Senate legislation to end surprise medical bills includes provision opposed by White House

Written by on May 16, 2019

Newly released Senate legislation to curb surprise medical bills would allow third parties to settle billing disputes, a provision that could complicate passage because it is opposed by the White House and absent from a House draft.

The Senate bill represents nearly a year of work led by Sens. Bill Cassidy, R-La., and Maggie Hassan, D-N.H. If lawmakers aren’t able to resolve the differences between the two chambers and win over the White House, then a victory on healthcare that was once in sight this year may escape them.

The bill would have insurers pay out-of-network doctors and hospitals for the difference between a patient’s in-network cost-sharing requirements and the median in-network rate for their services. If either party wanted to appeal the amount, they could do so using an arbitration process.

The arbitration process, which is already used in New York and a handful of other states, would let an independent arbiter determine a fair price for a bill after evaluating what hospitals and doctors are charging compared with what insurers are willing to pay. The binding arbitration is supposed to give both sides an incentive to offer a realistic figure. It’s often referred to as “baseball-style arbitration” because it’s similar to how salaries are decided in Major League Baseball.

President Trump has vowed to end surprise billing and spoke about it at the White House last week. On Wednesday, the Wall Street Journal reported that the administration has been working on an idea behind the scenes that would force health insurers to share what they pay for medical care and would have doctors and hospitals tell patients what they’ll be charged before they’re treated.

But the White House has said it isn’t enthusiastic about the arbitration idea.

“We believe that would be disruptive,” a senior White House official said.

The method has helped lower costs in New York and reduce complaints about surprise medical bills from consumers, according to a study this week from the Georgetown University Health Policy Institute. Hassan introduced a standalone bill last year to introduce the arbitration method at a national level.

Politicians have been paying attention to consumer complaints about high medical costs, particularly the problem patients face when they receive eye-popping medical bills that they didn’t expect, often after receiving care in an emergency room or after undergoing surgery. The bills arrive in the mail even in instances where people have health insurance coverage, when care was given to them while they were under anesthesia, and even when they tried to ask questions to make sure they’re financially prepared for a medical procedure.

The bill introduced from the Senate on Thursday is called the STOP Surprise Medical Bills Act, and was also introduced by Sens. Michael Bennet, D-Colo., Todd Young, R-Ind., Lisa Murkowski, R-Alaska, and Tom Carper, D-Del. It contains sweeping provisions that would require insurers and medical providers to be more forthcoming in telling patients what their prices are and what patients should expect to pay.

“This bill puts the burden of negotiating prices of medical procedures on the insurer and provider, and, as much as possible, takes the burden off of the patient,” Carper said in a statement. “Put simply, patients should be able to focus on getting healthy rather than having to negotiate over their medical bills.”

The House bill, called the No Surprises Act, is still a discussion draft, and lawmakers will be taking feedback in the coming weeks. The version looks similar to proposals the Senate had released last year and mirrors other parts of the Senate bill out Thursday.

Both bills, for instance, call for medical providers to tell patients which providers are out of their network and whether they could face additional charges.

The House bill provides $50 million in grants for states to use to put together databases about healthcare costs and to come up with ideas about how to lower them. While both bills would disallow “balanced billing,” a practice in which hospitals charge patients for the cost of medical care that their health insurer wouldn’t cover, the Senate version of the ban is stricter. It would apply to cases in which a patient is taken another hospital that is out of network, or if a doctor orders images or tests that turn out to be from an out-of-network facility.

As the House continues to make changes to its bill, the Senate has pledged to move ahead. Sen. Lamar Alexander, R-Tenn., who leads the Senate Health, Education, Labor, and Pensions Committee, said last week that a bill would be sent out of committee by the summer.

Source: Washington Examiner – Congress

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