This is welcome news, although I have 2 major concerns:

1) Federal employees deserve parity treatment under the law. If 6 million are not protected by this law, that’s 15% of Californians! The trouble is that insurance is regulated at the state level and big insurers have gotten legal theories pushed through regarding federal preemption and exhaustion of administrative remedies so that federal employees are not protected by state laws even as the Congress does nothing to put similar protections in place for them.

Something similar occurred with crimes on federal property. They couldn’t even charge people with things like drunk driving. So the federal government introduced 18USC13 the assimilative crimes act, which allowed the federal govt to use state criminal codes on properties with federal jurisdiction. Note this didn’t help where drunk driving is not covered by criminal code. Note also that it allows the federal government to use state criminal codes but does not mean the state code is adopted, so the federal govt can use the codes to charge crimes but people cannot use the codes to protect themselves. Everyone is at risk, not just federal employees. I’ve heard PhD black and brown researchers complain about harassment just doing field research in national parks; they have no legal protections they would have under state codes if wrongly detained. There is a glaring void in the law.

An equivalent void exists for health insurance. The federal code should be updated to allow the federal government to adopt state insurance protections as a whole, to give federal workers parity in insurance protections.

2) It’s good that this went through, but what’s to prevent this from just being the latest round of whack-a-mole in surprise medical billing? It takes years for laws to catch up to specific surprise billing setups—is there anything in the law that creates a broad surprise billing protection, and if not, why not?

The City of Palo Alto's Fire Department has the FireMed program.

Web Link

FireMed covers ambulance transport out-of-pocket expenses and co-pays for anyone in your household. My bill last year was $2,393 and my insurance covered only about $800. With Palo Alto FireMed, the remainder of my bill was covered by Palo Alto's FireMed program. Even if you don't use program, you're supporting the Palo Alto Fire Department's daily operations at only $8/month.

We need a federal universal healthcare system including anyone in America.

When my daughter was in Germany and got a bee bite which swelled, we stopped in BadenBaden at the local hospital emergency center. Infections like this can be life-threatening. They gave her antibiotics and a cast to prevent her arm from moving to avoid lymph gland involvement. Took her infection very seriously. Cost : ZERO. Imagine at the PA Clinic or Stanford Hospital.

This is great progress. It's never ok to have this kind of 'punitive' charge showing up for services where the patient doesn't have the opportunity to decide otherwise. A shame that it required a law when the insurance companies started doing the wrong thing.

However, the claim: ""It's the last remaining gap, but it's a really big one," Van Dynze said." is not correct. There is still a HUGE, similar gap for out-of-network providers working at an 'in-network" facility. You can go to an ER or Urgent Care center that you know is in-network and have a doctor show up (anesthesiologist are the classic case but there are many others) who is not in-network. This should NOT be the patient's responsibility to know. It should be mandated as part of the in-network status of a facility. The facility or insurance company need to sort it out.