- Representatives for providers, payers, hospitals and employers clashed over how best to execute a federal legislative ban on surprise medical billing Tuesday in front of the House Ways and Means Subcommittee on Health.
- All groups agreed the practice should be outlawed, and that patients should not be caught in the middle of price negotiations. However, they differed over how the rates for out-of-network doctors should be reimbursed and whether an arbitration process should be mandated.
- Also Tuesday, another bill to ban surprise billing surfaced, joining previous bipartisan proposals in the House and Senate. Senate HELP Committee Chairman Lamar Alexander, R-Tenn., also said he plans to unveil a package of bills that includes surprise billing legislation later this week.
The flurry of bills addressing surprise billing comes after President Donald Trump highlighted the issue earlier this month and called on Congress to find a bipartisan solution that protects patients in all insurance markets and does not raise the federal deficit.
On the key issue of arbitration, the White House does not support such a process in surprise billing laws. That's in line with the position of the payer lobby and large employers. The American Hospital Association, however, said it could support arbitration, and some policy experts argue it's necessary for a comprehensive fix.
Although lawmakers in Congress have been eager to put forward proposals to address surprise billing, there are still key discrepancies in the legislation — and even the most bipartisan policies are likely to struggle in the current political climate. Several states have taken up the issue in the meantime. In recent weeks, bills have advanced in Colorado, Washington and Texas. Those bills, however, cannot protect patients who are covered by self-funded employer plans — the majority of Americans.
At the hearing Tuesday, AHA and the American Medical Association largely placed the bulk of the responsibility for surprise billing on payers, while the representative from America's Health Insurance Plans pointed the finger at specialists who she said are effectively "price-gouging."
James Gelfand, health policy senior vice president at the ERISA Industry Committee, which represents businesses that provide coverage to their employees, called out physician staffing firms, which often provide the out-of-networks doctors a patient may encounter at an in-network hospital.
He criticized arbitration as a distraction that deflects tough decision-making away from Washington and said requiring price transparency alone is not nearly enough. "We are dealing with a market failure, and in some cases, with de facto monopoly powers," he said.
AHA Executive Vice President Tom Nickels said his group opposes bundling of the clinical and hospital services, which the White House said it could potentially support. Hospitals are also against a set rate for payments to out-of-network doctors. "Our concern is if you set some sort of rate it becomes a default rate," he said, arguing that would incentivize payers to further narrow their networks and step away from negotiations with providers.