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 AlexanderAndrew (Lamar) Lamar AlexanderPoll finds support for independent arbiters resolving 'surprise' medical bills Democratic Senate candidate in Tennessee discusses working-class background Pelosi urges early voting to counter GOP's high court gambit: 'There has to be a price to pay' MORE (R-Tenn.) and Sen. Patty MurrayPatricia (Patty) Lynn MurrayPoll finds support for independent arbiters resolving 'surprise' medical bills Senate Democrats introduce legislation to probe politicization of pandemic response Trump health officials grilled over reports of politics in COVID-19 response 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 CassidyWilliam (Bill) Morgan CassidyCoushatta tribe begins long road to recovery after Hurricane Laura Senators offer disaster tax relief bill Bottom line MORE (R-La.), Michael BennetMichael Farrand BennetOVERNIGHT ENERGY: House Democrats tee up vote on climate-focused energy bill next week | EPA reappoints controversial leader to air quality advisory committee | Coronavirus creates delay in Pentagon research for alternative to 'forever chemicals' Senate Democrats demand White House fire controversial head of public lands agency Next crisis, keep people working and give them raises MORE (D-Colo.), and Maggie HassanMargaret (Maggie) HassanDemocrats step up hardball tactics as Supreme Court fight heats up Congress needs to prioritize government digital service delivery Senate Democrats demand answers on migrant child trafficking during pandemic 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.”