Bipartisan legislation unveiled Tuesday would limit hospitals and doctors to charging health insurers local market prices for care that is outside a patient’s network, a measure intended to curb surprise medical bills.
The unveiling of the plan from the House Energy and Commerce Committee, called the “No Surprises Act,” gets Congress closer to notching a bipartisan victory on healthcare. The parties have advanced small measures on drug prices, but are deeply divided over the topic of health insurance coverage and what to do about the Affordable Care Act, commonly known as Obamacare.
Both Democrats and Republicans, however, have gotten behind the idea that the government has to help end the phenomenon of patients being hit with unexpected, large medical bills — even in cases where they had health insurance coverage and asked questions before accepting medical services.
The document released Tuesday is a draft, and lawmakers will be collecting feedback in the coming weeks. Energy and Commerce Committee Chairman Frank Pallone, D-N.J., and the top Republican on the committee, Rep. Greg Walden of Oregon, said in a statement that they believed the ideas would protect people from surprise medical bills.
“We must ensure that patients are not responsible for these outrageous bills, which is why our discussion draft removes patients from the middle,” they said.
Patients get large bills if they are given a pricey medication at the hospital that their health insurance won’t cover, or if a doctor who assists in surgery turns out to be outside of their network. Multiple reports have surfaced about patients undergoing emergency surgery for a traumatic injury or while under anesthesia, when they don’t have control over what happens to them, and facing surprise bills.
Under the No Surprises Act, patients would need to be told which providers are out of their network and whether they could face additional charges. They would only have to pay the amount of money for their medical bills that they would have had to pay if providers were in network. The bill would disallow emergency rooms from using “balanced billing,” in which they send patients a bill charging them for the cost of medical care that a health insurer wouldn’t cover.
It also provides $50 million in grants for states to use to put together databases about healthcare costs and to come up with ideas about how to lower them.
President Trump has elevated the issue of surprise billing, talking about it at the White House last week. The draft released Tuesday does not contain an arbitration process opposed by the White House in which a third party decides what a high-priced medical service should cost. The method has helped lower costs in New York, and the House bill wouldn’t undo measures states have already set up.
It’s not clear yet whether the arbitration policy will be part of a bill expected soon by Sens. Bill Cassidy, R-La., and Maggie Hassan, D-N.H. The upper chamber is committed to acting on the issue, with Sen. Lamar Alexander, R-Tenn., who chairs the Senate Health, Education, Labor, and Pensions Committee, pledging last week that a bill would be sent out of committee by the summer.
The bipartisan legislation still must clear potential backlash from the medical industry. Hospitals, doctors, and insurers have been deeply divided as to which of the industry groups should be made to take a hit under new legislation, though they all have said they do not believe patients should be held responsible.
