End the surprise insurance gap

Members of Congress and Physicians React to Energy and Commerce Health Subcommittee Markup, Warn Against One-Size-Fits-All Solutions to End Surprise Billing

Date created

Fri, 07/12/2019 - 10:04

WASHINGTON Yesterday, the U.S. House Energy and Commerce Subcommittee on Health held a markup of HR 3630, the No Surprise Billing Act, proposed by Chairman Frank Pallone (D-NJ-06) and Ranking Member Greg Walden (R-OR-02).


During the markup, several members spoke about the importance of ensuring the patient perspective is reflected in any legislation aimed at solving the problem of surprise bills so their access to quality care is preserved.


In particular, Rep. Larry Buschon (R-IN-08), one of the many physicians in Congress who is speaking up for patients on this issue, expressed concern about the benchmarking approach to surprise medical bills because of its unintended consequences for patients.


“A benchmark rate without a dispute resolution process will have unintended consequences,” said Rep. Bucshon. “Without an IDR process in some form… I’m concerned that for physicians it could be a race to the bottom on reimbursement, it could limit patient options to see a physician of their choice with limited networks, and I’m worried about implications in rural areas. I represent a rural district where it’s difficult already to attract physicians.”


Rep. G. K. Butterfield (D-NC-01) reiterated the apprehension of his Republican colleague, saying, “I’m concerned about the potential negative impacts on rural access to care… Much of my district is rural, and in recent years we have seen a reduction in local access to care. I’ve heard from providers in my district over and over again who are really concerned about the [benchmarking] approach we are taking, and so I want us to do a deep dive and to make sure that this legislation will not have a negative impact on rural hospitals.”


The idea that benchmarking could have undesired and unanticipated consequences went beyond concern over access to care in rural districts and members urged caution in adopting that approach. “We need to have further discussion about how to ultimately resolve the issues with provider and insurer payments,” said Rep. Doris Matsui (D-CA-06). She continued, “I’ve heard many concerns from doctors and hospitals in my state over the past few weeks about their experience with California’s similar surprise billing law. While the California law and the bill before us today aim to target a specific market failure, we must recognize a broader impact that action may have on access and cost to the health care system.”


“When it comes to legislation to end surprise billing, protecting patients and their access to quality care must be the primary goal and reflected in the policy approach,” said Dr. Sherif Zaafran, Chair of Physicians for Fair Coverage. “A one-size-fits-all model, however, misses the mark because it would exacerbate rural hospital closures and threaten millions of Americans’ ability to see the doctors they trust. One size does not fit all — we’ve seen that approach fail before in states like California, and there is no question that it will fail again. Instead of dangerous government price setting proposals, Congress should follow the states’ lead and pursue proven patient-centered solutions – like an Independent Dispute Resolution approach – to protect patients from surprise bills without threatening their access to care.”



Each year, millions of Americans seek emergency care at a hospital, and they do their best to ensure they receive care at an in-network hospital covered by their health insurance plan. However, even if patients receive care at an in-network hospital, they could be treated by an out-of-network physician, which may result in what is commonly referred to as a surprise or balance medical bill.



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