Mientras que las agencias federales toman medidas enérgicas contra las "tarifas basura", los expertos creen que pueden aprender un par de cosas de Nueva York. El estado es uno de los 13 que aprobaron reformas en las tarifas de las instalaciones, que están creciendo a medida que más sistemas hospitalarios se fusionan con médicos independientes. Estas tarifas pueden variar en precio y se utilizan para ayudar a los sistemas hospitalarios a mantener varias clínicas. Nueva York aprobó un proyecto de ley que exige a los hospitales revelarlos a los pacientes con antelación. Diane Spicer, de Community Health Advocates, dice que los consumidores se están quedando sin dinero con las tarifas de las instalaciones.

"Los honorarios de las instalaciones suelen ser pequeños en comparación con algunos de los casos de deuda médica que manejamos, ¿verdad? $250, $500, pero todo eso suma," insistió además Spicer.

Estas tarifas son parte de la creciente crisis de la deuda médica nacional. Un informe de KFF encuentra que la deuda médica nacional ascendió a al menos $220 mil millones en 2021. Alrededor de 910 mil personas en Nueva York informan tener deuda médica, a pesar de que más personas tienen seguro médico.

La Comisión Federal de Comercio celebrará una audiencia sobre las "tarifas basura" este mes. Los grupos de salud comunitarios nacionales firmaron una carta pidiendo la prohibición de las tarifas de las instalaciones. Mona Shah, de Community Catalyst, considera que estas tarifas no cumplen su propósito original, incluidos los centros que cobran tarifas por las visitas de telesalud.

"Es tan simple como que actualmente no hay nada que prohiba a un hospital decir que no se puede cobrar una tarifa de instalación individual por una visita de telemedicina," enfatizó también Shah.

Los hospitales y centros médicos han respondido diciendo que estas tarifas son una fuente importante de ingresos para cubrir los costos operativos y generales. La Asociación Estadounidense de Hospitales se ha opuesto a leyes anteriores del Congreso que prohibían las tarifas de las instalaciones porque los recortes a los hospitales y sistemas de salud podrían afectar gravemente la atención de los pacientes.

Access to reduced-price medication is a necessity for many rural Missourians with low income.

Rep. Cindy O'Laughlin, R-Shelbina, the Senate Floor Leader, said Big Pharma is trying to confuse legislators with unrelated hot-button topics such as abortion access and illegal immigration in a last-ditch effort to stop the state from joining a program to force drugmakers to sell medicines at a discount.

"Appealing to nuclear topics, which really do not apply in this situation, is a disingenuous way to try to defeat a bill that is actually good for Missouri," O'Laughlin asserted.

O'Laughlin pointed out the program is transparent, and uses the tax money saved to help low-income families deal with chronic conditions such as diabetes.

The drugmakers object to the government forcing them to give significant discounts, arguing hospitals' and for-profit pharmacies' bottom lines, particularly those owned by pharmacy benefits managers, are being exploited. Nationally, 46% of contract pharmacy agreements involve pharmacies linked to the three largest benefits managers.

Rep. Tara Peters, R-Rolla, introduced the 340B contract pharmacy access billand said the lobbying is absurd.

"Federally, 340B program does not allow for abortion drugs," Peters stressed. "Why would any legislation that we're trying to pass in the state allow for that? I mean, the thought of that even being in existence is absolutely ludicrous."

The Missouri Senate passed the bill 27-3 on Monday and it now goes to the House.


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Alabama is running out of time to tackle Medicaid expansion this legislative session.

More than 230 people gathered earlier this month with the group Alabama Arise, urging state lawmakers to prioritize the issue. Their message: Access to health care isn't just a matter of policy, it can be a matter of life and death.

Debbie Smith, Cover Alabama campaign director for Alabama Arise, said as the session winds down, the group will continue to echo the call for increased access to health coverage. She thinks it would not only save lives but revitalize communities across the state.

"Over 80% of our rural hospitals are operating in the red," Smith pointed out. "Not a great stat. About 19 rural hospitals are at immediate risk of closure, and those are the lifeblood of those communities. They're on life support."

Smith emphasized hospitals at financial risk also put their workforce at risk. Those who are against Medicaid expansion believe it is ultimately unaffordable for the state. However, Smith argued it could save the state nearly $400 million over the next six years. According to the Public Affairs Research Council of Alabama, those savings would be enough to cover the cost.

The council's study also showed Medicaid expansion would generate nearly $2 billion of economic growth. Beyond economic benefits, Smith pointed to the stark disparities in maternal and infant mortality rates in Alabama.

She stressed Medicaid expansion would do more than provide health care coverage during pregnancy or postpartum, it is about ensuring comprehensive coverage.

"We've been lucky enough to expand Medicaid coverage up to 12 months postpartum but we still need to figure out how to cover people before they even get pregnant," Smith asserted. "It's really important for people to have health coverage so they can address any kind of issues they might have, like if they have diabetes or high blood pressure that might affect their pregnancy in the future."

With limited time left in the legislative session, she noted one option could be Gov. Kay Ivey's executive authority to enact Medicaid expansion. Smith added using the power could be the simplest path forward, backed by the promise of additional funding from the American Rescue Plan.

A Connecticut bill would expand the state's paid sick leave law.

The initial 2011 law requires 40 hours of paid sick leave for workers at employers with 50 businesses or more. The new bill covers all workers regardless of their employer's size.

Janée Woods Weber, executive director of the nonprofit She Leads Justice, said the legislation can benefit workers without access to paid sick leave.

"These are people for whom taking a few hours off when their child has a cold or perhaps they need to take themselves to a doctor's appointment are the kinds of challenges that many of us don't worry about, those of us who do have access to paid sick days," Woods Weber explained.

Small businesses were concerned about how the change could affect them. To address worries, the bill has a three-year implementation cycle giving them time to adapt. It also creates a task force studying the feasibility of providing tax credits to businesses with the smallest workforces. The bill passed the House and awaits a vote in the Senate.

An estimated 11% of workers are eligible for paid sick leave under the current criteria. Though expanding the law has taken over a decade, Woods Weber argued it has always been necessary.

"Nobody should be forced to make what is often times a very difficult and sometimes impossible choice between their livelihood," Woods Weber emphasized. "Getting a paycheck and getting to take paid time off to take care of themselves or a loved one if they get sick."

She added once the bill is passed, the state can build on it by allowing people to earn additional time off, at least up to 40 hours. It stems from the pandemic, when people had to isolate for up to five days if they contracted COVID-19, which could burn through their allotted sick time.


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