Michigan Association of Health Plans

Congress Debates Push to End Surprise Medical Billing

Negotiations on Capitol Hill over the next package of coronavirus economic relief have revived discussions about ending surprise medical billing, an effort to bolster patient protections that has sparked heavy spending by opponents who warn of damage to the health-care system.

Surprise billing typically occurs when a patient is treated at a hospital that is in their insurance network by a medical professional who isn’t, potentially leading to crippling medical charges. The push to end surprise billing pits patient advocates and health-insurance providers, who back the effort, against hospital and medical groups who say it amounts to government rate-setting that would would jeopardize the finances of some hospitals and mean out-of-network doctors earn less money.

Lawmakers and the administration have already ensured that anyone without insurance getting treated for Covid-19, the disease caused by the new coronavirus, can’t get stuck with an unexpected medical bill—and advocates say that protection should be expanded to cover patients with any medical issue. But the pandemic’s effect on hospitals, especially rural hospitals that have halted the elective procedures that bring in much of their revenue, adds a complication to the debate, according to congressional aides. Moving to end surprise medical billing could cost hospitals more money just as they are already struggling.

The top Republicans and Democrats on the Senate health committee and House Energy and Commerce panel have been pushing for almost a year to end surprise medical billing. They reached a rare, high-level bipartisan agreement in December, backed by President Trump, to end the surprise bills and include a new system in which insurers would pay at least an agreed-upon rate for services, and independent arbitration would settle billing disputes.

But its supporters—chief among them the Senate health committee’s chairman, Sen. Lamar Alexander—weren’t able to include it in a must-pass spending measure at year’s end, leaving its fate uncertain. Mr. Alexander, a Tennessee Republican, is retiring at the end of this year and has made ending surprise medical billing one of his final goals.

Lawmakers discussed including broader protections against surprise medical bills in previous coronavirus-aid bills and are resuming those talks, according to lawmakers and aides. Congress decided to make coronavirus testing free for patients, and administrative guidance makes clear that health-care providers receiving federal emergency aid can’t spring surprise bills on uninsured Covid-19 patients.

“There’s a certain irony here that we were able to put into statute that you can’t surprise-bill a Covid patient and nobody objected, but if you have a heart condition that pops up and you’re out of network, it’s OK? I don’t think so,” Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, said in an interview. “We’ve won the intellectual argument.”

This article was originally featured in the Wall Street Journal, read more here.