May 23, 2019

Vox Highlights Broad Support for Arbitration Model as Proposed in Bipartisan STOP Surprise Medical Bills Act

Doctors, Hospitals, and Insurers Have “Sounded Supportive of the Provisions in the Legislation from Cassidy and Hassan that Allow for Arbitration Within Certain Limits.”

WASHINGTON – In case you missed it, Vox published an article today highlighting broad support for an arbitration model to end the practice of surprise medical bills. Senator Hassan joined her colleagues last week to introduce the bipartisan STOP Surprise Medical Bills Act to end the practice of surprise medical billing, which includes a “baseball-style” arbitration process to solve disputes between providers and insurance companies.

The Vox article notes that doctors, hospitals, and insurers “have sounded supportive of the provisions in the legislation from Cassidy and Hassan that allow for arbitration within certain limits,” suggesting that the STOP Surprise Medical Bills Act could become “the middle ground to clear this policy obstacle.”

Today, Chairman of the Senate Health, Education, Labor, and Pensions Committee Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA), released a legislative package to reduce health care costs, which included an arbitration model as an option to end the practice of surprise medical bill.

See below for highlights of coverage or click here for the Vox article:

President Trump and Democrats want to fix an important health care problem, but lawmakers still have one very difficult question to figure out before they can move forward.

… Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), the top Republican and Democrat on the Senate health committee, introduced a health care costs bill on Thursday but it did not come up with a way for out-of-network health care providers to get paid by health insurers. Instead, it offers three options for determining those payments, and they will decide later which one to actually include in the final version. 

… “My No. 1 goal is clear: Let’s protect patients by ending surprise medical bills. The path to achieving this goal has multiple roads,” Walden told Vox. “I believe it’s fair to base the compensation mechanism off of private-market rates and that any solution should not raise federal health care costs. This is one solution. Arbitration is another.”

… Broadly speaking, the various House and Senate bills to prevent surprise medical bills would have the same consequences for patients: They would be obligated to pay only in-network costs for out-of-network emergency care.

… Doctors and health plans really prefer some kind of arbitration. They want to have the opportunity to appeal and seek a better price, rather than being wholly bound by what is effectively a government-set price. Cassidy and Hassan, who have been working on a surprise bills proposal for a year, certainly found that to be true while they drafted their plan. The Cassidy-Hassan bill would allow for arbitration, with the median in-network price as the backstop if neither side seeks arbitration within 30 days.

… The House bill from Pallone and Walden notably goes with price-setting. The White House has signaled it would prefer something other than arbitration as well.

But the politics are trickier: Doctors, hospitals and insurers could mobilize against such a bill, whereas they have sounded supportive of the provisions in the legislation from Cassidy and Hassan that allow for arbitration within certain limits.

It could be that highly regulated arbitration — like Option No. 2 in the Alexander and Murray legislation — becomes the middle ground to clear this policy obstacle. New York, when passing its own surprise medical billing plan, took such an approach, and the new plan from Ruiz and Roe is modeled on that state’s law.

 

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