Illustration: Rebecca Zisser/Axios

Although the surprise billing debate is often framed as a battle between insurers and doctors, hospitals also have a huge financial stake in the issue and are fighting tooth and nail to make sure they get their way.

Why it matters: Congress' effort to rein in surprise medical bills is on the rocks, thanks largely to industry opposition, and its failure would leave patients at risk.

How it works: Congress' leading solution would set a benchmark rate that insurers would pay the doctors and hospitals who are outside their coverage networks. It would only apply in certain circumstances.

  • Some experts say that would erode hospitals' negotiating power with insurers — staying outside an insurer's network wouldn't be as lucrative, and therefore hospitals wouldn't be able to make as many demands by threatening to remain out-of-network.
  • By reducing hospitals' leverage, this approach to surprise billing could help insurers pay hospitals less.
  • “That’s a pretty hefty threat that the hospital implicitly has with any negotiation with an insurance company," said Loren Adler of the Brookings Institution. “That is a reason for insurance companies to pay a hospital more than they otherwise would have.”

Hospitals "don’t have a dog in the fight — they have an elephant in the fight," USC health economist Glenn Melnick said.

  • Hospitals can profit from turning a blind eye to independent physician practices' billing, or in some cases they'll explicitly agree to share those profits, Yale's Zack Cooper said.

The big picture: On its face, this approach to surprise billing is more relevant to individual doctors than to hospitals.

  • But because of these second-order effects that could ultimately cut into hospitals' bottom lines, the industry is fully engaged in what has become an expensive, protracted lobbying battle.
  • "I don’t see any difference between this approach, rate-setting under the guise of surprise billing, and Medicare for All," said Tom Nickels, executive vice president of the American Hospital Association. "They would both have very negative consequences on providers.”

Go deeper: ER bills are skyrocketing

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Illustration: Sarah Grillo/Axios

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  3. Politics: In reversal, CDC again recommends coronavirus testing for asymptomatic people.
  4. Health: The dwindling chances of eliminating COVID-19.
  5. World: Guatemalan president tests positive for COVID-19 — The countries painting their pandemic recoveries green.

The positions of key GOP senators on replacing Ruth Bader Ginsburg

Senate Majority Leader Mitch McConnell talks to reporters on Capitol Hill last Thursday. Photo: Chip Somodevilla/Getty Images

With President Trump planning to nominate his third Supreme Court justice nominee by next week, key Republican senators are indicating their stance on replacing the late Justice Ruth Bader Ginsburg just over six weeks out from Election Day.

The big picture: Senate Majority Leader Mitch McConnell (Ky.) has vowed that "Trump’s nominee will receive a vote on the floor of the United States Senate." But Sen. Lisa Murkowski (Alaska) told Alaska Public Media, "I would not vote to confirm a Supreme Court nominee. We are 50 some days away from an election."

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ActBlue collects a record $91 million in hours after Ginsburg's death

A makeshift memorial in honor of Justice Ruth Bader Ginsburg in front of the U.S. Supreme Court on Sept. 19. Photo: Samuel Corum/Getty Images

ActBlue received a record $91.4 million in the 28 hours following Supreme Court Justice Ruth Bader Ginsburg's death, the Democratic donation-processing site confirmed to Axios late Saturday.

Why it matters via the New York Times: "The unprecedented outpouring shows the power of a looming Supreme Court confirmation fight to motivate Democratic donors."