President Trump and Democrats want to solve an important health care problem, but legislators have one very difficult question to find before they can move on.
Congress has a bunch of bills suddenly to stop unexpected medical bills, which can even leave some people who have been insured with tens of thousands of dollars in medical bills for a simple trip to the emergency room, t but how many providers we actually get – is still a very open question.
Alexander Lamar (R-TN) and Patty Murray (D-WA), the leading republicans and the Democrats on the Senate health committee, introduced a health care bill on Thursday but did not make things out – a network of care providers health to be paid by health insurers. Instead, we offer three options for determining those payments, and they will decide which one to include in the final version later. It's quite a big hole left to fill legislation that is otherwise ambitious.
Providers' charges are the hardest issue to calculate for any plan to prevent unexpected medical bills. It affects the bottom lines for doctors, hospitals and insurers, so they care a lot about those provisions and lobbying them hard on them. Different House and Senate bills would establish different systems for determining those payments.
Trump has promised to sign a bill that prevents unexpected medical bills. For the time being, the legislators who are working on breathtaking billing are diplomatic about the differences between their plans. But resolving the issue of provider payments is a significant barrier to doing something.
“My No. 1 goal is clear: Let us protect patients by ending unexpected medical bills. The path to achieving this goal has a number of ways, ”Walden told Vox. “I think it's fair to base the compensation mechanism from private market rates and that no solution should raise federal healthcare costs. This is one answer. Mediation is another. ”
He explained the Congress plan to prevent patients from facing unexpected bills
Alexander-Murray's proposal joins many others who have already introduced: a recent housing bill released by Reps, Frank Pallone (D-NJ) and Greg Walden (R-OR); another bill from Senate Bill Billidy (R-LA) and Maggie Hassan (D-NH) released last week; Another House offered again by Representative Raul Ruiz (D-CA) and Phil Roe (R-TN) who came out on Thursday. The Lloyd Doggett (D-TX) representative presented a bill back in January. The Congress is serious about doing something on unexpected bills.
Broadly, the various bills to House and Parliament to prevent unexpected medical bills would have the same results for patients: They would only have to pay network costs for emergency care outside the network.
Under the proposal legislation, if someone comes to the emergency room or if he has an operation, and that is not the facility or one of his providers in their network of their health insurer, t they cannot be asked to pay the full cost for their medical care. The practice known as balancing is prohibited – when a provider balances a patient between what the patient's insurer paid for a service and the price the provider wants to charge for that service -.
The legislation by Alexander and Murray requires that no extra money can be raised for patients for any emergency care, ancillary care (anesthesia, radiology, etc.), or diagnostic care that they receive from an outside provider. 39 network. Only for whatever co-payment, co-insurance or other expenses could be billed would they be required to pay for a network provider under their health insurance scheme. If someone is moved from the emergency room to a general hospital setting, they must be informed in advance of any care outside the network and its costs. They must also be made aware of the network options available to them.
The new Alexander-Murray bill also includes a bunch of other provisions beyond unexpected bills to reduce healthcare costs for patients. Given the Tennessee senator expecting retirement, he could be trying to group some other cost control provisions to package omnibus healthcare costs, using the popularity of doing something about unexpected billing as an incentive. Some of the other provisions of the Senate bill include: t
- prevent “parking” from generic drug applications that defer other drugs coming into the market;
- prohibit “pay for delay” payments between brand name manufacturers and generic drugs;
- require insurers to provide timely information on provider networks to their patients;
- new federal grants for maternal deaths and integrated pregnancy care.
Stunning bills seem to be the best bet to act at the moment. But there is one other big piece to this puzzle.
He explained the providers versus unexpected billing
If a patient's bill is limited to what it would be for a provider in a network, but the healthcare provider and the insurance company do not have a preexisting contract, then it is a must & # 39 The Congress thought about how much an insurer pays the provider for care outside the network. That's the real money that's at stake in this legislation, so the lobbyists for the health insurers and the doctors are much worried about these provisions.
