Rep. Neal Kurk is sponsoring a 2018 bill that would require health insurers to reward some enrollees for choosing lower cost health care.
Kurk’s bill, HB 1784, would require each insurer to offer a small group plan with an incentive program. That program would give enrollees cash payments, gift cards, discounts, or some other reward for choosing a cheaper-than-average health care provider. The program would apply to nonemergency outpatient services, including physical and occupational therapy, radiology and imaging, labs, and infusion therapy.
HB 1784 includes several other provisions:
- The bill requires doctors who provide a referral to notify patients of their right to shop around for a cheaper provider.
- HB 1784 also requires the state and insurers to offer an online cost comparison tool for health care services.
- Starting in 2020, the bill requires the Insurance Commissioner to evaluate the health insurer incentive programs.
- If a patient seeks a service out-of-network that costs less than average, HB 1784 requires insurers to apply that cost to the patient’s deductible and out-of-pocket maximum.
About incentives for cheaper care
Last year Maine passed a law that requires insurers in the small group market to compensate customers for choosing lower cost health care.
Some insurers and private companies – such as the company Vitals – already voluntarily offer incentives for individuals to choose cheaper health care providers.
Arguments in favor of mandatory incentives
An insured patient generally pays the same amount for a service at any in-network health care provider, but costs can vary widely for the insurer. For example, the New Hampshire Health Cost website shows that the average charge for an outpatient colonoscopy ranges from under $1,000 to over $5,000, depending on where you go for the test.
If consumers are rewarded for choosing less expensive providers, they are more likely to seek out low cost care. The insurance company then also saves money, which helps keep down premiums. Meanwhile health care providers are motivated to provide less expensive services to attract patients.
Arguments against an incentive program
Opponents of a mandatory incentive program argue that patients should be encouraged to choose a provider based on quality, not just cost.
Incentive programs also hurt rural health care providers, which often charge more because they have fewer patients and provide care in critically underserved areas.
Other opponents of HB 1784 argue that if incentive programs are successful, then insurance companies will choose to adopt them without a government mandate.
Do you support a law that would require health insurers to establish a limited incentive program for enrollees who choose cheaper health care providers? Let us know in the comments below.