President Donald Trump called on lawmakers to come together to address one of the most frustrating and costly aspects of America’s health care system for patients — surprise medical bills.
The President announced on Thursday that he’s sending a set of principles to Congress that aims to end patients’ responsibility for big charges when they unknowingly are treated by out-of-network doctors or hospitals, often in an emergency situation.
“In emergency care situations, patients should never have to bear the burden of out-of-network costs they didn’t agree to pay,” Trump said at press conference Thursday, standing with a family that was billed nearly $18,000 for a urine drug test that would have carried an in-network charge of just $101. “No family should be blindsided by outrageous medical bills.”
Half of Americans say shielding people from surprise medical bills should be a top priority for Congress, according to an April Kaiser Family Foundation poll. That ranks behind lowering drug costs and protecting those with preexisting conditions, but ahead of major changes to the nation’s health care system, such as repealing the Affordable Care Act or implementing a national “Medicare for All” plan.
The goal is to make sure that consumers who go to an emergency room would only pay what they would if they went to in-network providers, letting insurers and health care professionals work out the remaining payment, Joe Grogran, director of the Domestic Policy Council, told reporters Thursday.
In the case of elective surgery, patients would have to be told in advance and given a written estimate that details any out-of-network providers and charges.
Just what the President can accomplish, however, is unclear. Lawmakers on both sides of the aisle are trying to address the problem but have been stymied by health care industry groups who shift the blame and responsibility for the matter.
A bipartisan group of senators led by Bill Cassidy, a Louisiana Republican who is a doctor, unveiled draft legislation last fall that would limit patients’ financial responsibility when they receive out-of-network care. They also requested more information about the issue from insurers and providers in February. Sen. Maggie Hassan, a Democrat from New Hampshire, also introduced a bill that would involve arbitration — an approach senior administration officials said they do not support.
Industry groups say they are open to federal legislation, with hospitals, doctors and a coalition of insurers, employers and patient advocates each releasing guiding principles in recent months. Hospitals and doctors agree that patients should be protected and removed from payment negotiations, but oppose the government setting the reimbursement methodology. They say insurers must make sure to include an adequate number of providers in their network and keep their directories up to date.
The coalition wants payments to be based on a federal standard and say patients should be informed when care is outside their network.
State officials have also passed laws to protect consumers, but they don’t have authority over many insurance plans offered by large employers, which cover nearly half of Americans. These policies are regulated on the federal level.