Surprise Medical Bill Disputes Spur Lawmakers to Seek Changes

Lawmakers unhappy with how the government is carrying out a landmark law to curb surprise medical bills are renewing pressure on the Biden administration to change course, with some pushing for legislation to get their way.

Republicans and Democrats over the past week have publicly and privately pressed Health and Human Services Secretary Xavier Becerra to change surprise billing policies to favor health-care providers over insurers. Some warned if Becerra doesn’t change the policies they’ll join lawsuits and pursue legislation in hopes of forcing action.

The No Surprises Act, enacted in 2020, is designed to protect Americans from surprise medical bills by ensuring they get good-faith estimates for certain services and to help them avoid hefty charges from out-of-network providers or facilities for emergency care.

“Leadership is going to have some conversations” with Becerra “and say we’re ready to take the next step,” Rep. Brad Wenstrup (R-Ohio) said in an interview. “What do you want to do? Either we legislate, we go to court, whatever it takes.”

Rep. Brad Wenstrup (R-Ohio), shown at a March 8, 2023 hearing on Capitol Hill, wants changes in the way the government handles surprise medical bills.

Ting Shen/Bloomberg via Getty Images

Rep. Brett Guthrie (R-Ky.), head of the Energy and Commerce Committee’s health panel, said his subcommittee will hold a hearing on the surprise billing law after colleagues complained about how it’s being carried out.

Rep. Larry Bucshon (R-Ind.), a member of the Energy and Commerce Committee, said it’s time to amend the surprise billing law and is working on drafting legislation.

If successful, this effort could result in a rewrite of surprise billing policies to the benefit of doctors and hospitals and larger bills for insurance companies. It mirrors a fight currently going in the courts between the government and provider groups.

HHS under the law created what’s called an independent dispute resolution process to settle disputes between insurers and providers who disagree over how much providers should be paid for their services. Previously, providers would charge the patient for whatever the insurer wouldn’t pay, but that practice is largely banned under the law.

Providers have initiated tens of thousands of these disputes—insurers have an incentive to minimize payments to providers, and providers have an incentive to maximize their payment. Medical groups have sued the government to revise the dispute resolution system.

Becerra Defends System

Becerra, in a series of hearing about his department’s proposed budget for fiscal 2024, has defended how his department has carried out the law.

“We’re making sure patients are not getting the bills in the mail saying, you owe this money,” he said during a Senate Finance Committee hearing. “It’s going to be between the provider and the insurer and what we’re trying to do is have a system that works.”

Becerra said arbitration has been bogged down with “frivolous” cases from providers trying to get insurers to pay them more.

Wenstrup, along with key lawmakers such as Richard Neal (D-Mass.), ranking member of the House Ways and Means Committee, have told Becerra this process favors insurers by suggesting providers should accept a plan’s median in-network rates. They’re concerned insurers are underpaying doctors.

Wenstrup and other lawmakers publicly chastised Becerra at congressional hearings recently about the issue, saying HHS isn’t following the language of the law.

Neal said he spoke privately with Becerra last week to demand the changes.

“I told him we don’t want this settled by the courts,” Neal said. “We had it settled by Congress.”

Becerra has allies in Congress. Patty Murray (D-Wash.), head of the Senate Appropriations Committee and a key player in the passage of the No Surprises Act, said she doesn’t want to see the policies altered to favor providers.

“I like how they’re implementing the law. Period,” she said.

‘Schoolhouse Rock’

The law itself is partly to blame because it was written to include this arbitration system instead of just setting a payment statement or having only limited arbitration, Loren Adler, a health economist who has studied surprise billing as associate director of the USC-Brookings Schaeffer Initiative for Health Policy, said in an email.

The surprise billing law reflects lawmakers’ compromises around arbitration, Sen. Michael Bennet (D-Colo.) said in an interview. Bennet himself is unhappy with the current process.

“We need to make sure that the administration is implementing what we passed consistent with the legislative intent, we had a very complicated coalition of people to come together to support this legislation,” said Bennet.

Wenstrup had a similar message.

“I grew up watching Schoolhouse Rock and I don’t remember the part where after the president signed something into law that says you get to change it to whatever you want,” he said.