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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

Go deeper

Mike Allen, author of AM
31 mins ago - Politics & Policy

First look: Anita Dunn advises Dems on economy message for '22

Signs from a President Biden event yesterday in Kansas City, Mo. Photo: Chase Castor/Bloomberg via Getty Images

In a midterm preview, top Democratic strategist Anita Dunn advises the party's House and Senate members to frame Republicans "as being against the economic interests of working Americans."

What she's saying: "Explicitly framing Republicans as opposing policies to lower costs does better than simply framing Republicans as the 'party of no,'" Dunn, White House senior adviser until August, writes in the memo.

JPMorgan: "Full global recovery" in 2022

Photo: Erik McGregor/LightRocket via Getty Images

JPMorgan Chase Global Research says in a forecast to clients: "2022 will be the year of a full global recovery, an end of the global pandemic, and a return to normal conditions we had prior to the COVID-19 outbreak."

The big picture: The bullish report sees "a return of global mobility, and a release of pent-up demand from consumers (e.g. travel, services)."

Inside Trump's hunt for "disloyal" Republicans

Illustration: Aïda Amer/Axios

Donald Trump and his associates are systematically reshaping the Republican Party, working to install hand-picked loyalists across federal and state governments and destroy those he feels have been disloyal, sources close to the former president tell Axios.

Why it matters: If most or all of Trump’s candidates win, he will go into the 2024 election cycle with far more people willing to do his bidding who run the elections in key states.