House plans first-ever hearing on surprise medical bills

As surprise medical bills get a whole lot more attention in the media, Congress seems to be getting serious about cracking down on the practice.

A congressional aide tells me that the House will hold a hearing on the issue on April 2. The hearing is meant to explore the scope of the problem and what types of policy solutions would be best to fix it.

The hearing will be convened by a subcommittee of Education and Labor, which has jurisdiction over some of the key laws that regulate surprise medical bills.

As far as I can tell, this will be the first-ever congressional hearing on surprise medical bills. And according to the aide I spoke with, who asked for anonymity to discuss a hearing that isn’t yet public, you can expect to hear from a mix of academics who study the issue, patients who have been hurt by surprise bills, and the nonprofits that advocate for those patients.

This is the first big action we’ve seen from the House on surprise medical bills lately. So far, the Senate has really taken the lead on this issue. That’s where you have two separate bills to outlaw surprise medical bills. Senators have been sending letters to key industry groups to get their feedback on how best to fix the problem.

And most recently, Sen. Lamar Alexander (R-TN), asked the Congressional Budget Office to review the different policy options for tackling the issue — another indication that the Senate is serious about it.

There are not a lot of areas in health policy where Democrats and Republicans agree (exhibit A: Obamacare). But ending surprise medical bills seems to be the rare area where there is space for Congress to work across the aisle and pass something. You see Republican and Democratic legislators both pretty active on this issue.

The biggest debate, in my view, will be what policy solution they settle on to fix surprise bills. Most legislators agree that they want to help patients who end up seeing an out-of-network provider at an in-network facility (and get a surprise bill from that out-of-network provider as a result). Those I’ve spoken with agree: This is a billing dispute between an insurer and a doctor or hospital. Patients shouldn’t be caught in the middle.

Every proposal I’ve seen so far attempts to stop doctors and hospitals from pursuing patients for these surprise bills. But they take different approaches to figuring out how:

Cap the prices that out-of-network providers get paid. This policy approach essentially bars out-of-network providers from billing patients directly. Instead, they would have to seek payment from the health insurer, which would be required to pay a price similar to local market rates. This is the approach that Sen. Bill Cassidy (R-LA) has advocated for, and also has some similarities to California’s state-level law.

Force the hospital and the insurer to negotiate a fair price. This approach also bars out-of-network doctors from seeking payments from patients. But what happens next is pretty different. This type of policy would send the hospital and the insurer into an arbitration process, where each submits what it thinks is a fair price for the medical service and an impartial arbiter picks one. This is an approach that Sen. Maggie Hassan (D-NH) has supported, and one that New York used in its 2015 law to prevent surprise medical bills.

I’ve also seen one other policy idea floated, mostly by Ben Ippolito and David Hyman at the American Enterprise Institute. They suggest banning “independent billing by emergency department and ancillary physicians.” Instead, their costs would get bundled into a larger fee charged by the emergency room (similar to how nurses, for example, don’t bill patients directly but rather have their services included in a larger hospital charge).

My reporting suggests that the arbitration approach seems to have the most traction right now — but also that negotiations are still early, and that things could shift in the coming months. What seems more certain is that Congress isn’t dropping this issue anytime soon, and that it will keep exploring all these policy options as it works toward making surprise medical bills a thing of the past.

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