network service might not be covered at all.”
  2. An additional amount the physician or other provider may bill the patient directly, which is known as “balance billing.” “Typically, health plans negotiate discounted charges with network providers and require them to accept the negotiated fee as payment-in-full. Network providers are prohibited from billing plan enrollees the difference (or balance) between the allowed charg and the full charge. Out-of-network providers, however, have no such contractual obligation. As a result, patients can be liable for the balance bill in addition to any applicable out-of-network cost sharing.”

The problem is widespread: A 2018 University of Chicago survey found that 57% of respondents had experienced a surprise medical bill. Additionally, this survey found that 86% of all respondents blamed health insurance companies and 82% blamed hospitals for surprise medical bills. A large study published in 2020 that looked at over 347,000 surgical patients found that over 20% had incurred out-of-network charges.

The problem has serious consequences, especially for communities of color: Almost half of respondents in a Commonwealth Fund survey said that they could not cover an unexpected medical bill of $1,000 within 30 days. And this can have a disproportionate impact on marginalized communities, with Black (63%) and Hispanic (59%) respondents reporting higher inability to cover such a bill compared to Non-Hispanic White respondents (40%). This issue also impacts the overall cost of employer-sponsored insurance plans, according to a December 2019 article in Health Affairs.

Download the full report to read more.

New Legislator Resource: Ending Prison Gerrymandering

State legislators have a crucial role in advancing accurate and equitable redistricting. That means ending prison gerrymandering: the harmful practice of counting incarcerated people as residents of prison districts instead of at home. 

SiX and Prison Policy Initiative are thrilled to release a new resource on prison gerrymandering.

Our brief includes messaging guidance, policy design considerations, practical lessons on bill drafting, coalitions, and implementation, and sample legislation.

Why take on prison gerrymandering? Because the 2020 Census is about to count more than 2 million people in the wrong place. Counting incarcerated people at home is a crucial correction that will make redistricting in your state more accurate and equitable.

Shout out to Colorado legislators, Reps. Kerry Tipper and James Coleman, whose bill to end prison gerrymandering is currently on the Governor's desk! Check out their op-ed on why this reform matters for the state. Legislators in eleven other states have also filed prison gerrymandering bills this session (CT, FL, IL, LA, MI, MN, NE, PA, RI, VA, WI). If you've already sponsored a bill, review our resource to see how your proposal could be strengthened and how to talk about this issue effectively. And reach out to SiX and Prison Policy Initiative for support!

image

Many thanks to Prison Policy Initiative for their partnership and support to state legislators ending prison gerrymandering across the country!

Reach the prison gerrymandering brief here.

Commonsense Gun Safety Reforms Receive Broad Bipartisan Support in Colorado

A recent poll conducted by Strategies 360 for the State Innovation Exchange (SiX) shows that Coloradans strongly support progressive solutions to improve gun safety. Across the board from liberals to conservatives, these commonsense policies receive overwhelming support statewide. 

Lost and Stolen Reporting and Safe Storage

Seven in ten Colorado voters favor holding gun owners legally accountable for failing to store their guns securely and for failing to report lost or stolen guns. Colorado voters are demanding action on gun reform as a result of the dramatic and pervasive violence that has permeated every corner of the state. Both measures earn the strong support of at least half the electorate, while just a quarter oppose them. Majorities of liberals (87%), moderates (70%), and conservatives (59%) back safe storage accountability. A similarly diverse coalition stands behind accountability for failing to report lost or stolen guns (87% of liberals, 74% of moderates, and 60% of conservatives). 

See the full survey memo here.

Survey Methodology: Strategies 360 conducted a survey of 600 registered voters in Colorado from January 2-5, 2020. Interviews were conducted on landlines and cell phones. The margin of error for a survey of 600 interviews is ±4.0% at the 95% confidence level.