AFPAfter years of debate and false starts, Congress reached a bipartisan deal on Friday night that would ban surprise medical bills.
The proposal, which may end up in a larger legislative package, would safeguard patients against bills from out-of-network providers unexpectedly involved in their care.
The issue had enjoyed bipartisan, bicameral support for years, and President Donald Trump has been a champion of the reform. But legislators had struggled to agree on details as doctors and hospitals lobbied furiously against various versions. An earlier attempt nearly passed last December, but was scuttled at the last minute.
With Congress failing to act, patients continued to face large, surprise medical bills through the coronavirus pandemic. One virus patient in Pennsylvania received a $52,112 bill for an out-of-network air ambulance ride this summer, a fee that would become illegal under the agreement. Research shows that as many as 1 in 5 visits to an emergency room can generate a surprise bill for patients.
Even with widespread support, the issue has proved difficult for Congress to solve. Doctors and hospitals have worried that a law that prevents them from billing patients directly could hurt their negotiating stance with insurance companies, lowering their pay.
Indeed, the Congressional Budget Office found that an earlier version of the plan would do just that, causing modest reductions in payments to affected medical providers, who include emergency room doctors, radiologists, pathologists and anesthesiologists, even if they do not send surprise bills.
A single dark-money doctor’s group spent tens of millions of dollars on television advertisements and direct mail on the issue over the last two years, targeting senators facing reelection.
The current proposal would require insurers and medical providers who cannot agree on a payment rate to use an outside arbitrator.
The policy would bar air ambulances from surprise-billing patients, but would allow ground ambulances to continue to do so.
The emerging agreement cheered the consumer groups who have been pushing for a solution.
“As families face the darkest days of the pandemic, the last thing they should be worried about is receiving an unexpected bill for necessary medical care,” said Frederick Isasi, the executive director of Families USA Action, in a statement. “This debate has far too often been about powerful special interests when our nation’s families are the ones who are directly impacted and are hurting.”
Top House and Senate committee leaders tasked with writing health legislation announced the agreement Friday evening, and both Speaker Nancy Pelosi of California and Sen. Chuck Schumer of New York, the minority leader, announced support for the agreement.
The proposal, which may end up in a larger legislative package, would safeguard patients against bills from out-of-network providers unexpectedly involved in their care.
The issue had enjoyed bipartisan, bicameral support for years, and President Donald Trump has been a champion of the reform. But legislators had struggled to agree on details as doctors and hospitals lobbied furiously against various versions. An earlier attempt nearly passed last December, but was scuttled at the last minute.
With Congress failing to act, patients continued to face large, surprise medical bills through the coronavirus pandemic. One virus patient in Pennsylvania received a $52,112 bill for an out-of-network air ambulance ride this summer, a fee that would become illegal under the agreement. Research shows that as many as 1 in 5 visits to an emergency room can generate a surprise bill for patients.
Even with widespread support, the issue has proved difficult for Congress to solve. Doctors and hospitals have worried that a law that prevents them from billing patients directly could hurt their negotiating stance with insurance companies, lowering their pay.
Indeed, the Congressional Budget Office found that an earlier version of the plan would do just that, causing modest reductions in payments to affected medical providers, who include emergency room doctors, radiologists, pathologists and anesthesiologists, even if they do not send surprise bills.
A single dark-money doctor’s group spent tens of millions of dollars on television advertisements and direct mail on the issue over the last two years, targeting senators facing reelection.
The current proposal would require insurers and medical providers who cannot agree on a payment rate to use an outside arbitrator.
The policy would bar air ambulances from surprise-billing patients, but would allow ground ambulances to continue to do so.
The emerging agreement cheered the consumer groups who have been pushing for a solution.
“As families face the darkest days of the pandemic, the last thing they should be worried about is receiving an unexpected bill for necessary medical care,” said Frederick Isasi, the executive director of Families USA Action, in a statement. “This debate has far too often been about powerful special interests when our nation’s families are the ones who are directly impacted and are hurting.”
Top House and Senate committee leaders tasked with writing health legislation announced the agreement Friday evening, and both Speaker Nancy Pelosi of California and Sen. Chuck Schumer of New York, the minority leader, announced support for the agreement.
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