(Washington, DC) – U.S. Senator Jeanne Shaheen (D-NH) introduced legislation today to combat escalating out-of-pocket health care costs for uninsured patients and for patients in the individual health insurance market who receive out-of-network care. U.S. Senator Maggie Hassan (D-NH) also announced that she will introduce companion legislation to help eliminate a related problem: surprise medical bills, where patients receive massive, unexpected medical bills, often for receiving care that they didn’t realize was considered out-of-network. Shaheen’s legislation protects patients who are uninsured or in the individual health insurance market, while Hassan’s legislation protects patients with employer-sponsored health plans.
Shaheen’s bill, the Reducing Costs for Out-of-Network Services Act of 2018, which Hassan is cosponsoring, would cap the amount that hospitals and physicians could charge uninsured patients and out-of-network patients who have individual market coverage. These charge caps would also improve the ability of individual market health insurers to reduce premiums by lowering costs for in-network hospital and physician services. This legislation provides patients in the individual insurance market with similar protections to safeguards that Medicare Advantage beneficiaries have already benefitted from for years. Those Medicare protections have proven successful in holding down in-network health care provider costs in the Medicare market, so expanding similar protections to the individual market could help address rising premiums.
“Far too many Americans know what it’s like to receive an exorbitant health care bill and not know how they’re going to pay for it. As the Trump administration continues to sabotage the Affordable Care Act, destabilizing the insurance markets and driving up out-of-pocket expenses for families throughout the country, it’s imperative that Congress take action to reduce these costs and help ensure every American has access to quality, affordable health care,” said Shaheen. “Families in New Hampshire and throughout the nation have been forced to make difficult financial sacrifices to afford their medical care – that’s unacceptable. The bills that Senator Hassan and I are introducing would help fix chronic problems in our health care system by lowering costs for patients and increasing access to health services. I’ll continue to prioritize efforts in Congress to protect the progress made through the Affordable Care Act, and improve the health care law so Granite Staters and patients in every community can access and afford the care they need.”
The bill Hassan will introduce, the No More Surprise Medical Bills Act of 2018, which Shaheen will cosponsor, would help eliminate surprise medical bills for people with employer-sponsored health plans. The bill will protect patients with medical emergencies from surprise billing by prohibiting hospitals and providers from charging more than the in-network amount. The bill also protects patients in non-emergency situations from surprise bills by requiring hospitals and providers to notify patients if services will be out-of-network and get their consent. Without proper notification and consent, a provider can only charge a patient the in-network amount. If payment disputes arise when these rules aren't followed, the legislation would establish an independent entity to resolve disputes between providers and health insurance plans, without putting patients in the middle. This dispute resolution system is based on a "baseball-style" or “final offer” model, where the provider and insurance plan submit their best and final offer, and the independent entity must choose one of the offers. This model helps incentivize providers and plans to come to a reasonable amount.
“It’s unacceptable that consumers are increasingly faced with massive surprise medical bills from care that they thought was in their insurance network,” said Hassan. “It’s also unfair that consumers get caught in the middle between health care providers and insurance plans haggling over charges. The legislation I will introduce, along with Senator Shaheen’s bill that I’m cosponsoring, will help ensure that patients don’t receive unexpected, surprise medical bills for seeking care.”
The Reducing Costs for Out-of-Network Services Act is endorsed by the National Partnership for Women & Families and Protect Our Care.
“Egregiously high out-of-network bills put a substantial financial burden on consumers who want, need and deserve affordable access to care,” said Debra Ness, President of the National Partnership for Women & Families. “We support this bill because it protects women and families from excess charges, and moves us towards greater equity and affordability in the Marketplace.”
"We hear about it all the time - astronomical out-of-network charges that bankrupt families - and it's unacceptable," said Leslie Dach, Chair of Protect Our Care. "Insurance companies and providers could fix this, but they won't. Any lawmaker who says they are serious about reducing health care costs for Americans should get behind this commonsense bill."
The Reducing Costs for Out-of-Network Services Act would do the following:
Senators Shaheen and Hassan have led efforts in the Senate that would provide marketplace stability by permanently funding and increasing eligibility for cost-sharing reduction payments. Shaheen’s bill, which Hassan cosponsored – the Marketplace Certainty Act – would make cost-sharing reduction payments permanent and expand eligibility to more working Americans. Last year, the Senators helped introduce the Individual Health Insurance Marketplace Improvement Act to create a permanent reinsurance program for the individual health insurance market, similar to the successful programs used to lower premiums and spur competition in the Medicare Part D program. Shaheen and Hassan also joined a bipartisan group of Senators in support of the Bipartisan Health Care Stabilization Act of 2017, which would lower premiums and improve quality of care for patients and families across the nation.