The Alexander-Murray bill on this question; instead they set three options and intend to choose one after seeking feedback from the interested parties representing health insurers, doctors and patients. The three options are:
- Guarantee to patients and insurers that each individual provider in a network facility will also be considered a network. That prevents patients from being hit with a bill by a particular doctor outside the network when they go to a hospital in a network. Providers can either join the network voluntarily or they can bury insurers through the in-network facility. For any care outside the network remaining, insurers and providers have 30 days to agree a price; otherwise, the median price in the area is used for that service.
- Allow arbitration for bills above $ 750. For bills less than that amount, the health insurer will only pay the average price in the area. For bills above the threshold, either side could ask a third party arbitrator to review best final offers from the provider and the insurer. The referee then chooses the best one in a binding decision.
- In that geographical area, prescribing that the health insurer pays the provider outside the network regardless of the median price in the network. Only the price that the insurer pays to the provider is the best solution from a policy perspective. It is guaranteed that the price will be whatever the insurer has already negotiated with other providers in the same region for the same service.
Doctors and health schemes prefer some form of mediation. They want to have the opportunity to appeal and seek a better price, rather than being completely bound by what is effective according to the government's price. Cassidy and Hassan, who have been working on offering surprising bills for a year, certainly found that that was true as they drafted their plan. Cassidy-Hassan's bill would allow arbitration, with the median in-network price acting as the default payment if neither side tries to arbitrate within 30 days.
“I still believe that the STOP Surprise Surprise Medical Bills Act – given its support from stakeholders on both sides of this issue – is the most practical option to become law and end the ridiculous practice of unexpected medical bills, ”Hassan told Vox in a statement. “Every day, patients continue to receive these scandalous bills in the post, and I will continue to work with my colleagues on both sides to pass bilateral legislation without delay.” T
Some experts believe that having a regulated price or network matching, rather than allowing for arbitration, is a better policy because mediation could lead to higher prices than the other two options, mitigating potential cost savings for these schemes. . The Pallone House and Walden House bill goes particularly in terms of price setting. The White House has shown that he would prefer something else than mediation too.
But the politics is more difficult: Doctors, hospitals and insurers could move against such a bill, but they have sounded support for the provisions in the legislation by Cassidy and Hassan. allows mediation within certain limits.
“The standard method of pure payment associated with median rates… would be much more obvious in reducing healthcare costs, as the median rate for specialties is mainly related to surprisingly significantly lower than the mean, ”said Loren Adler, associate director of the Schaeffer Initiative of the USC-Brookings Health Initiative. “The price setting approach is clearly better than arbitration from a policy perspective, but it is certainly possible that politics is easier on arbitration.” T
Arbitration might have been regulated greatly – as Option No. 2 in Alexander and Murray's legislation – becomes the middle ground to clear this policy barrier. It took New York, when passing its own medical billing scheme, a method of this kind, and the new scheme by Ruiz and Roe has been modeled on the law of that state.
But right now, the Congress leaves this space blank, as shown by Option A, B, or C unusual in the bill Alexander-Murray.
Congress really wants to set unexpected medical bills
The safest bet is always against healthcare legislation that passed Congress, especially in a time of divided government. But unexpected medical bills could be an exception.
Alexander and Murray lead the most prestigious Senedd healthcare committee, and Pallone and Walden are the main members of a powerful House panel. Having the Democrats and the best Republicans on those committees that co-sponsor these bills denotes a real intention to pass something – if they can resolve this dispute first about payments and arbitration.
Surprising bills are actually a symptom of the underlying disease that cheats American healthcare – prices are set unreasonably high and unreasonable – but they're a particularly suspicious example, as they can leave even patients who have insurance with medical bills totaling tens of thousands of dollars. Sarah Kliff Vox summarized her findings after collecting ER bills for a year like this:
Patients find themselves in a vulnerable position during these encounters with the healthcare system. The result is often high – and unpredictable – bills. Hospitals are not transparent about the cost of their services, their prices range from one ER to the other, and it's hard to tell which doctors come under insurance (up even if the hospital itself has to be included). In many cases, patients cannot be sure what they owe until they receive a bill in the post, sometimes weeks or months later.
States like California and New York act on their own to get to grips with unexpected bills, but the Congress is looking firmly at implementation across the country. These new bills are a hopeful sign that the days of patients in the emergency room could be numbered not only with a broken arm but also a huge bill.
Li Zhou contributed to this report.