As the U.S. continues to battle the coronavirus pandemic, there have been growing concerns about surprise medical bills, the unexpected charges that patients receive after unscheduled or emergency out-of-network medical services.
An August 2019 study in the Journal of the American Medical Association found that the percentage of emergency room visits with surprise bills jumped 10% between 2010 and 2016, while the number of inpatient admissions that resulted in surprise bills rose nearly 16%. The cost of those bills has also increased, often leading to significant financial strain on patients.
Twenty-eight states have enacted consumer protections against surprise medical billing, according to the Commonwealth Fund, but those laws can only go so far. For example, they do not apply to consumers treated by out-of-state providers. The coronavirus has increased the need for tests and emergency treatment, and experts warn that more Americans could receive unexpected medical bills this year.
The issue had been a growing concern in Congress even before the pandemic hit. As of early 2020, at least three bills aimed at curbing surprise medical billing were making their way through Congress, each with a different approach to the problem.
In February, the House Ways and Means Committee approved the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826), which would establish a dispute resolution process in which medical providers and insurance plans would have 30 days to negotiate payment for out-of-network services. If no agreement is reached, they would enter a mediation process with an independent arbiter. The bill, which was introduced by Ways and Means Chairman Richard Neal (D-Mass.) and ranking member Kevin Brady (R-Texas), would also require that patients receive an advanced explanation of benefits at least three days in advance.
Medical providers have largely backed that approach. “We applaud the committee for protecting patients from surprise medical bills and for developing a workable approach for determining the patient’s cost-sharing amount so they can be ‘taken out of the middle’ of any discussions between the health plan and the provider regarding reimbursement,” Richard Pollack, president and CEO of the American Hospital Association, said in a statement.
The group also backed the dispute resolution process outlined in the bill but encouraged the committee to consider adding additional stipulations to the mediation process, such as directing mediators not to consider Medicare reimbursement rates, which are often below the actual cost of care.
The House Education and Labor Committee, meanwhile, approved the Ban Surprise Billing Act (H.R. 5800) from Chairman Bobby Scott (D-Va.) and ranking member Virginia Foxx (R-N.C.). Their bill proposes that for bills up to $750, health insurers pay out-of-network providers the median in-network rate for a geographic area. For charges greater than $750, insurers and providers could request an arbitration process.
At least one Education and Labor Committee member, Rep. Donna Shalala (D-Fla.), says she prefers the Ways and Means version and wants to amend H.R. 5800 before voting for it on the floor. Shalala, a former Health and Human Services secretary, voiced concern that the bill favors insurance providers and could hurt hospitals, which are the largest employers in her district.
H.R. 5800 is similar to a bipartisan compromise proposal announced in December 2019 by the House Energy and Commerce and the Senate Health, Education, Labor and Pensions committees, which also approved the creation of a payment standard with dispute resolution as an option for higher-cost bills. The members who crafted that December proposal say the new House bills show the bipartisan interest in solving the problem and have said it is incumbent on Congress to find a solution that can reach the president’s desk.
Some Republicans have requested the December compromise proposal be included in a coronavirus stimulus package.
In the interim, the Trump administration has taken steps to protect Americans from the surprise bills if they seek treatment for COVID-19. In March, President Trump signed a law ensuring free testing for anyone who needs it, regardless of insurance status. In April, the administration also announced that medical providers cannot access money from the $2 trillion stimulus bill unless they agree not to send surprise medical bills to COVID-19 patients.
For more background, see the March 2016 issue of Congressional Digest on “Obamacare Update.”
