Dec 10, 2019

Health care industry opposes Congress' new surprise medical bill legislation

Sen. Lamar Alexander (R-Tenn.). Photo: Astrid Riecken/Getty Images

The health care industry is not very happy with Congress' latest proposal on surprise medical bills, which also includes other provisions designed to lower health costs.

Driving the news: The bill, championed by Sen. Lamar Alexander and Reps. Frank Pallone and Greg Walden, cracks down on industry behavior that is often profitable at patients' expense.

What they're saying: Providers are complaining that arbitration can only be used to settle payment disputes over out-of-network bills over $750.

The other side: The Coalition Against Surprise Medical Billing, which includes employer groups and insurers, is complaining that arbitration is included at all.

  • The generic drug industry also released a statement criticizing the bill's drug component.
  • The White House released a statement of support, writing that "this compromise reflects the input of doctors and hospitals and is the result of months of delicate work to reach a deal among congressional members and the White House that protects patients."

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Why it matters: While most patients with insurance don't pay these prices for their care — insurers typically negotiate lower rates — those who are uninsured or out-of-network often do.

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Surprise medical bills inflate everyone's health insurance premiums

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Four specialties that are often out-of-network — anesthesiologists, pathologists, radiologists and assistant surgeons — raise employer insurance spending by 3.4%, according to a new study in Health Affairs.

Why it matters: Surprise medical bills are not only unaffordable for the patients who receive them, but also inflate everyone else's premiums.

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Jurisdictional issues scuttled surprise billing fix

Jurisdictional infighting and intense lobbying from industry ultimately scuttled Congress' efforts to deal with surprise medical bills this year.

Why it matters: Surprise bills were about as close to a slam-dunk as Congress gets in health policy, and lawmakers' failure to get such an easy thing across the finish line doesn't bode well for other, harder priorities.

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