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!

Catch up on the day's biggest business stories

Subscribe to Axios Closer for insights into the day’s business news and trends and why they matter

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!
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

Dems race to address, preempt stimulus fraud claims

Illustration: Aïda Amer/Axios

Biden officials are working to root out the systematic fraud in unemployment and Paycheck Protection Program claims that plagued the Trump administration’s efforts to boost the economy with coronavirus relief money, Gene Sperling told House committee chairmen privately this week.

Why it matters: President Biden just signed another $1.9 trillion of aid into law, with Sperling tapped to oversee its implementation. And the administration is asking Congress to approve another $2.2 trillion for the first phase of an infrastructure package.

3 hours ago - Politics & Policy

Scoop: Biden close to picking Nick Burns as China ambassador

Nicholas Burns. Photo: Alex Wong/Getty Images

Nicholas Burns, a career diplomat, is in the final stages of vetting to serve as President Biden’s ambassador to China, people familiar with the matter tell Axios.

Why it matters: Across the administration, there's a consensus the U.S. relationship with China will be the most critical — and consequential — of Biden's presidency. From trade to Taiwan, the stakes are high. Burns could be among the first batch of diplomatic nominees announced in the coming weeks.

Biden's Russian sanctions likely to achieve little

President Biden announces new sanctions against Russia. Photo: Chip Somodevilla/Getty Images

Despite bold talk from top administration officials, there's little reason to think the Russia sanctions package President Biden announced Thursday will do anything to alter Russian President Vladimir Putin's behavior or calculus.

Why it matters: While it's true some elements of the package — namely, the targeting of Russia's sovereign debt — represent significant punitive measures against Moscow, it leaves plenty of wiggle room for the Russian president.