Sign up for our daily briefing

Make your busy days simpler with Axios AM/PM. Catch up on what's new and why it matters in just 5 minutes.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Stay on top of the latest market trends

Subscribe to Axios Markets for the latest market trends and economic insights. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sports news worthy of your time

Binge on the stats and stories that drive the sports world with Axios Sports. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tech news worthy of your time

Get our smart take on technology from the Valley and D.C. with Axios Login. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Get the inside stories

Get an insider's guide to the new White House with Axios Sneak Peek. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Denver news?

Get a daily digest of the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Des Moines news?

Get a daily digest of the most important stories affecting your hometown with Axios Des Moines

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Twin Cities news?

Get a daily digest of the most important stories affecting your hometown with Axios Twin Cities

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Tampa Bay news?

Get a daily digest of the most important stories affecting your hometown with Axios Tampa Bay

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Charlotte news?

Get a daily digest of the most important stories affecting your hometown with Axios Charlotte

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

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

Dan Primack, author of Pro Rata
1 hour ago - Economy & Business

Coinbase files to go public

Illustration: Eniola Odetunde/Axios

Cryptocurrency exchange Coinbase on Thursday filed to go public via a $1 billion direct listing.

Why it matters: This comes in the midst of a crypto boom, and the listing may further legitimize the industry.

Trump’s blunt weapon: State GOP leaders

Trump supporters rally near Mar-a-Lago on Feb. 15. Photo: Joe Raedle/Getty Images

President Trump didn't have to punish his critics in Congress — his allies back in the states instantly and eagerly did the dirty work.

Why it matters: Virtually every Republican who supported impeachment was censured back home, or threatened with a primary challenge.

The modern way to hire a big-city police chief

Illustration: Annelise Capossela/Axios

When it comes to picking a city's top cop, closed-door selection processes have been replaced by highly public exercises where everyone gets to vet the candidates — who must have better community-relations skills than ever.

Why it matters: In the post-George-Floyd era, with policing under utmost scrutiny, the choosing of a police chief has become something akin to an election, with the need to build consensus around a candidate. And the candidate pool has gotten smaller.