By Shefali Luthra and Emmarie Huetteman February 5, 2019
Surrounded by patients who told horror
stories of being stuck with hefty bills, President Donald Trump recently waded
into a widespread health care problem for which almost everyone — even those
with insurance — is at risk: surprise medical billing.
Trump’s declaration that taming
unexpected bills would be a top priority for his administration echoed through
the halls of Congress, where a handful of Republican and Democratic lawmakers
have been studying the problem the past couple of years.
The sudden presidential interest has
lawmakers on both sides of the aisle expressing optimism about attacking a
problem that has affected 57 percent of American adults, according to a University of Chicago
survey conducted last summer. Sen. Lamar Alexander, the Tennessee
Republican who chairs the influential Health, Education, Labor and Pensions Committee,
recently told reporters that he expects to see surprise billing legislation “in
the next several months.”
Alexander is encouraged by the movement
on both sides of the aisle, said a committee spokesman — giving a particular
nod to the efforts of Sen. Bill Cassidy (R-La.). “The chairman looks forward to
reviewing their work and hopes it leads to a bipartisan consensus on how to
address the issue,” the spokesman added.
“Indications in Congress have always
been that this would be something they could do on a bipartisan basis,” said
Paul Ginsburg, a health economist at the Brookings Institution, a D.C.-based
think tank.
Attention to this practice, which
involves charging patients for care that is more expensive than anticipated or
not covered by their insurance, has grown following an ongoing Kaiser Health News-NPR “Bill of the Month”
investigation into medical billing at large.
While appetite for policymaking is on
the upswing, the details of a possible solution remain up in the air.
The Trump administration has not laid
out precisely how it would take on surprise bills. But key lawmakers, including
Alexander and Cassidy, have met with administration officials to discuss how to
reduce health care costs.
With an eye toward drafting legislation,
these two senators and several others have been consulting with billing
experts, as well as state and local officials, about the biggest challenges and
most promising approaches being used around the country.
And, though Senate Majority Leader Mitch
McConnell (R-Ky.) has yet to address the issue, House Speaker Nancy Pelosi
(D-Calif.) said it would be a priority.
“Ending surprise billing is an
important part of Democrats’ ongoing effort to lower out-of-pocket health
costs, and we’ll be working on it in the coming Congress,” said Henry Connelly,
a Pelosi spokesman.
Previously introduced bills would
impose new notification requirements, as well as limitations on what doctors
and hospitals might charge patients. They would regulate bills for either emergency
care at an out-of-network facility, or non-emergency care when the facility is
in-network but the doctor is not.
·
A draft bill pushed by
Cassidy — a gastroenterologist by trade and the leader of a small, bipartisan
group of senators studying the issue — would cap what patients pay, and
prohibit balance billing, when a patient is expected to make up the difference
between what the provider charged and what the insurer paid. Instead of
arbitration, the state would set the amount a health plan must pay. In the
absence of a local policy, health plans would default to a federal formula
outlined in the bill. (This is similar to laws passed in California and
Connecticut.)
·
A bill from Sen. Maggie Hassan (D-N.H.) would tackle the
issue by preventing a hospital, physician group or other medical provider from
charging patients more for an emergency procedure than they would have expected
to pay for in-network care. It would then establish an arbitration process to
determine what the patient’s health plan should pay. (This is similar to laws
passed in New York and New Jersey.)
·
A bill from Rep. Lloyd
Doggett (D-Texas), the chairman of the House Ways and Means’ health
subcommittee, introduced during the last Congress with Sen. Sherrod Brown
(D-Ohio), would require hospitals to notify patients whether they, and the
doctors and other providers the patient would see there, are in-network, as
well as how much patients could expect to pay out-of-pocket. Without at least
24 hours’ notice and the patient’s consent — or if the patient was receiving
same-day, emergency treatment — the hospital would be able to charge the
patient no more than an in-network provider would.
To draw attention to the issue, Hassan
planned to bring a guest to Tuesday’s State of the Union address who was billed
more than $1,600 for a trip to an in-network emergency room. The patient
learned after the fact that the doctor she briefly saw there was
out-of-network.
“There does seem to be across-the-board
understanding that what’s happening to patients right now isn’t right or fair,”
Hassan told KHN.
Other members of Congress, including Sen. Amy Klobuchar
(D-Minn.) and Sen. Tammy Baldwin
(D-Wis.), will bring guests with painful, personal stories regarding the high
cost of prescription drugs.
For its part, the administration says
its commitment to addressing surprise medical bills is firm.
“President Trump has identified
surprise medical bills as a serious concern of the administration. Protecting
patients from these outrageous and unexpected bills and charges is a top
priority for Secretary [Alex] Azar,” said Caitlin Oakley, a Department of
Health and Human Services spokeswoman.
Hassan said she has not heard anything
from the White House. But as Congress shifts its focus away from the partial
government shutdown, she predicted, surprise billing could emerge as a
legislative priority, adding that she and Cassidy have coordinated on the
issue.
Both Hassan’s and Cassidy’s bills
“would go a long way toward protecting patients,” suggested Zack Cooper, a Yale
health economist who researches surprise billing. Hassan’s legislation, he
said, has the additional benefit of likely bringing down health care costs.
“There are a lot of issues that can’t
be fixed or at least can’t be fixed easily. This is an issue that causes
immense pain and is quite visceral and can be fixed,” Cooper said.
And federal legislation is likely
necessary, experts say. Some states have passed laws meant to curb surprise
billing, and to protect patients from the costs — but those laws don’t affect
self-insured large employers, which fall under federal jurisdiction and affect more than 60 percent of
people who get insurance through work.
The presidential bully pulpit could be
hugely influential — in particular, Ginsburg suggested, by “leaning on Congress”
to bring legislation to Trump’s desk.
And new legislation probably is the
most effective vehicle, health policy experts said. It’s unclear whether or
what kind of executive action HHS could take without Congress.
“Some creative lawyers could come up
with creative interpretations [of existing laws] and lead to smart policy,”
said Barak Richman, a Duke University law school professor who focuses on
health policy.
But re-interpreting federal law would
almost certainly invite legal challenges, he added.
Already, competing industry groups are
lobbying to put their stamp on any federal policy. The emergency physicians’ trade
group has backed an approach like Hassan’s, while the insurance lobby is calling
for a Cassidy-style bill. When asked about the industry’s response, Hassan said
she has gotten “a variety of feedback — as you would expect.”
Shefali Luthra: ShefaliL@kff.org, @Shefalil
Emmarie Huetteman: ehuetteman@kff.org, @emmarieDC
https://khn.org/news/ideas-to-curb-surprise-medical-bills-percolate-with-rare-bipartisan-push/?utm_campaign=KFF-2019-The-Latest&utm_source=hs_email&utm_medium=email&utm_content=69670249&_hsenc=p2ANqtz-84CSFp-2D6FVvtpuN5LVYEtb0fW5PAnN_76f6GmJYqvEsoAQSR1nWoaxlm7KAD0d-cHSGJUUVwp7RzCTpt4YYkZEAVFg&_hsmi=69670249
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