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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.  

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