The
bipartisan push to end surprise medical bills is ramping up.
Congress
is ramping up its push to stop surprise medical bills.
Reps.
Frank Pallone (D-NJ) and Greg Walden (R-OR), the top Democrat and Republican on
the House Energy and Commerce Committee, have jointly released a draft bill
that would prevent patients from facing unexpected charges after they go to the
emergency room or receive other non-emergency medical care.
The
draft legislation, shared exclusively with Vox, is the most robust proposal yet
as lawmakers from both parties and President Donald Trump say they want to end surprise billing. The plan would
prohibit surprise charges not only for emergency care when a patient ends up at
a hospital that is out of their insurance plan’s network, but also for
non-emergency care when the facility might be in network but certain providers
are not.
“The
Energy and Commerce draft is the strongest proposal at the federal level to
date,” Loren Adler, the associate director of the USC-Brookings Schaeffer
Initiative for Health Policy, told me. “It clearly eliminates the problem of
surprise billing in both emergency and non-emergency situations.”
Pallone
has a powerful perch as the chair of his committee and, importantly, has the
cooperation of Walden, the top Republican on the panel. The pair intend to move
the bill through the committee and send it to the House floor.
“We
must ensure that patients are not responsible for these outrageous bills, which
is why our discussion draft removes patients from the middle,” Pallone and
Walden said in a joint statement to Vox. “We look forward to receiving
constructive feedback on ways to build upon our proposal, so we can advance a
bipartisan solution that protects patients from costly surprise medical bills.”
The
Senate has working on its own legislation for a while;
Trump held an event last week urging Congress to pass a bill to stop surprise medical
billing. This is a problem that, after the reporting of Sarah Kliff for Vox and other journalists on the egregious
bills that Americans sometimes face when they end up in the emergency room,
policymakers want to solve.
The House’s plan to end surprise medical bills, explained
The
problem here is simple: Sometimes patients go to the emergency room and end up
getting unexpected charges because the hospital itself or some of the doctors
who treated them do not have contracts with the patient’s health insurer.
The
Pallone and Walden bill takes a multi-pronged approach to ending surprise
medical bills:
- Health
insurers would be required to treat out-of-network emergency care as in
network for their enrollee’s cost-sharing and out-of-pocket obligations.
So patients wouldn’t have to pay any more for receiving emergency
treatment at an out-of-network hospital than they would at an in-network
one.
- Balance
billing — when a health care provider sends a patient a bill charging them
whatever the difference is between the price set for a service by the
provider and the price the health insurer is willing to pay — would be
prohibited.
- Insurers
would have to make a minimum payment to out-of-network providers for their
enrollee’s care, based on the price the insurer pays to nearby in-network
providers. (Some states have their own laws for setting those payments,
however, and they would not be overridden by the federal law.)
One
dividing line between the various bills has been on that latter point — what
price does an insurer have to pay an out-of-network provider in lieu of
surprise balance billing? Some plans have featured arbitration, which would
require an insurer and provider to negotiate a price. That approach is favored
by emergency room doctors but has been opposed by the White House, and the
House bill opts instead to use a local market price.
We also
typically think of surprise bills for emergency care — you get hit by a bus and get taken to a hospital you
didn’t choose to go to and then face $30,000 bill for your troubles—
but the House bill also tries to prevent surprise bills for scheduled care.
It
stipulates that patients must receive both written and oral notice about
whether their providers will be in or out of network and what charges they must
face. If they do not sign a consent form after that notice, they can not be
balance-billed. The legislation also prohibits balance billing from providers
that a patient could not reasonably be expected to choose themselves, like
anesthesiologists, radiologists, and pathologists.
The
bill isn’t flawless in the eyes of experts who want to fix surprise billing.
Like the other bills in Congress, it does not prohibit surprise billing for
ground or air ambulances. (Here’s the story of one family that
faced a $40,000 charge for their son’s air ambulance.) Pallone and Walden are
aware of that gap and have asked stakeholders for input on how they could
address surprise ambulance bills in future iterations of their legislation.
Even
so, this is the most robust and foolproof plan introduced in Congress yet to
stop surprise billing.
Lawmakers seem serious about fixing surprise medical bills
The
safest bet is always against health care legislation passing Congress, especially
in a time of divided government. But surprise medical bills might be the
exception.
The
Senate had already taken up the cause of surprise bills — Sens. Bill Cassidy
(R-LA) and Maggie Hassan (D-NH) have been leading a group dedicated to the
issue, while health committee chair Lamar Alexandar (R-TN) has also indicated
his interest in tackling the issue — and it can only help that President Trump
is on board.
Now we
have another strong bipartisan plan for the pile, which should add to the
momentum to fix the problem this year. Lawmakers still have issues to figure
out; right now, it looks like the Senate is at odds with the House on the
arbitration question. But their intent seems genuine.
Surprise
bills are really only a symptom of the underlying disease plaguing American
health care — exorbitantly high and irrationally set prices — but they are a
particularly egregious example, as they can leave even patients who have
insurance with medical bills that total tens of thousands of dollars. Vox’s Sarah Kliff summarized her findings after
collecting ER bills for a year like this:
Patients
find themselves in a vulnerable position during these encounters with the
health care system. The result is often high — and unpredictable — bills.
Hospitals are not transparent about the cost of their services, their prices
vary wildly from one ER to another, and it’s hard to tell which doctors are
covered by insurance (even if the hospital itself is covered). In many cases,
patients can’t be certain what they owe until they receive a bill in the mail,
sometimes weeks or months later.
States
like California and New York have acted on their own to
crack down on surprise bills, but Congress looks insistent on taking action
nationwide. The Pallone/Walden bill yet is the most hopeful sign yet that the
days of patients ending up in the emergency room with not only a broken arm but
also a huge bill might be numbered.
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