AMA: Surprise billing legislation will hold patients harmless despite contrary claims

July 29, 2019

The American Medical Association has announced a letter it sent to members of the Committee on Energy and Commerce that suggests health insurers are intentionally muddying the waters about the impact of surprise billing legislation – a bipartisan compromise designed to protect patients – approved recently by the House Energy & Commerce Committee.

The organization said America’s Health Insurance Plans (AHIP) and others have incorrectly suggested that the bill would increase the financial burden on patients, ignoring the fact that the legislation uses the same approach for protecting patients from unanticipated coverage gaps as other proposals that were publicly supported by the industry.

“AHIP’s angst apparently results from the fact that the ‘baseball style’ arbitration adopted by the Committee, like New York’s successful system, would allow an independent third party to determine whether the plan’s payment amount or the provider’s bill represents the most appropriate resolution for certain claims,” the letter said.

In one part of the letter, AHA CEO James L. Madara, MD wrote, “Last week, the House Committee on Energy and Commerce reported the “No Surprises Act” as part of a broader package of bills. During that mark up, the Committee adopted an IDR process as a backstop should the bill’s underlying payment methodology not result in a resolution that is acceptable to both parties. While there are additional improvements that can be made going forward, the American Medical Association commends the Committee for this important step toward maintaining balance in the healthcare marketplace.   

“It is discouraging, however, that America’s Health Insurance Plans (AHIP) declared that the Committee’s actions would allow providers to ‘price gouge patients.’ This is a clear mischaracterization of the actions taken by the Committee. Under the Committee’s bill, no patient who receives a surprise bill would be obligated to pay more than if they received care by an in-network provider - identical to the protection provided by a previous version of the bill supported by health plans.”

Read the entire letter here. 

Shortly thereafter, AHA also reported that the National Governors Association has issued a report on state strategies to protect consumers from surprise medical bills. Eleven states have enacted surprise billing legislation since 2017, including six this year.

"As increasing numbers of states implement new and innovative policies, there is a growing number of examples from which others can learn," the report notes. "If Congress takes action, as proposed in NGA's principles to Congress and the Administration, it will likely create a baseline protection for all consumers on which states can build. If this happens, it will be important for states to evaluate their own policies and federal policies over time to understand the impact on contracts, network access and cost of care to consumers as measured through premiums and other cost sharing."

The report summarizes roundtable discussions on the issue hosted by the NGA Center for Best Practices Health Division last fall in Washington, D.C., in which the AHA participated.