More than 1 in 6 patients have received at least one out-of-network charge as the result of an emergency room visit, according to a new study by the Kaiser Family Foundation released in June. That same study also showed two-thirds of Americans are worried about being able to afford surprise medical bills for them and their family.
The issue is also troubling for physicians, payers, and lawmakers. As the surprise billing debate continues, emergency physicians have begun lining up behind one bipartisan House bill that was officially introduced June 26th, just days before the July 4th Congressional recess.
H.R. 3502 – The Ruiz Bill
H.R.3502 – To amend the Public Health Service Act and title XI of the Social Security Act to protect health care consumers from surprise billing practices, and for other purposes, also known as the “Protecting People From Surprise Medical Bills Act,” was introduced by Rep. Raul Ruiz (D-CA) and currently has 48 co-sponsors from both parties and from 18 states.
According to a May 23 press release from Rep. Ruiz, the bill would protect patients from paying any more than in-network cost-sharing amounts and deductibles in the following situations:
- Emergency care in both in-network and out-of-network facilities
- Scheduled anticipated care with unanticipated out-of-network providers
- Out-of-network after-emergency care when a patient cannot travel without medical transport
- Out-of-network imaging or lab services when ordered by an in-network provider
As well, the bill would implement an independent dispute resolution (IDR) process, or what’s known as “baseball-style” arbitration, that identifies a reasonable payment rate when insurers and providers cannot agree on the cost of care and would improve transparency by requiring health plans to clearly identify in-network providers and patients’ deductibles.
The American College of Emergency Physicians (ACEP) has endorsed the Ruiz bill, saying it goes “further than any other legislative proposals to encourage transparency from insurance providers and make sure that patients understand the limitations of their insurance.” The organization is encouraging its members to contact their House Representatives to support H.R. 3502.
“This bill makes certain that a patient only pays the in-network amount for emergency care, whether the care delivered was in- or out-of-network,” said ACEP president, Vidor Friedman, MD, FACEP. “ACEP strongly supports the bill’s provision that extends this important protection to the patient’s deductible – bringing down the amount a patient must pay out of their own pocket before their insurance kicks in. This key provision will encourage health plans to expand their networks for emergency care – helping to address the root cause of ‘surprise bills,’ narrow insurance networks.”
Other Bills Being Considered
Two other bills addressing the surprise billing issue also have also been introduced in the Senate.
S.1895 – A bill to lower health care costs cosponsored by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), includes similar patient protections but uses benchmarking for provider payments. This bill passed out of the Senate Health, Education, Labor, and Pensions (HELP) Committee at the end of June and is headed to the full senate, for what HELP Committee Chair Sen. Alexander hopes will be a late-July vote.
S.1531 – Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019, introduced by Sens. Bill Cassidy (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Maggie Hassan (D-NH), Lisa Murkowski (R-AK), and Tom Carper (D-DE) in mid-May, is similar to H.R. 3502, limiting patients to in-network rates for surprise out-of-network care and implementing an independent dispute arbitration process. At least three of this bill’s sponsors, Sens. Cassidy, Hassan, and Murkowski, voted to move S. 1895 out of committee; however, all three cited concerns with that bill’s benchmarking provision. During the committee hearing, Sen. Alexander, the HELP committee chair, vowed to continue working on the bill with hopes of addressing their concerns.
A second House bill, still in draft form and cosponsored by Reps. Frank Pallone (D-NJ) and Greg Walden (R-OR), the Democratic and Republican leaders of the House Energy and Commerce Committee, lines up with the Alexander/Murray bill, offering patient protections but using benchmarking for provider payments. Dr. Friedman testified during a House Energy and Commerce Committee hearing on the draft bill, offering a framework of key principles ACEP believe Congress should consider. Those principles include protecting patients by taking them out of billing disputes, improving transparency, and leveling the playing field with a “baseball-style” dispute resolution process.
“The lack of a system to ensure fair benefit reimbursements has allowed insurers/plans to underpay the fair value of emergency services, which has created an imperative to preserve balance billing, or at the very least establish a corresponding fair and independent mechanism to resolve provider/insurer reimbursement disputes,” Dr. Friedman said. “This is vital to ensuring the financial viability of the nation’s emergency care system. If an emergency department cannot keep its doors open, then the community it serves loses access to these lifesaving services, and that affects the insured and uninsured equally.”
For more information, check out this complete list of all the Congressional bills currently being considered, along with links to committee hearings and media coverage about each. The bills are listed in the order they were discussed in the article above:
H.R.3502 – To amend the Public Health Service Act and title XI of the Social Security Act to protect health care consumers from surprise billing practices, and for other purposes,
- Information about H.R. 3502 from Congress.gov (register to receive updates)
- Press release about H.R. 3502 from Rep. Raul Ruiz’s website
- Call to action from ACEP regarding H.R. 3502
- “Industry Voices—The case for arbitration in ending surprise medical bills” from Fierce Healthcare (explains the how and why of the IDR process in more detail)
S.1895 – A bill to lower health care costs
- Information about S. 1895 from Congress.gov (register to receive updates)
- Senate HELP Committee Hearing on S. 1895
- “Senate Committee OKs Act to End Surprise Billing” from Medpage Today
S.1531 – Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019
- Information about S. 1531 from Congress.gov (register to receive updates)
- “Breaking Down The Bipartisan Senate Group’s New Proposal To Address Surprise Billing” from Health Affairs
H.R. XX – No More Surprises: Protecting Patients from Surprise Medical Bills
- Discussion draft of the bill from the House Energy and Commerce Committee
- House Energy and Commerce Committee Hearing on the draft bill
- Testimony during the hearing from ACEP president, Vidor Friedman, MD, FACEP
- “Exclusive: the new bipartisan House bill to stop surprise medical bills, explained” from Vox
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