Lawmakers in Congress seem to have reached a solution on the issue of surprise medical bills.
The widely unpopular practice, in which patients are charged for medical products and services they thought their insurance covered, has drawn the attention of federal lawmakers of both parties for years. However, a solution has eluded a divided Congress.
Now, in the midst of the COVID-19 crisis, a new effort is underway that appears to have enough bipartisan support to land it on the agenda in the next session of Congress. The “Stop Surprise Medical Billing Act” currently has 30 Senate co-sponsors. After the usual wrangling over amendments and wording, the measure—two years in the making—was approved by large majorities in the Senate Committee on Health, Education, and Labor and the House Committee on Energy and Commerce and the House Committee on Education and Labor.
Key Provisions
The legislation has three key provisions. First, it would remove patients from the middle of billing disputes between providers and insurance companies. Second, it seeks to ensure that providers receive timely payments based on where patients live and where they receive care. This is often called an interim payment. Third, if a health care provider determines that an interim payment is unfair, the matter will be subject to a process known as Independent Dispute Resolution, more commonly referred to as baseball-style arbitration.
“I do not think it possible to write a bill that has broader agreement than this one does among Senate and House Democrats and Republicans on Americans’ number one financial problem: what they pay out of their own pockets for health care,” Sen. Lamar Alexander, R-Tenn., said in a statement after the outlines of a deal had been reached.
The sticking point in getting to a compromise involved doing away with the current practice of “balance billing” and replacing it with interim billing and Independent Dispute Resolution. Under balance billing, a provider whose charges are not covered under a patient’s insurance plan will charge the patient for the difference—the balance—between what the insurer is willing to pay and what the provider wants to charge. This arrangement has left patients stuck with bills they hadn’t expected, which has prompted lawmakers to try to do something about surprise billing.
A Pathway to Price Controls?
There is concern the legislation could open the door to price controls.
“I’m afraid this compromise will start out as price controls and never transition to arbitration,” said Ryan Ellis, president of the Center for a Free Economy. “What incentive does Congress have to let that transition happen?”
The Health Care Choices 2020 plan by the Health Policy Consensus Group offers an alternative solution to surprise bills.
“Congress should require insurers and medical providers to give patients accurate and honest information before they receive medical care and penalize entities that provide consumers with false and misleading information,” the proposal states. (See related article, page 18).
Bonner R. Cohen, Ph.D., (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research.
