par Thomas Dworetzky
, Contributing Reporter | January 28, 2020
Bipartisan proposals to prevent providers from issuing patients “surprise” bills, and have insurers cover them using an average price known as benchmarking, are coming under attack from a new conservative coalition.
The proposals are backed by Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.).
The Coalition Against Rate-Setting — including the Taxpayers Protection Alliance (TPA) and Heritage Action for America — claims the plan would interfere with private healthcare decisions. It is planning an ad campaign to run digitally and over the air through May.
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"This coalition is prepared to push back against ill-considered rate-setting proposals and educate lawmakers and the public on the perils of federal meddling in healthcare decisions," TPA president David Williams said, according to The Hill
The TPA has blanketed Kentucky, Kansas, Texas and New York with $500,000 worth of ads; the National Taxpayers Union has spent $1.2 million since December, 2019, and Blackstone-and-KKR-backed Envision and TeamHealth have put in another $54 million to fight the proposals, according to the political news site.
An alternative Ways and Means proposal now being looked at to address the issue would ban the bills to patients. Instead it would leave who pays up to a negotiation between insurers and doctors — with an outside neutral party's help, if needed.
It was called encouraging and “a great first step,” by TPA director of external relations Grace Morgan, indicating she looked forward to “working with Ways and Means Committee members” on it, according The Hill.
Surprise bills were in the news in December, 2019, when Rice University researchers looked at
out-of-network free-standing EDs and emergency care spending.
“Your average customer who is driving through their neighborhood and doesn’t have any background could possibly view one of these facilities as a substitute for the ER. The patient walks in and says ‘I have Blue Cross Blue Shield insurance. Do you take that?’, and they say, ‘Sure. We’ll bill your provider for your services,’ Vivian Ho, health economist at Rice University Baker Institute and at the Baylor College of Medicine, told HCB News at the time. “They don’t tell you that they’re out-of-network, and you end up receiving a surprise bill.”