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Senators ask CBO to review options for preventing surprise medical bills

Senators ask CBO to review options for preventing surprise medical bills
© Greg Nash

The leaders of the Senate Health Committee are asking the Congressional Budget Office (CBO) to analyze possible options for protecting patients from getting hit with massive, unexpected medical bills.

Chairman Lamar AlexanderLamar AlexanderCongress addressed surprise medical bills, but the issue is not resolved Trump renominates Judy Shelton in last-ditch bid to reshape Fed Senate swears-in six new lawmakers as 117th Congress convenes MORE (R-Tenn.) and Sen. Patty MurrayPatricia (Patty) Lynn MurrayOvernight Health Care: 50 million coronavirus vaccines given | Pfizer news | Biden health nominees Rand Paul criticized for questioning of transgender health nominee Biden health nominee faces first Senate test MORE (Wash.), the panel's top Democrat, sent options for analysis to the CBO, according to Senate aides.

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It's the latest sign that lawmakers are serious about moving forward on legislation to address so-called surprise medical bills, a rare issue where there could be bipartisan action this year.  

The goal is to stop instances like a viral story last year of a teacher in Texas who got a $108,951 bill from the hospital after his heart attack because the hospital was not in his insurance network.

Alexander and Murray’s action is preliminary and lawmakers have not decided on the details of any legislation yet.

The two are working in consultation with a bipartisan group of senators that is in discussions on the issue, which includes Sens. Bill CassidyBill CassidyOvernight Health Care: Johnson & Johnson vaccine safe, effective in FDA analysis | 3-4 million doses coming next week | White House to send out 25 million masks Koch-backed group launches ads urging lawmakers to reject COVID-19 relief bill Biden health nominee faces first Senate test MORE (R-La.), Michael BennetMichael Farrand BennetDemocrats: Minimum wage isn't the only issue facing parliamentarian Democrats plan crackdown on rising drug costs Overnight Health Care: Biden officials announce funding to track virus variants | Senate Dems unveil public option proposal | White House: Teacher vaccinations not required for schools to reopen MORE (D-Colo.), and Maggie HassanMargaret (Maggie) HassanSenate Democrats call on GAO to review child care access barriers for disabled parents, kids Biden signs supply chain order after 'positive' meeting with lawmakers Koch-backed group launches ads urging lawmakers to reject COVID-19 relief bill MORE (D-N.H.), a Senate aide said.

Alexander and Murray are known as two of the best bipartisan dealmakers in the Senate. The pair tried, ultimately unsuccessfully, in 2017 and 2018 to pass an agreement to stabilize ObamaCare.

Since then, Alexander has said he wants to move on from debating the politically charged health care law and instead focus more broadly on lowering health care costs, including countering surprise medical bills.

Lawmakers in both parties and industry groups largely agree that patients should be protected from getting massive, unexpected medical bills.

The debate is over how to determine how much the insurer will pay to the doctor or hospital.

Insurers, doctors and hospitals are jockeying over those details, fearful of taking a financial hit in the legislation.

Alexander and Murray sent a range of possible options on those details to the CBO.

One option is to have an arbitrator determine how much the insurer pays the doctor or hospital. Another option is to set a payment rate based off a percentage of Medicare’s payment rates or something similar. A third option is to require hospitals to send a single bill to the insurer, preventing doctors within the hospital from independently charging the insurer at much higher rates.

Those three options are not the only options that Alexander and Murray sent to the CBO, though.

“People go to the emergency room and they suddenly are surprised a few weeks later with a bill for $3,000 from an out-of-network doctor,” Alexander told reporters in January. “We don’t want that happening, so one way or the other I expect to see that addressed in the next several months.”