Informing Policymakers On the Impact on Emergency Care of California's Ban on Balance Billing

The researchers explored the effect of California’s ban on balance billing on the quantity and quality of emergency room care in that state. Balance billing is a practice that previously allowed hospitals to bill patients directly for a portion of their medical bill left unpaid by their health plan. The California Department of Managed Health Care rules prohibit physicians and hospitals from billing for outstanding out-of-network emergency care costs not covered by health plans. The move comes amid several legal challenges over balance billing and is consistent with the actions of several other states that have implemented bans on balance billing. Focusing primarily on Kaiser Permanente patients but with additional analyses of patients covered by other insurers, the researchers compared the quality and quantity of care received by treatment and control groups before and after the balance billing ban. They controlled for confounding factors that may affect treatment intensity and health outcomes and tested robustness using a subset of enrollees whose final diagnosis was a heart attack, as patients with a heart attack routinely go to the closest emergency room and do not self-select their hospital. The goal of this project was to provide policymakers with information on the effects of balance billing bans as they relate to the quality of care received in the emergency department.