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Surprise Medical Billing

Broad bipartisan support from the Trump administration as well as Congress has created momentum around surprise medical billing. Earlier this week, the House Energy and Commerce Committee released draft legislation to protect patients against surprise billing tactics. This bill will enforce that patients are only responsible for what they would pay to an in-network care provider and that they would have to acknowledge that a provider is out of their network before receiving care. The challenge: insurers and providers would have to navigate new payment issues if providers cannot balance bill their patients.

Read the memo from our legal team at Steptoe & Johnson.

On May 16, another bill was introduced in the Senate to protect patients from surprise hospital bills. The proposed bill would protect patients from receiving out-of-network bills in emergencies or when receiving scheduled care from out-of-network doctors at in-network facilities. Providers would be paid the difference between a patient’s in-network bill and the median in-network rate for those services. It would also ask HHS to explore the possibility of having physicians and hospitals submit one bill to patients based on a single episode of care.

  • How The Council is raising its voice: The Council has joined over 30 other employment-based trade groups to provide two letters on the issue of surprise medical billing to House leadership, and the chair and ranking member of the House Education and Labor Subcommittee on Health, Employment, Labor and Pensions. We will continue to urge Congress to find legislative solutions that protect the consumer and maintain affordability. Read the letters here and here.


What the States are Doing to Fight Surprise Medical Bills

Our legal team at Steptoe & Johnson surveyed statewide efforts to combat surprise medical billing practices. These efforts are categorized as comprehensive or piecemeal, a yardstick developed by a recent study from the Commonwealth Fund.

Click here to access the details.


Drug Pricing and the ACA Wrapped into One…

House Democrats announced that they will vote on a combined package of bills to strengthen the ACA marketplace and lower prescription drug prices. Critics warn that combining the three drug-pricing and four ACA bills could impact current bipartisan efforts on drug pricing.

One of the drug pricing bills is the long awaited CREATES Act, which would penalize name-brand manufacturers who obstruct generic drug makers from entering the market. One ACA provision would give states roughly $200 million in federal funding per year to establish state-based marketplaces. Another would reverse the Trump administration’s efforts to expand short-term health plans.

The Council’s take: This package will likely die on arrival in the Senate, as Republicans have voiced opposition to Democratic efforts to expand the ACA. Additionally, this could ruffle feathers of moderate Democrats who want to demonstrate that Congress is able to work across party lines.


The Partnership for America’s Health Care Future Reacts to New Single-Payer Bills

Two new Medicare for All bills will likely cost trillions in tax hikes and shift healthcare choices from doctors and patients to government officials. Watch the video below to learn what PAHCF is saying about the implications of those bills.


CBO: Medicare For All ‘Could Adversely Affect Access To And Quality Of Care’

The Congressional Budget Office (CBO) released a report shedding light on the costs and risks associated with implementing a single-payer healthcare system in the U.S. PACHF calls out the highlights here.


The 40-Hour Work Week

On May 16, both the House and Senate will introduce a 40-hour work week bill, the Employee Flexibility Act. The bill would repeal the 30-hour threshold for classification as a full-time employee for purpose of the employer mandate under the ACA. If signed into law, it would be effective after December 31, 2019.

The House bill sponsors are Rep. Jackie Walorski (R-IN), Rep. Dan Lipinski (D-IL), Rep. Mike Kelly (R-PA), Rep. Collin Peterson (D-MN); Senate bill sponsors are Sen. Todd Young (R-IN), Sen. Joe Manchin (D-WV) and Sen. Kyrsten Sinema (D-AZ). Other originals may be added throughout the week.


The Administration’s Efforts to Facilitate Patient Access to Health Data

CMS and the Office of the National Coordinator for Health Information Technology (ONC) released related proposed rules to improve individuals’ access to their health data and facilitate interoperability and timely information flow between healthcare providers and payers. Our legal team at Steptoe & Johnson put together a memo breaking down the proposal, and how it aligns with Council member priorities.

Access the memo.