Trump Throws Support Behind Fix For Surprise Medical Bills, But Hurdles Remain

CALAAEM News Service at
Tue May 21 14:59:19 PDT 2019


May 21, 2019


Trump Throws Support Behind Fix For Surprise Medical Bills, But Hurdles




May 9, 20193:03 PM ET




Kaiser Health News


President Trump called on Republicans and Democrats to pass legislation this
year to end surprise medical bills, in remarks made in the White House's
Roosevelt Room Thursday.


"We're determined to end surprise medical billing for American patients,"
Trump said.


Bills like those have been featured in the NPR-Kaiser Health News series
launched in February 2018. Two patients whose medical bills were part of the
series attended the event.


Austin, Texas, teacher Drew Calver talked about the six-figure bill he
received after having a heart attack. "I felt like I was exploited at the
most vulnerable time in my life," he said. His bill was reduced to $332
after the NPR-KHN story was published.


A bipartisan group of senators has been working to come up with a plan for
the past several months. The lawmakers said Thursday they hope to have a
bill to the president by July.


But will bipartisanship be enough? Even political will might not overcome
divisions within the health industry.


Specifically, lawmakers aim to address the often-exorbitant amounts patients
are asked to pay out of pocket when they receive care at health facilities
that are part of their insurance network but are treated by out-of-network
practitioners. Legislators are also looking to address bills for emergency
care at a facility that doesn't have a contract with patients' insurers.


"We're getting really close to an approach that we'll be able to unveil
pretty soon," Sen. Maggie Hassan, D-N.H., told reporters on a conference
call Thursday with Sen. Bill Cassidy, R-La.


And it's not just politicians and patients: Out-of-network doctors,
insurance companies and hospital groups say they want the problem for
consumers fixed, too.


Despite that broad agreement, a hurdle remains. Insurers and health care
providers each oppose the other side's preferred solution to end surprise
bills. That conflict makes it almost impossible for lawmakers to come up
with a fix that won't leave one of the influential groups unhappy.


"It's a different axis than the partisan [conflicts] we're used to," said
Loren Adler, who has been studying the surprise-bill problem for the
USC-Brookings Schaeffer Initiative for Health Policy. The fight over how to
fix it is less likely "to break down between Republicans and Democrats and
more likely to break down to where the money is" and which group will have
to take less of it.


"I don't see a coalescence around a solution," said Chip Kahn, president and
CEO of the Federation of American Hospitals, which represents for-profit


The divide is wide, despite the overall interest in protecting consumers.


"What we'd most like to see is clarity for the patients," said Bob Kneeley,
a senior vice president for Envision Healthcare, which employs physicians to
staff a variety of hospital departments, such as emergency rooms, neonatal
units and anesthesiology. "This is a system that's just not working well for
the patient, and we need to establish some appropriate guardrails."


"We want this to be solved. We know it needs federal legislation," agreed
Molly Smith, a vice president at the American Hospital Association. She said
hospitals believe that patients should "not have to be involved in any
process if there's a dispute between the payer and the provider."


States have been working on the problem for several years. Nine now have
programs aimed at protecting patients from surprise bills. But state laws
cannot reach those with employer-provided insurance - more than half of all
Americans -because those plans are regulated by a federal law called the
Employee Retirement Income Security Act. That means only Congress can fix it
for everyone.


Patients and groups that represent them say the problem is more urgent than


"We are talking about situations in which families, despite enrolling in
health insurance, paying premiums, doing their homework and trying to work
within the system are being left with completely unanticipated and sometimes
financially devastating bills," Frederick Isasi, executive director of the
consumer group Families USA, told a House education and labor subcommittee
hearing in April. "This is inexcusable behavior on the part of hospitals,
doctors and insurers. They each know - or should know - that patients have
no real way to understand the financial trap they have just walked into."


Dr. Paul Davis, whose daughter received a bill for a $17,850 for a urine
test after back surgery, also spoke at the White House Thursday: "The
situation is terrible. It is a national disgrace and I think a lot of people
would support me on that," Davis told a reporter. Their story was the first
in the Bill of the Month project.


