MESSAGE
| DATE | 2020-05-14 |
| FROM | Ruben Safir
|
| SUBJECT | Subject: [Hangout - NYLXS] Suprise billing?
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https://www.wsj.com/articles/congress-debates-push-to-end-surprise-medical-billing-11589448603?mod=hp_lead_pos3
WASHINGTON—Negotiations on Capitol Hill over the next package of
coronavirus economic relief have revived discussions about ending
surprise medical billing, an effort to bolster patient protections that
has sparked heavy spending by opponents who warn of damage to the
health-care system.
Surprise billing typically occurs when a patient is treated at a
hospital that is in their insurance network by a medical professional
who isn’t, potentially leading to crippling medical charges. The push to
end surprise billing pits patient advocates and health-insurance
providers, who back the effort, against hospital and medical groups who
say it amounts to government rate-setting that would jeopardize the
finances of some hospitals and mean out-of-network doctors earn less money.
Lawmakers and the administration have already ensured that anyone
without insurance getting treated for Covid-19, the disease caused by
the new coronavirus, can’t get stuck with an unexpected medical bill—and
advocates say that protection should be expanded to cover patients with
any medical issue. But the pandemic’s effect on hospitals, especially
rural hospitals that have halted the elective procedures that bring in
much of their revenue, adds a complication to the debate, according to
congressional aides. Moving to end surprise medical billing could cost
hospitals more money just as they are already struggling.
The top Republicans and Democrats on the Senate health committee and
House Energy and Commerce panel have been pushing for almost a year to
end surprise medical billing. They reached a rare, high-level bipartisan
agreement in December, backed by President Trump, to end the surprise
bills and include a new system in which insurers would pay at least an
agreed-upon rate for services, and independent arbitration would settle
billing disputes.
But its supporters—chief among them the Senate health committee’s
chairman, Sen. Lamar Alexander—weren’t able to include it in a must-pass
spending measure at year’s end, leaving its fate uncertain. Mr.
Alexander, a Tennessee Republican, is retiring at the end of this year
and has made ending surprise medical billing one of his final goals.
Health-care providers receiving federal emergency aid can’t spring
surprise bills on Covid-19 patients. Advocates say all patients need
that protection.
PHOTO: KAREN DUCEY/GETTY IMAGES
Lawmakers discussed including broader protections against surprise
medical bills in previous coronavirus-aid bills and are resuming those
talks, according to lawmakers and aides. Congress decided to make
coronavirus testing free for patients, and administrative guidance makes
clear that health-care providers receiving federal emergency aid can’t
spring surprise bills on uninsured Covid-19 patients.
“There’s a certain irony here that we were able to put into statute that
you can’t surprise-bill a Covid patient and nobody objected, but if you
have a heart condition that pops up and you’re out of network, it’s OK?
I don’t think so,” Rep. Greg Walden of Oregon, the top Republican on the
House Energy and Commerce Committee, said in an interview. “We’ve won
the intellectual argument.”
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A multimillion-dollar lobbying effort that began last year has pushed
back on the legislation, and those groups say they are poised to act if
the House and Senate health committees resurrect their plan or a version
of it. Legislation released by House Democrats on Tuesday prevents any
insured or uninsured patients from getting surprise medical bills for
Covid-19 treatments, but that bill isn’t expected to advance in the
GOP-led Senate.
“Congress should segregate legislation linked to the coronavirus
pandemic and economic fallout from broader policy questions such as
medical billing,” said David Williams, president of the Taxpayers
Protection Alliance, which is behind a project called the Coalition
Against Rate Setting. That group includes conservative entities such as
FreedomWorks and Heritage Action for America.
Mr. Williams said the urgency of coronavirus aid, coupled with
stay-at-home restrictions, likely means “there wouldn’t be hearings,
wouldn’t be any debate” on something that he argues would upend the
health-care system.
The leading spender against the approach championed by the health
committees is a group called Doctor Patient Unity, a nonprofit funded by
TeamHealth and Envision, two of the largest private-equity-backed
medical-staffing companies.
Doctor Patient Unity has spent about $58 million on television and radio
commercials and nearly $1 million on Facebook ads since last summer,
according to ad tracker Kantar/CMAG. The bulk of the group’s spending
occurred last summer, and was targeted at senators and House members who
backed the bill that first passed out of the Senate health committee led
by Mr. Alexander.
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In March, as the country began locking down as the coronavirus pandemic
spread, Doctor Patient Unity spent about $2 million on new ads.
Ads up recently on Facebook thank doctors for being on the front lines
of the crisis and thank certain lawmakers “for standing with doctors
while they stand with patients during this crisis.”
Doctor Patient Unity has said in previous ads that it doesn’t oppose
efforts to end surprise medical billing, but instead favors an approach
such as in Louisiana GOP Sen. Bill Cassidy’s bill, which calls for
disputes over certain medical bills to be settled in arbitration instead
of the rate-setting approach. He is among the recipients of the group’s
thank-you ads.
The ad campaign displayed “the power of these bad-faith actors driven by
private-equity interests that really work to artificially raise rates so
the profits work better for them,” said Sen. Maggie Hassan (D., N.H.), a
supporter of the bicameral agreement.
There was much less spending on the other side. Groups that support a
plan similar to Mr. Alexander’s include the Coalition Against Surprise
Medical Billing and the Patient Protection Coalition, which together
have spent about $210,000 on TV and radio ads to back the legislation,
according to Kantar/CMAG.
Supporters of the December deal are optimistic it will pass before the
end of the calendar year, either as part of a coronavirus-relief bill or
on its own.
Concerns over hospitals’ financial health during the pandemic could
siphon some support for including the broader bill in the next aid
package, aides said. Groups opposing the bicameral plan say that
establishing rate-setting as some doctors are overworked treating
Covid-19 and others are unemployed because of state-level moratoriums on
elective surgeries is particularly bad timing.
On the other hand, patients seeking care for other ailments might be
more likely now to get stuck with a surprise bill if they avoid or are
directed away from in-network hospitals in cities where Covid-19 is more
prevalent, lawmakers said. Congress has already approved billions in aid
for the nation’s health-care system.
“It is true that health-care facilities are really challenged right now,
especially rural and small ones, but the same is true for patients and
families,” Ms. Hassan said.
Write to Kristina Peterson at kristina.peterson-at-wsj.com and Julie
Bykowicz at julie.bykowicz-at-wsj.com
--
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