The American public overwhelmingly supports protections against "surprise medical bills," those pesky charges from out-of-network providers or other professionals that fall between coverage cracks. But powerful special interests — namely, two large private-equity firms that bought up doctor staffing companies — that profit from this gap do not want things to change.
Will Congress choose to stand with consumers? Or will lawmakers cave after well-heeled lobbyists come calling or, in this case, drop millions on attack ads in states like Minnesota? All eyes ought to be on Washington, D.C., this fall as the fate of legislative fixes hangs in the balance.
It should be an easy choice for elected officials to side with patients. Many surprise bills occur when people have made good-faith efforts to seek care at medical centers within their insurers' network.
The problem occurs when an in-network hospital contracts for care services with doctors or other specialists — such as emergency room physicians or radiologists — who are out-of-network. Insurers typically cover a smaller percentage of out-of-network costs. Patients consequently may be on the hook to pay a higher share of these bills out of pocket.
Research appearing in the Journal of the American Medical Association family of publications suggests that surprise medical bills are happening more frequently. Minnesota Gov. Tim Walz, in fact, had one after his knee surgery this year.
That there's uncertainty in Congress about enacting consumer protections is an outrage. Few issues come with such built-in momentum. A recent poll from the respected Kaiser Family Foundation found support for fixes at close to 80%.
This spring, President Donald Trump urged Congress to act. Fixes in the House and Senate — which would ensure that patients in most situations only pay in-network costs — also enjoy broad bipartisan support. U.S. Sen. Tina Smith, D-Minn., is a cosponsor on a bill whose champions include Sen. Bill Cassidy, R-La., as well as Sen. Maggie Hassan, D-N.H.
The momentum earlier this year suggested that the measures might clear the House or Senate before the August recess, but progress slowed after lawmakers delved into the details. A key disagreement: determining how much of the difference insurers will pay between the patient's in-network responsibility and the out-of-network providers' higher bill.
Attack ads against Smith and other senators of both parties this summer tried to capitalize on the slowdown to kill the bill. The ads dubiously implied that the legislation would cause a government takeover of medicine, hurting patients and hospitals. The ads, to no one's surprise, were mainly paid for by two large physician-staffing companies that profit from surprise bills.
As patients know all too well, the real harm is coming from surprise medical bills. The differences in payment methodology that Congress is wrestling over matter little to patients. They want — and deserve — protection when illness strikes.
Minnesota is fortunately one of a number of states with some surprise billing protections already on the books. But its safeguards fall short of comprehensive protection, according to a national analysis. Nor do state measures protect those with large-employer plans that fall under federal regulation.
Surprise billing protections should have easily passed Congress already. Smith merits praise for not backtracking after the ominous ads appeared. The rest of Congress needs to join her in standing up to special interests.