Still, it's not clear where compromise might be found.


By and large, doctors favor some sort of negotiated-fee system when there is
a dispute about a bill, such as binding arbitration, in which an independent
third party makes the ultimate payment decision.


"That's consistent with what's working in some states," said Envision's


Among those frequently cited by doctor groups is New York, which has one of
the strongest state laws on surprise billing. There patients are not
required to pay more than they would for an in-network doctor or hospital.
For the remaining bill, an independent arbitrator settles any dispute
between the provider and insurer.


But the insurance industry worries about that approach. "Our larger concern
with arbitration is that it still relies on bill charges," said Adam Beck, a
vice president for America's Health Insurance Plans, an insurance industry
trade group. And insurers think those charges are too high.


A senior administration official also said on Thursday that the
administration does not favor the arbitration approach either.


Insurers - and many consumer groups - "believe if you have a clear benchmark
pegged to reasonable rates, that will really solve this problem," Beck said,
because insurers would be more likely to cover charges they found more in
line with what they consider reasonable.


A "benchmark" payment might correspond to what Medicare pays for the same
service, for instance.


But doctors don't like that idea one bit. "Even if [the benchmark] is on the
high side, it's still rate-setting," said Kneeley.


Hospitals don't like it, either.


"We can't get behind any sort of rate-setting in statute," said Smith of the
AHA. "We have too many concerns about getting that wrong." For example, she
said, if the rate is set too low, hospitals might have trouble finding
doctors willing to provide care.


Meanwhile, insurers and hospitals want to ban out-of-network providers from
billing patients for whatever part of the charge the insurer won't cover, a
practice called "balance billing."


Such bans are anathema to doctors, who instead believe insurers bear
responsibility for doctors not being in their networks because they "don't
have an incentive to offer fair rates," said Kneeley. Although insurers
often feel they must contract with specific high-profile hospitals, he
explained, the doctors who work there are often "invisible providers."


Addressing the underlying causes of high health costs, however, will be
difficult, said Adler of USC-Brookings.


Doctors want to be paid more than insurers typically offer, he said, which
is why some do not join insurance networks. And insurers "want the problems
[with surprise bills to patients] to go away." The question for them, he
said, is, "How much are insurers willing to pay to have their patients not
get surprise bills?"


In the end, a settlement that eliminates surprise bills but builds the
excess into everyone's premiums doesn't truly address health care's spending


"I think there's a good chance it gets solved," Adler said, and that
lawmakers will eventually agree on a plan. "But I'm pessimistic it gets
solved in a way" that deals with health care's high costs.


Kaiser Health News is a nonprofit news service covering health issues. It is
an editorially independent program of the Kaiser Family Foundation that is
not affiliated with Kaiser Permanente. KHN's Fred Schulte contributed to
this report.





Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service


Contact us at:  < at> at

For more articles, visit our

 <mailto:somcaaem at> To
<>  unsubscribe from this
list, visit our mail server.

Copyright (C) 2018. The California Chapter of the American Academy of
Emergency Medicine (CAL/AAEM).  <> All rights reserved.

CAL/AAEM, a nonprofit professional organization for emergency physicians,
operates the CAL/AAEM News Service solely as an educational resource for
physicians. Dissemination of an article by CAL/AAEM News Service does not
imply endorsement, agreement, or recommendation by CAL/AAEM News Service,


Follow CAL/AAEM on Facebook and Twitter and check out WestJEM:


 <>       <>





-------------- next part --------------
An HTML attachment was scrubbed...
URL: <>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image001.jpg
Type: image/jpeg
Size: 14160 bytes
Desc: not available
URL: <>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image002.jpg
Type: image/jpeg
Size: 982 bytes
Desc: not available
URL: <>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image003.jpg
Type: image/jpeg
Size: 919 bytes
Desc: not available
URL: <>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: image004.jpg
Type: image/jpeg
Size: 2533 bytes
Desc: not available
URL: <>

More information about the CALAAEM mailing list