Surprise billing advances to Senate

The Lower Health Care Costs Act has advanced to the full Senate. This legislation is intended to address the surprise billing issue that has captured the attention of many in the media as well as elected officials from both parties. The Senate Health Education, Labor and Pensions (HELP) Committee marked up the act and advanced it out of Committee by a vote of 20 – 3.

The committee did not make any major changes to the surprise medical draft bill released in June. The new legislation would establish the median in-network rate as the benchmark payment rate for surprise out-of-network scenarios. The committee did approve an amendment that gives Health and Human Services more authority to update the benchmark based on geography as frequently as it deems necessary. The committee also added provisions related to generic drug pricing and added language raising the minimum purchase age for tobacco products to 21.  

In a letter to the Committee Chair Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA), the College expressed grave reservations about the legislation, stating 

We agree that patients who are unable to obtain care from in-network providers should be protected from unreasonable out-of-pocket expenditures. However, protecting patients from such unreasonable expenses should not be used as a pre-text to protecting health plans from negotiating fairly with those providers who are either unwilling or unable to have the opportunity to be in-network providers for a health plan.

We believe that your legislation, if adopted as proposed, will disrupt and distort the well-established negotiating process that has existed for many years between physicians and health plans. Your legislation will, we believe, incentivize health plans to demand below market payment rates as part of the physician contracting process. More importantly, such intervention by the federal government, is unnecessary to achieve the goal of protecting patients from unreasonable out-of-pocket expenditures.”

A full Senate vote is expected before the August recess. The bill, of course, will be open to amendment, and we anticipate that there will be changes prior to final consideration in the Senate. The College and Advocacy Council will continue to oppose the legislation as drafted because it distorts the balance in network negotiations too far in favor of health plans. We are calling on all members to contact your Senators to oppose this legislation.


Advocacy Issue: 
Skinny Networks