The U.S. House Energy and Commerce Committee approved the “No Surprises Act,” which is intended to protect patients from the financial hardship and emotional stress of surprise medical bills when their insurance fails them.
Both the California Medical Association and the American Medical Association weighed in on the bill.
"While the California Medical Association (CMA) is committed to working towards a solution that protects patients from surprise medical bills, we continue to oppose the underlying bill (H.R. 3630)," CMA said in a post.
"The “No Surprises Act” mirrors California’s failing law in that insurers are not incentivized to contract with physicians and offer an appropriate network of physicians to ensure access to care. Like the California law, H.R. 3630 would establish an extremely low payment benchmark for out-of-network physicians and does not have an effective dispute resolution process with an independent database of rates."
While patients in California have been protected from surprise medical bills, the rest of the law has not worked according to CMA. Under California’s surprise billing law (AB 72, 2017), insurance company physician networks are diminishing, patient access to in-network physicians is declining, patient access to emergency physicians and on-call physician specialists is in jeopardy, patient deductibles for out-of-network care are increasing, and patient complaints about access to care have increased by almost 50%.
CMA urged Congress to develop a "more balanced approach that ends balance billing but does not give insurers unilateral control of the market that causes more out-of-network care. CMA believes that Congress should adopt a system modeled after the successful New York law that has been in effect since 2015. The law has helped keep insurance rate hikes in New York well below the national average."
CMA touts the New York system as a more balanced model that encourages physicians and insurers to be more reasonable, resolve their disputes and enter into contracts to ensure patients have an appropriate choice of physicians in their insurance company networks. There has been a 34% drop in out-of-network billing because networks have stabilized.
“CMA looks forward to continuing to work with the committee and others to further improve this legislation,” said CMA President David H. Aizuss, MD. “We must protect patients from surprise medical bills, while also making sure rates paid by health plans are sufficient to ensure there are providers available in hospitals, emergency rooms and clinics to treat patients who need care.”
The American Medical Association said in a press release that 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.
"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 AMA said in a letter to Committee on Energy and Commerce Chairman Frank Pallone and Ranking Member Frank Walden.
Both CMA and AMA are backing an alternative approach to end surprise billing — “Protecting People from Surprise Bills Act of 2019” — introduced by four physician congressmen, Raul Ruiz, MD (D-CA), Phil Roe, MD (R-TN), Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN), as well as Joseph Morelle (D-NY), Van Taylor (R-TX), Donna Shalala (D-FL) and Brad Wenstrup (R-OH).
Based on New York state’s successful law, this proposed legislation creates incentives for physicians and insurers to contract and resolve their differences. It also addresses the underlying cause of the problem — the insurance industry’s oligarchic market dominance — that has allowed insurers to narrow their physician networks so patient access to physicians is limited.
The CMA-backed proposal requires insurers to give patients a robust choice of physicians, including hospital-based emergency physicians, on-call surgeons and anesthesiologists, who will be there for patients in life and death emergencies. It allows insurers to pay commercial rates for out-of-network care, but if parties disagree, the proposed “baseball arbitration” system encourages insurers and physicians to resolve their disputes without costly lawsuits.