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Expand chart
Reproduced from a Kaiser Family Foundation report. Margin of error was ±3 percentage points. Survey methodology. Chart: Axios Visuals

There is growing interest in the problem of surprise medical bills in the media and on Capitol Hill, with a bipartisan group of senators drafting legislation to crack down on the problem. But the issue has not been prominent in midterm campaigns and is not showing up in campaign ads.

Why it matters: Recent analyses, including polling and a report on employers' medical claims, show that surprise bills could have as much — or even more — traction with the public than other health issues being featured in the midterms. In an election where health care is top-of-mind, candidates may be missing an opportunity.

The big picture: As the chart shows, unexpected medical bills are the number one health cost problem people worry about, ahead of all the cost issues that get more attention, including deductibles, drug costs, and premiums. They're even a bigger concern than other family expenses, such as paying the rent, mortgage, or utilities. 

  • Surprise medical bills also affect a lot of people. In a recent Kaiser Family Foundation tracking poll, four in ten adults (39 percent) say they had a surprise bill from a doctor, hospital or lab in the past year.
  • 10 percent report that an unexpected bill was from an out-of-network provider.

An analysis of large employer health plans showed that a significant share of inpatient hospital admissions includes bills from providers that aren't in the health plans’ networks. That leaves patients subject to higher cost-sharing and potential additional bills from providers.

  • Almost 18 percent of inpatient admissions result in non-network claims for patients with large employer coverage.
  • Even when enrollees choose in-network facilities, 15 percent of admissions include a bill from an out-of-network provider, such as a surgeon or an anesthesiologist.

Surprise bills have the elements of a perfect campaign issue. There is a victim: consumers. And a villain — providers — even if they argue that out-of-network providers are necessary to ensure adequate access as networks shrink to reduce costs.

There are a range of actions liberal or conservative candidates can endorse to address the problem, as this Brookings Institution report shows.

One downside from a purely political perspective: neither Republicans or Democrats created the problem of surprise bills, so it’s not a great issue for candidates to attack their opponents on. Politicians will also be mindful that providers will fight any efforts to limit balance billing, and insurers will resist any attempt to stick them with all or part of the bill.

The bottom line: Unlike consumers, experts do not generally put surprise bills at the top of their list of the problems in the health system. But people talk about their unexpected bills a lot, and with a sense of outrage. It’s the candidates who aren’t talking about it on the campaign trail, and that’s almost certainly a missed opportunity.  

Go deeper

Tech scrambles to derail inauguration threats

Illustration: Sarah Grillo/Axios

Tech companies are sharing more information with law enforcement in a frantic effort to prevent violence around the inauguration, after the government was caught flat-footed by the Capitol siege.

Between the lines: Tech knows it will be held accountable for any further violence that turns out to have been planned online if it doesn't act to stop it.

Dave Lawler, author of World
2 hours ago - World

Uganda's election: Museveni declared winner, Wine claims fraud

Wine rejected the official results of the election. Photo: Sumy Sadruni/AFP via Getty

Yoweri Museveni was declared the winner of a sixth presidential term on Saturday, with official results giving him 59% to 35% for Bobi Wine, the singer-turned-opposition leader.

Why it matters: This announcement was predictable, as the election was neither free nor fair and Museveni had no intention of surrendering power after 35 years. But Wine — who posed a strong challenged to Museveni, particularly in urban areas, and was beaten and arrested during the campaign — has said he will present evidence of fraud. The big question is whether he will mobilize mass resistance in the streets.

Off the Rails

Episode 1: A premeditated lie lit the fire

Photo illustration: Sarah Grillo/Axios. Photo: Chip Somodevilla/Getty Images

Beginning on election night 2020 and continuing through his final days in office, Donald Trump unraveled and dragged America with him, to the point that his followers sacked the U.S. Capitol with two weeks left in his term. Axios takes you inside the collapse of a president with a special series.

Episode 1: Trump’s refusal to believe the election results was premeditated. He had heard about the “red mirage” — the likelihood that early vote counts would tip more Republican than the final tallies — and he decided to exploit it.

"Jared, you call the Murdochs! Jason, you call Sammon and Hemmer!”