Congress

Trump calls for end to surprise out-of-network medical bills

The leaders of the House Energy and Commerce Committee, ranking member Greg Walden, R-Ore.,  left, and Chairman Frank Pallone, D-N.J., support the push to clamp down on surprise medical bills. (Tom Williams/CQ Roll Call file photo)

President Donald Trump on Thursday called on Congress to pass legislation intended to curb surprise medical bills, an issue with bipartisan interest on Capitol Hill but one that has stalled under intense industry lobbying.

Trump laid out core principles the White House wants in legislation, which officials hope Congress will send to the president later this year. Trump’s remarks came after lawmakers focused on the issue asked the White House to get involved to secure more support, a senior White House official said.

“Our initiative to end surprise medical billing is one of the many steps we’re taking to fix our nation’s broken health care system and to deliver better care with more choices at lower costs,” Trump said. “My administration is eager to work with both parties in Congress to save American patients thousands and thousands and thousands of dollars and to give American patients better piece of mind.”

The president called it “rather shocking” that the effort has bipartisan support.

The White House tasked Congress with addressing two situations where patients can face unexpected medical bills. One is when a patient goes to an out-of-network emergency room for urgent care, and secondly, when a patient is having elective surgery at an in-network facility but unexpectedly receives care from an out-of-network provider, such as an anesthesiologist or radiologist.

In the latter case, the administration says patients should be told before elective surgery of any out-of-pocket costs. Patients should not receive medical bills for out-of-network care they did not choose to have, Trump said.

“No one in America should be bankrupted, and unexpectedly, by health care costs that are absolutely out of control,” he said.

White House goals

The administration also said any solution should not increase federal spending and should extend to all insurance markets. Any cost-sharing should equal what patients would pay in their insurance networks, officials said.

“We aim to address surprise billing in a way that will protect American patients from this abusive practice and lay a foundation for a system where the patient is put at ease and in control,” Health and Human Services Secretary Alex Azar said in a statement.

The White House’s principles largely square with the broad themes lawmakers have discussed in recent months. The administration, lawmakers and industry groups say they agree patients should not face unexpected bills and that providers and payers should negotiate over how to pay those bills.

Still, there hasn’t been an agreement on the basis for those negotiations. The senior administration official poured cold water on using baseball-style arbitration, which is one proposal that has been discussed. Under that approach, payers and providers would both offer a proposed price and an independent arbiter would choose one.

Arbitration is one method that some advocates support, pointing to a New York state law as a model.

“We do not have a lot of enthusiasm for arbitration,” the official said. “We believe that would be disruptive.”

The administration did not back a specific plan for negotiations, but said bundling payments to cover a range of services for a condition is one option on the table. Another idea that has been floated is to base the payment on the average in-network rate in a certain geographic area.

Congressional outlook

Health, Education, Labor and Pensions Chairman Lamar Alexander, R-Tenn., told Trump on Thursday he hopes to pass legislation by July.

Surprise medical bills are expected to be part of a broader effort to lower health care costs that Alexander hopes to advance.

House leaders have also said they hope to pass legislation on the issue.

“We are committed to working together on bipartisan legislation that protects patients and families from surprise medical bills and the crippling financial debt that comes with them,” Energy and Commerce Chairman Frank Pallone Jr., D-N.J., and ranking member Greg Walden, R-Ore., said in a joint statement. “No family should be left in financial ruin through no fault of their own, which is why we have been working together on a bipartisan solution to protect patients that we hope to announce soon.”

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