- The White House on Thursday called on Congress to pass legislation banning surprise medical bills, which President Donald Trump called "one of the biggest concerns Americans have about healthcare."
- Trump laid out core aspects of legislation he would support and said the protections should include emergency and elective services and patients should never receive a separate bill from an out-of-network provider. The bill should apply to all insurance markets and not increase federal spending, he said.
- Senior administration officials told reporters the White House does not support including an arbitration process in the legislation — a tactic used in some states that have tackled the issue that's opposed by most payers. Arbitration "would get in the way of solving this problem and would be an unnecessary distraction," officials said.
While nearly everyone agrees patients should not receive an unexpected bill that causes sticker shock after a medical procedure, policy solutions differ on a few key aspects. One is how providers who are not in a patient's network would be reimbursed. Another is how payers and providers would settle disputes when a payment agreement can't be reached.
Several states have taken up surprise billing legislation, but those are limited in their effects. State laws can't protect people who get coverage from an employer's self-funded plan.
That's why "it's really important for Congress to act," Thomas Waldrop, policy analyst for the left-leaning Center for American Progress, told Healthcare Dive.
A group of six senators from both parties last year put forward the Protecting Patients from Surprise Medical Bills Act, which caps charges at 125% of the average amount payers in the geographic area allow for the particular service when it is in-network.
It has yet to gain significant traction, though renewed interest in the topic and prodding from Trump could spur more action.
Congressional leaders said Thursday they are on board with the idea of enacting a ban. The chairman and ranking member of the Senate Energy & Commerce Committee said in a joint statement they are "committed to working together on bipartisan legislation that protects patients and families from surprise medical bills and the crippling financial debt that comes with them."
Kevin Lucia, who has studied surprise billing legislation for The Commonwealth Fund, told Healthcare Dive this is the highest level of conversation on the topic he's seen on the Hill in more than a decade. "You get the sense that there's something real happening at the federal level and I'm optimistic that something helpful for consumers will come out of it," he said.
And there's public support behind a federal surprise billing ban. A recent Kaiser Family Foundation poll found that half of respondents said it should be a "top priority" for Congress. Another 36% said it was "important" but not a top priority.
Research shows the extent of surprise billing. Nearly 15% of in-network hospital admissions include at least one out-of-network professional claim and about 20% of ER visits involve an out-of-network provider.
America's Health Insurance Plans thanked the president for taking up the issue. "We appreciate the bipartisan attention that the problem of surprise medical bills has received, and we stand ready to work with the Administration and Congress on real solutions," AHIP CEO Matt Eyles said in a statement.
AHIP has said it would support legislation that sets rates for payment to out-of-network providers, either based on a percentage of Medicare or a similar metric that takes into account geographic market differences.
The American Hospital Association and other hospital groups, however, said in a letter to lawmakers earlier this year "the government should not set a fixed payment amount or reimbursement methodology for out-of-network services." AHA added in a statement Thursday: "Untested proposals such as bundling payments would create significant disruption to provider networks and contracting without benefiting patients."
The American College of Emergency Physicians in its statement also took a shot at bundled payment approaches. ACEP President Vidor Friedman said the White House principles "do not go far enough to protect patients." Patients "should only be held responsible for any in-network cost-sharing amounts of emergency care, whether the care received is in- or out-of-network," he said. "However, such protection is currently applicable to only coinsurance and co-pays. To effectively address surprise billing, any legislation needs to extend this protection to the deductible portion of the patient's bill."