Carlos Trujillo’s balance billing: Straight Outta Obamacare

Carlos Trujillo’s attempt to fix balance billing (HB 221 – Health Insurance Coverage for Emergency Services) is LITERALLY lifted from the federal law commonly referred to as “Obamacare” – or as some Republicans have called it, “The end of the world as we know it.”

To be fair, sometimes Trujillo’s bill tracks the federal law word for word, and other times it merely acts like a college student not wanting to be seen as plagiarizing a Wikipedia page.

Trujillo’s bill basically says that in an emergency situation, a doctor, who is required by law to provide the service, cannot seek payment from the patient but must instead go on bended knee to the insurer. The bill then sets forth how that negotiation is to take place and forces the doc to accept payment that is “the greater of the following” (or as it says in Obamacare, “equal to the greatest of the three amounts”).

Here are the three ways Trujillo’s Straight-Outta-Obamacare bill sets forth how the doctor is to be paid by the insurance provider:

The first way is on line 41 of HB 221: “The amount negotiated with a provider…reduced only by any coinsurance amount or copayment…”

This language comes from Obamacare, which reads: “The amount negotiated with in-network providers…excluding any in-network copayment or coinsurance.”

Nearly the same words, with the exact same effect.

The second one (line 44 of HB 221) reads, “The usual and customary reimbursement…reduced only by any coinsurance amount or copayment that applies to the provider;”

Obamacare reads: “the usual, customary and reasonable amount…reduced by the in-network copayment or coinsurance…”

Again, similar words,with the exact same effect.

And the third (line 48 of HB 221) reads: “The amount that would be paid under Medicare for the service, reduced only by any coinsurance amount or copayment that applies to the provider.”

And Obamacare? “The amount that would be paid under Medicare … for the emergency service, excluding any in-network copayment or coinsurance imposed with respect to the participant or beneficiary.”

Close enough, as they say, for government work.

In short, House Bill 221 tracks the language of the balance billing section of Obamacare.

Seeing the word-for-word language makes it hard to conclude anything other than the fact a whole bunch of lawmakers are going to be asked to vote for a bill that is taken right from a law that many of those same lawmakers have spent the last five years railing against.