Momentum is building for action to prevent patients from receiving massive unexpected medical bills, aided by President Trump, who is vowing to take on the issue.
Calls for action against so-called surprise medical bills have been growing, spurred by viral stories like one involving a teacher in Texas last year who received a $108,951 bill from the hospital after his heart attack. Even though the teacher had insurance, the hospital was not in his insurance network.
Lawmakers in both parties say they want to take action to protect people from those situations, marking a health care area outside of the partisan standoff over ObamaCare, where Congress could advance bipartisan legislation to help patients.
Trump gave a boost to efforts on Wednesday.
“[People] go in, they have a procedure and then all of a sudden they can’t afford it, they had no idea it was so bad,” Trump said at a roundtable with patients about the issue.
“We’re going to stop all of it, and it’s very important to me,” he added.
But the effort still faces obstacles from powerful health care industry groups — including hospitals, insurers and doctors. Those groups are jockeying to ensure that they avoid a financial hit from whatever solution lawmakers and the White House back.
Asked if he expected resistance from the health care industry, Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health Committee, told reporters Thursday, “I would expect so.”
“Someone has to pay the bill,” Alexander added.
A source familiar with the discussions said insurers and hospitals are “both at the table,” but “they’re just battling with each other on who’s going to take the bigger hit.”
Alexander insisted lawmakers would push forward nonetheless.
“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 said. “We don’t want that happening, so one way or the other I expect to see that addressed in the next several months.”
Trump also received praise from Democrats for highlighting the issue this week.
“I was very glad to see the president start to pay attention to the issue,” Sen. Maggie Hassan (D-N.H.), who has sponsored legislation to protect patients from surprise bills, said in an interview.
She said she is “very optimistic that we will be able to find common ground.”
Lawmakers must first reconcile competing bills. In addition to Hassan’s measure, there is a bill from a bipartisan group led by Sen. Bill Cassidy (R-La.), and a House bill from Rep. Lloyd Doggett (D-Texas), the chairman of the Ways and Means health subcommittee.
“I am encouraged by the increased bipartisan interest, but we still face significant pushback,” Doggett said in a statement, adding that he will keep pushing to end the “predatory practice” of surprise billing.
The Senate group led by Cassidy hopes to get bipartisan support to coalesce around one bill on the issue. They’ve been in touch with Hassan’s office to discuss the best way to address the problem, a GOP aide said. Cassidy’s group hopes to introduce updated legislation soon, the aide said.
In the House, a Democratic aide said there is “momentum” for legislation on surprise bills and a hearing and markup are expected, but there is no timeline yet.
House Democratic staff have been in touch with Cassidy’s office, and there is a briefing on the issue from outside experts for staff for Ways and Means Committee members set to happen in the coming weeks.
All of the possible solutions would protect patients from having to pay exorbitant amounts if their doctor is outside of the insurance network. But the lingering question is who decides how much the insurer should pay to the doctor or hospital for that care.
Those details are what health care groups will be fighting over.
Molly Smith, a vice president at the American Hospital Association, said “patients need to be held harmless” and “we definitely want to be at the table” to discuss the solution.
“We are all on the same page of what the problem is,” said Kristine Grow, a spokeswoman for America’s Health Insurance Plans. Grow said the debate comes down to details over how health care providers will be paid and ensuring that insurance companies are able to maintain control over their networks.
Alexander said Congress will act even if health care groups cannot agree.
“The first place to deal with it is for the hospitals and doctors and insurance companies to get together and end the practice,” Alexander said.
“And if they don’t, Congress will do it for them.”