The topic of “surprise” medical bills has been gaining traction with federal legislators even as some states have begun to pass their own laws intended to protect patients from the financial challenges these bills can create. Several members of Congress are taking on the issue, including U.S. Senator (and physician) Bill Cassidy (R-LA), who has introduced language in the Senate Health Committee, and U.S Representative (an emergency room physician) Raul Ruiz (D-CA), who has crafted an approach in the House of Representatives. Surprise billing is seen as one of the few areas in healthcare where more action can be taken this year on a bipartisan basis.
California itself passed a bill in 2016 forbidding balance billing for out-of-network care at in-network facilities. That law took effect on July 1, 2017.
There is wide agreement among both Democratic and Republican legislators that patients should not be left with an unexpected bill, especially when the patient is complying with his or her insurer’s requirements and accessing services within network. But a large point of contention is how to craft bill language that will not create a greater advantage for one stakeholder over the other when it comes to provider payments and a process to settle disputed claims. Those stakeholders are the hospitals, providers, and insurers.
While the insurers would prefer Congress to set reimbursement rates, something the Senate Health Committee proposes with a cap (benchmark payments) on providers, hospitals and providers are advocating for an independent dispute mediation process. The mediation approach is included in the approach by Congressman Ruiz.
Back in March, Ruiz, along with his Republican colleague, Congressman and physician Larry Bucshon (R-IN), began the work of outlining a bipartisan legislative proposal titled "Protecting People from Surprise Medical Bills." That proposal was introduced to the House on June 28 as H.R. 3502 and at the time of introduction included the cosponsorship of 40 other House members (18 Democrats and 22 Republicans).
A few days before H.R. 3205 was introduced, CAP member James Strebig, MD, joined CAP’s federal lobbyist and CAP's public affairs staff to visit with the legislative directors of multiple members of California’s Congressional Representatives – and of its two U.S. Senators – in Washington D.C., to speak in support of the balanced approach taken by H.R. 3205.
Gabriela Villanueva is CAP’s Public Affairs Analyst. Questions or comments related to this article should be directed to gvillanueva@CAPphysicians.com.