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Illustration: Lazaro Gamio/Axios

Every American who gets private health insurance — most of whom get it through their jobs— is at risk of getting a surprise bill from hospitals, doctors, air and ground ambulances, and other providers.

The big picture: Employers would need to be part of any solution, and they say they want this problem fixed. But they don't support some prominent proposals to rein in surprise billing, including tinkering with their own regulations or giving governments more power over doctors and hospitals.

Where things stand: Analysts at the Brookings Institution have suggested fixes that would force health care providers and the purchasers of care (employers and insurers) to agree on a couple things:

  • Patients should not be on the hook for surprise bills that are tied to emergencies, nor should they have to pay for care they receive at in-network hospitals where a specific doctor, like an anesthesiologist or a surgeon, turns out to be out-of-network.
  • Regulators should cap how much hospitals, doctors and others can charge in certain situations, and legislation should force fair arbitration when providers and insurers/employers can't agree.

Yes, but: Providers loathe the idea of having their payments regulated, and employers aren't keen about being forced into a dispute resolution process.

Employers believe arbitration benefits providers who stay out-of-network and charge at will, and that it unnecessarily pierces holes in the Employee Retirement Income Security Act of 1974 (ERISA), which governs employer plans that directly pay for their workers' medical claims and preempts state insurance laws.

  • "This is not an issue of the management of self-insured plans. It’s an issue about the practice of medicine," said James Gelfand, who handles health policy for the ERISA Industry Committee.

The bottom line: This is messy. Toying with ERISA "is a political third rail," health policy legal expert Nicholas Bagley wrote in 2016. That means provider regulation — like outlawing balance billing for emergency care, or requiring all doctors at in-network facilities to accept in-network rates — is probably the most direct way to solve this issue.

All-payer rate setting is viewed as a compromise that could neuter surprise billing by reining in providers, but corporate America isn't championing it.

  • The ERISA Industry Committee has not polled its member companies on all-payer rate setting but does support state efforts in California and Ohio, for instance, that would cap dialysis payments near Medicare rates, Gelfand said.
  • Steve Wojcik, a vice president of policy at the National Business Group on Health, would not say whether his organization supported all-payer rate setting, and instead said it supported "reasonable" pricing and billing.
  • "We feel insurers and employers through the contracting process can get there," he said.

Go deeper: Federal legislation proposed by New Mexico Rep. Michelle Lujan Grisham would ban surprise billing, but has gone nowhere in Congress.

Go deeper

17 mins ago - World

South Africa says it's being "punished" for detecting new COVID variant

South African Foreign Minister Naledi Pandor addresses the 76th Session of the U.N. General Assembly on September 22, 2021 in New York City. Photo: Eduardo Munoz - Pool/Getty Images)

South Africa said Saturday it's being "punished" for detecting the new Omicron coronavirus variant as more countries rush to enact travel bans and restrictions.

Driving the news: The U.S. imposed air travel restrictions from eight countries Friday in response to the Omicron variant. Countries in Europe and Asia have also implemented their own travel restrictions in response to Omicron.

Trump can't quit mainstream media

Bob Woodward and Robert Costa are interviewed by Chuck Todd on "Meet the Press" in September. Photo: William B. Plowman/NBC via Getty Images

Bob Woodward and Robert Costa issued a rebuttal on Friday to a statement by former President Donald Trump that misrepresented their reporting — and once again showed the 45th president's thin skin about mainstream media.

Driving the news: "Former President Trump said ... our book, 'Peril,' implied that he was planning to go to war with China," the statement begins. "[W]e report that Chairman of Joint Chiefs Mark Milley 'believed that Trump did not want a war' before or after the 2020 election."

NY declares state of emergency amid concerns over Omicron COVID variant

Governor Kathy Hochul makes an announcement about a new plan transforming Penn Station on Nov. 3, 2021. Photo: Lev Radin/Pacific Press/LightRocket via Getty Images

New York Gov. Kathy Hochul on Friday declared a state of emergency amid rising COVID-19 cases and the newly-identified Omicron variant of the virus.

Driving the news: The declaration enables the state to acquire supplies to fight a potential surge in cases, increase hospital capacity and combat potential staff shortages, NBC's local affiliate reports.