Ban on Surprise Medical Bills May Pass After All


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Credit…Courtland Wells/The Vicksburg Post, via Associated Press

Turns out, even as the impeachment debate blazes, Democrats and Republicans can agree on one thing: They don’t like surprise medical bills.

Leaders of key Senate and House committees have reached a consensus on how to eliminate them, increasing the chance that legislation on the issue will pass Congress this year.

The proposal would prevent doctors from sending unexpected bills to patients when they are treated in a hospital that accepts their insurance, and would establish a system for resolving related billing disputes between those doctors and insurance companies.

“It is long past time that Congress protect patients and families from the devastating financial toll of surprise medical bills, and this agreement puts an end to this egregious billing practice,” said Frank Pallone Jr., the chairman of the House Energy and Commerce Committee. “I’m hopeful that this bipartisan, bicameral agreement can be voted on quickly so that it can be signed into law before the end of the year.”

Solving the problem has been a priority for both Republicans and Democrats in Congress — as well as the White House. But progress stalled this summer, after bills passed through committees in both chambers.

A dark-money group funded by private-equity-backed physician staffing firms has spent tens of millions of dollars in television and direct mail advertising in a bid to scuttle the legislation.

The ads depicted the proposed policy as unfair to doctors and potentially ruinous to rural health care. In one commercial, an ambulance transports a patient to a hospital, only to find that it has closed.

Advocates for the measure dismissed the ads as scaremongering, and seized on the involvement of private equity as an argument for why the legislation was needed. A competing television advertisement, created by a health-insurer-led coalition, showed a dark room of suited men and one woman negotiating as a voice-over describes surprise billing as a “private equity business model.”

Behind the scenes, lobbyists for doctors, hospitals, air ambulances, insurers and large employer groups have been making the rounds on Capitol Hill. The bonanza for lobbyists and media consultants demonstrates the deep pockets of the health care industry, and the intense interest it takes in even relatively small policy changes.

The deal struck by the two committees — the House Energy and Commerce Committee and the Senate Committee on Health, Education, Labor and Pensions — also includes measures related to prescription drugs and five years of funding for community health centers. The legislation would also raise the minimum age for legal tobacco purchases to 21.

Up to one in five emergency room visits may result in a surprise bill, but research suggests that the problem is concentrated in a small number of hospitals that contract with physicians who fail to mirror their insurance arrangements. Envision and TeamHealth, the principal companies behind the advertising blitz, have employed out-of-network billing as a broad business practice, a study by Yale professors suggests. As Axios has reported, TeamHealth said in a letter to several senators that it now rarely sends surprise bills, but it did use the threat of out-of-network billing to negotiate higher prices from insurance companies.

Surprise bills can run into the thousands of dollars, representing shocks to patients who expect their care to be covered. The issue has emerged as a major consumer concern, popping up in public polling as a top health care worry and a priority for government action.

Passage of the bill is still not guaranteed, but the bipartisan agreement — in both the House and the Senate — substantially increases the likelihood that the legislation will move this year, most likely as part of a large government funding package expected to pass before a Dec. 20 deadline. The Congressional Budget Office has said that the approach in the deal will save the government money, making it a helpful piece to help offset other priorities.

The deal struck by the two committees shares key features with a bill the Energy and Commerce Committee passed this summer. Doctors who provide care that is out-of-network for a patient’s insurance will automatically be paid the median price of in-network doctors in the area. For certain large claims, doctors will be allowed to appeal to an outside arbitrator for reconsideration.

A similar process would also apply to hospitals that treat patients in medical emergencies, and to air ambulances (the helicopters and planes that transport patients from remote areas to major hospitals). Private equity is also highly invested in the air ambulance industry.

The solution is similar to one passed in California three years ago. That law appears to have substantially reduced the number of out-of-network bills in relevant medical specialties. But doctors there have said it has lowered their pay.

A joint statement from Senators Bill Cassidy of Louisiana, Maggie Hassan of New Hampshire and Michael Bennet of Colorado, the authors of another legislative approach to surprise billing, praised the committees for their work, including the “simple arbitration safety valve,” and said final details were still being negotiated.

“We are encouraged that we’re one step closer to giving patients these vital protections,” the statement said. “Patients have waited long enough, and we remain hopeful that we can get this done by the end of the year.”


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