03 April 2019 House Education and Labor Subcommittee holds hearing on surprise medical billing On April 3, 2019, the House Education and Labor Subcommittee on Health, Employment, Labor, and Pensions held a hearing entitled "Examining Surprise Billing: Protecting Patients from Financial Pain" to examine solutions to protect patients from surprise medical bills. Committee members expressed a bipartisan desire to work together to address the issue and the need for federal action to address self-insured Employee Retirement Income Security Act (ERISA) arrangements, which states have no jurisdiction to regulate. Rep. Joe Courtney (D-CT) also stressed the committee's jurisdiction over ERISA and its leadership over the issue of surprise billing. The witnesses included representatives from The Brookings Institution, American Benefits Council, Families USA, and Georgetown University Health Policy Institute. The panel discussed the drivers of surprise medical billing, noting that certain hospital-based physicians receive a flow of patients regardless of their network status; because volume does not depend on prices, they can set any rate they choose. They agreed that solutions must address these perverse incentives and be comprehensive while not holding patients accountable for surprise bills. The panel also discussed what is being done at the state level but mentioned that many laws are too new for the effects to be fully seen. Several e panelists noted some concern over New York's law, which they said could potentially have an inflationary effect due to its arbitration system, which defaults to regional payment standards as a guide. Rep. Joseph Morelle (D-NY), however, touted the plan, saying that 2,000 disputes have been settled through the law since January 2015 and that emergency room prices dropped 9%. While leaving open what exactly a federal policy should look like, they expressed interest in setting rates as a percentage of Medicare (such as 125%) for out-of-network providers, requiring in-network rates for providers based at in-network hospitals, and adapting payment standards or arbitration processes to their market environments. Rep. Phil Roe (R-TN) noted his specific concern with setting rates based on Medicare, which he said would further discriminate in low Medicare wage index states like Tennessee. For more details, see the attached Tax Alert or click here.
Document ID: 2019-0689 | |||||
