New York's surprise billing law — which providers hope will become the model for a national solution — has resulted in providers receiving some very high payments, according to a new analysis by the USC-Brookings Schaeffer Initiative for Health Policy.

Why it matters: Surprise medical bills impact two groups of people: The patients directly responsible for paying them, and the rest of us, who pay higher premiums as a result of their existence.

  • A solution resulting in higher provider reimbursements would still protect patients from enormous surprise bills, but it could raise health care costs and thus premiums.

Details: New York's law resolves payment disputes between insurers and providers — the heart of the surprise billing debate — by using an arbitration process.

  • State guidance says that arbiters should consider the 80th percentile of billed charges, or list prices. The problem is that these charges tend to be much higher than the negotiated rates that insurers pay for in-network care.
  • A New York Department of Financial Services report found that the average payment amount decided through arbitration is 8% higher than the 80th percentile of charges — a victory for providers.
  • This, in turn, is likely to raise physicians' leverage with insurers when negotiating payment rates.

Yes, but: The state's report says the law has saved consumers an estimated $400 million, "but there is no supporting evidence provided and the actual data released in the report strongly suggests that the opposite is true," the USC-Brookings analysis argues.

Go deeper: Hospitals' dog in the surprise billing fight

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Why it matters: Many state and local governments have had their budgets devastated by the economic impacts of the coronavirus, which have caused expenses to soar and revenues to plunge.

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Why it matters: President Trump's decision to bypass Congress to sign four executive actions, including one that provides $400 per week in extra unemployment benefits, has prompted outcry from Democrats and even some Republicans who believe he is overstepping his constitutional authority.

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Anti-government protesters in Beirut. Photo: STR/NurPhoto via Getty Images

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