JUNEAU, Alaska—Alaska’s emergency care is at risk if the state legislature enacts SB 129, which would rescind a rule that requires health insurance companies to provide adequate coverage for emergency care.
“The impact of SB 129 would destabilize the Alaska emergency care network, the health care safety net of our state,” said Dr. Benjamin Shelton, president of the Alaska Chapter of the American College of Emergency Physicians. “It also would increase health care costs for Alaskans. The legislation would rescind what is known as the “80th Percentile Rule,” which helps ensure that Alaskans have access to physicians and that the physicians are in the networks of insurance companies. The Rule was enacted to protect patients.”
The 80th Percentile Rule links payment for emergency care to an independent database that calculates fair charges for emergency care. Similar patient protection regulations in New York and Connecticut have eliminated balanced billing and controlled health care costs. An analysis of charges in states with a similar rule, such as New York and Connecticut, show the rule did not raise health costs (Physicians for Fair Coverage 2017).
“The proposal to use Medicare rates as a standard for determining payment for out of network providers is fundamentally flawed, because these rates do not represent the fair market value of healthcare services or even cover costs,” said Dr. Shelton. “Additionally, Medicare rates fluctuate based on variables unrelated to the services provided, such as the federal budget.”
Dr. Shelton said the 80th Percentile Rule filled its intended purpose — to provide Alaska’s patients with quality health care providers by allowing the state to recruit and retain capable physicians to practice and live in Alaska.
“The Alaska legislature needs to reject this harmful proposal that will harm our state’s already fragile trauma system,” said Dr. Shelton. “If we start losing doctors, or doctors start going out of insurance company networks, patients will suffer. The 80th Percentile Rule protects patients from balance billing and provides an appropriate incentive for health insurance companies to contract with physicians fairly to keep them in network.”
In addition, Dr. Shelton said Alaska emergency physicians are asking the State Legislature to:
- Not pass bill SB 129.
- Require all insurance companies to report to, and use for a minimum payment, a not-for-profit transparent data base so the State and public can see cost and make better public policy decision.
- Work with the medical community to find ways to decrease health care cost.
- Maintain fair insurance payments so patients are not burned with even more medical costs or lose access to care.
- Require insurance companies to bill for deductible and co-insurance amounts, instead of placing physicians in the middle. This would decrease the amount of uncompensated care and administrative costs in emergency medicine, allowing physicians and hospitals to bring down charges.
Alaska ACEP is the medical specialty society representing 80 percent of all the emergency physicians in the state and the patients they care for.