Surprise medical bill prevention included in year-end legislative package

Bipartisan legislation to protect patients from getting massive “surprise” medical bills is included in a year-end package deal reached Sunday, clearing the way for the measure to pass Congress after almost two years of negotiations. 

The legislation will protect patients from getting medical bills for thousands of dollars in common situations like going to the emergency room and getting care from a doctor who happened to not be covered by the patient’s insurance plan. 

Lawmakers in both parties have been pushing for a solution for months, identifying surprise bills as an especially egregious practice in American health care that should be relatively low-hanging fruit for Congress to solve. 

But the push set off fierce lobbying from powerful health care industry groups, including doctors, hospitals and insurers, who jockeyed over how much the insurer would have to pay the doctor once the patient was taken out of the middle. 

Showing the clout of doctors and hospitals, the final legislation moves significantly in their direction, and away from an earlier version that they warned would lead to damaging cuts to their payments, but that consumer groups and unions had touted as saving patients and the government more money.  

The measure uses a process known as arbitration to determine how much the insurer will pay the doctor, a shift from earlier versions that would have set the payment rate based on the median rate in that geographic area. 

The latest version moves even further towards doctors and hospitals by banning the arbiter from considering the lower payment rates paid by the Medicare and Medicaid programs. That was a demand of Senate Majority Leader Mitch McConnell (R-Ky.), according to a senior Democratic aide. 

The surprise billing protections were largely pushed by Speaker Nancy Pelosi (D-Calif.) at the leadership level. The provision is included in the massive government funding and coronavirus relief legislation set to pass Congress in the coming days. 

“We’re very proud that surprise billing is a part of this,” Pelosi said Sunday night. 

Nancy Brown, CEO of the American Heart Association, praised the deal.

“Patients nationwide have been waiting for years for legal protection from financially devastating surprise bills, and now relief is in sight,” she said. 

TeamHealth, a doctor staffing company owned by the private equity firm Blackstone, which has been among the companies at the center of controversy over surprise billing, praised the measure as moving towards the doctor position compared to earlier versions. 

“This agreement is good for patients and avoids unfair leverage for insurers that would have shred our healthcare safety net in the midst of a pandemic,” Leif Murphy, CEO of TeamHealth, said in a statement. 

A clash between House Ways and Means Committee Chairman Richard Neal (D-Mass.) and three other committees (House Energy and Commerce, House Education and Labor, and Senate Health) over rival versions of the legislation almost derailed the effort again earlier this month. Neal ultimately agreed to a deal after winning changes that moved the legislation towards doctors and hospitals. 

Sens. Bill Cassidy (R-La.) and Maggie Hassan (D-N.H.), who also helped lead the push, praised the provision’s inclusion in a statement Sunday. 

“For far too long, our constituents have done everything right at the doctor’s office or hospital yet still found themselves stuck with surprise medical bills, sometimes to the tune of tens of thousands of dollars,” they said.