Push to pass federal surprise balance billing legislation stalls

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Original story posted on: September 25, 2019

An ad campaign opposing the move is raising eyebrows nationwide.

We’re more than halfway into September, but if you’re like me, it feels like 2019 is already over. It doesn’t feel like I’ll have enough time to finish everything I was supposed to before the end of the year.

Congress is in the same boat.

When 2019 began, it looked like the one healthcare issue that Congress could solve would be the surprise balance billing issue. But now we’re on the eve of the fourth quarter, and it looks like Congress is further away from solving the problem than they have been all year. And they have a lot of other chores competing for their time and attention before the ball drops on 2019.

Their to-do list includes avoiding a government shutdown, gun control – especially after a violent August – the North American trade deal, and prescription drug prices. With all these competing issues, surprise balance billing may be moved to the bottom of the list and revisited next year.

That’s quite a change from earlier this summer.

If you remember, both the House and the Senate each had a bill with overwhelming support, and both bills looked strikingly and surprisingly similar.

Beyond the busy fall agenda, however, two other issues have emerged that tell us that the surprise balance billing issue has less of a chance of being settled quickly or easily, and there’s a danger it won’t be settled at all.

  1. First, there’s new interest by other committees in the House to present their own bills, including the House Labor and Education Committee and maybe the Ways and Means committee.

So while it looked like the House and Senate were converging on two fairly similar bills before the recess, now it’s beginning to feel like there are too many cooks in the kitchen, and it may be difficult to pull all of these proposals together into one that everyone will support.

  1. The second issue was a critical television advertising campaign waged in 12 states throughout August, to the tune of nearly $30 million. The ads alleged that the legislation being considered in Congress would hurt hospitals and providers. Industry news articles made the campaign sound pretty nefarious, suggesting some mysterious group was providing dark money, and then last week Politico reported that some of that money came from two physician staffing groups, Envision and TeamHealth, both owned by equity firms.

The way it is being reported now, it’s not the family doctor or the hospital where you gave birth to your children that will be impacted by a government-set benchmark, it’s New York financers and private equity firms worried about their bottom lines.

U.S. Health and Human Services Administrator Seema Verma’s talk last week in front of the American Hospital Association (AHA) reflects this negative narrative. She pointed at nonprofit hospitals that are garnishing wages and putting patients into bankruptcy. Notably missing from Verma’s speech were terms like network adequacy or narrow networks or any elements of the hospitals’ own viewpoint that the payers need to take some responsibility for the surprise balance billing issue.

While the recent lobbying may have hurt providers’ argument for arbitration, the fact that the pre-recess rush to pass legislation on surprise balance billing has slowed may be working in the providers’ favor. The one thing Congress has learned through this process is that the provider reimbursement issue is not an easy one to solve.

Rushing to pass a law holds the danger of unintended consequences for providers – and for healthcare costs in general.

So maybe it’s best that this issue gets moved to the bottom of the pile for Congress’s fall agenda.

Matthew Albright

Matthew Albright is the chief legislative affairs officer at Zelis Healthcare. Previously, Albright was senior manager at CAQH CORE, and earlier, he was the acting deputy director of the Office of E-Health and Services for the Centers for Medicare & Medicaid Services.

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