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Illustration: Aïda Amer/Axios

Washington's latest health care brawl is over wonky questions about how last year's law banning surprise medical bills will now actually be implemented by the Biden administration.

Why it matters: Billions of dollars are at stake — either for providers or for patients and employers.

The big picture: Last year's legislation prevents patients, in most cases, from getting surprise medical bills when they get out-of-network care. If providers and insurers can't agree on the reimbursement amount, either party can bring the issue to an independent arbitrator, who will ultimately make the call.

  • The administration is tasked with filling in the details of how this arbitration process will work. Its first deadline for these regulations is July 1, with additional ones expected later this year.

Driving the news: Nearly 100 bipartisan members of Congress sent a letter last night to the administration encouraging it to "[ensure] a balanced process to settle payment disputes between health plans and providers."

  • The letter, led by Reps. Tom Suozzi and Brad Wenstrup and provided exclusively to Axios, reflects providers' concerns that the implementation rules will bend the arbitration process in insurers' favor.
  • "The dispute resolution process established in the No Surprises Act prevents artificially low payment rates that would incentivize insurance companies to keep providers out of their networks," the letter argues, and lists multiple factors that should be taken into consideration by arbitrators.

The other side: A competing letter obtained by Axios encourages the administration to swing in the other direction.

  • "We have significant concerns ... that expanded arbitration considerations could place undue harm and financial burdens on consumers," the letter, led by Rep. Jan Schakowsky, writes.
  • "Failure to adequately address these potential regulatory loopholes would allow private equity firms and out-of-network providers to maintain a lucrative and inflationary business model designed to maximize profits at the expense of American families."

Details: The primary tension, for now, is how much weight median in-network rates should have in the arbitration process. Providers want other factors — like market share and prior contract history — to also be strongly considered.

  • "Providers are presumably correct that vaguer guidance ups their chances of capturing the arbitration process and generating higher payments out of it, which consumers and employers don’t like because that would in turn mean higher cost-sharing and premiums," said Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy.
  • He added that the difference between the factors could make a big difference financially, "particularly for the individual staffing companies that were profiting most off of surprise billing and are hoping arbitrators will award them their previously contracted rates."

The bottom line: In health care, every dollar spent goes toward someone else's salary. That means that when it comes to who has power over payment rates, there will always be winners and losers.

  • If providers end up with the upper hand and overall in-network rates continue to rise, those costs will ultimately be passed on to patients and employers through higher premiums and out-of-pocket spending.

Go deeper

Nursing homes could be forced to close if staff shortages worsen

Expand chart
Data: AHCA/NCAL; Chart: Sara Wise/Axios

We've all heard dire reports about the dearth of workers in nursing homes and assisted living facilities, but the situation continues to deteriorate — and the growing number of mask mandates, which are vital, could exacerbate the crisis.

Why it matters: Stalwarts of the care community could be forced to close if they can't find enough people to fill open positions or if current workers are forced into such onerous shifts that they can't take it anymore.

45 million Americans under winter storm watches near New England

Computer model projection showing the winds moving around the powerful East Coast storm on Saturday Jan. 29, 2022. Credit: https://earth.nullschool.net

Nearly 45 million Americans are under winter weather alerts and warnings from North Carolina to northeastern Maine Thursday night, as a major winter storm threatens the region.

Why it matters: It is predicted to be the biggest blizzard since 2018 to strike the Northeast with more than 2 feet of snow possible in parts of eastern Massachusetts, according to the National Weather Service.

1 hour ago - World

Zelensky questions U.S. warnings of "imminent" invasion in Biden call

Biden and Zelensky at the White House last October. Photo: Brendan Smialowski/AFP via Getty

President Biden and Ukrainian President Volodymyr Zelensky had a back-and-forth in their call this evening about just how "imminent" the threat of a Russian invasion might be, according to three sources briefed on the call.

Why it matters: Biden has said previously that he believes Russian President Vladimir Putin will probably "move in" to Ukraine, and White House press secretary Jen Psaki said Thursday afternoon that "an invasion could come at any time."