The president sets out guidelines for legislation on the issue.
This article was first published on Thursday, May 9, 2019 in MedPage Today.
By Joyce Frieden, News Editor, MedPage Today.
WASHINGTON -- President Trump announced an initiative Thursday aimed at ending the problem of surprise medical billing, in which patients undergoing procedures at in-network hospitals receive unexpectedly high bills because one or more of their clinicians was out of network.
Trump called surprise billing "one of the biggest concerns Americans have about healthcare" and added, "The Republican Party is very much becoming the party of healthcare. We're determined to end surprise medical billing for American patients and that's happening right now." He thanked the mostly Republican group of lawmakers who came to the White House to discuss the initiative, including senators Lamar Alexander (R-Tenn.), Maggie Hassan (D-N.H.), Bill Cassidy, MD (R-La.), and John Barrasso (R-Wyo.) and representatives Kevin Brady (R-Texas), Devin Nunes (R-Calif.), and Greg Walden (R- Ore.).
Trump announced guidelines that the White House wants Congress to use in developing surprise billing legislation. They include:
- In emergency care situations, patients should never have to bear the burden of out-of-network costs they didn't agree to pay. "So-called 'balance billing' should be prohibited for emergency care. Pretty simple," he said.
- When patients receive scheduled non-emergency care, they should be given a clear and honest bill up front. "This means they must be given prices for all services and out-of-pocket payments for which they will be responsible," Trump said. "This will not just protect Americans from surprise charges, it will [also] empower them to choose the best option at the lowest possible price."
- Patients should not receive surprise bills from out-of-network providers that they did not choose themselves. "Very unfair," Trump said.
- Legislation should protect patients without increasing federal healthcare expenditures. "Additionally, any legislation should lead to greater competition, more choice, and more healthcare freedom. We want patients to be in charge and in total control," the president said.
- All types of health insurance -- large groups, small groups, and patients on the individual market should be included in the legislation. "No one in America should be bankrupted unexpectedly by healthcare costs that are absolutely out of control," said Trump
He said that "we're going to be announcing something over the next 2 weeks that's going to bring transparency to all of it. I think in a way it's going to be as important as a healthcare bill; it's going to be something really special."
Also at the announcement was Martin Makary, MD, MPH, a surgical oncologist at Johns Hopkins University in Baltimore. "When someone buys a car, they don't pay for the steering wheel separately from the spark plugs," he said. "Yet, in healthcare, surprise bills and overpriced bills are commonplace and are crushing everyday folks ... People are getting hammered right now."
Trump also introduced two families who had experienced high medical bills. Drew Calver, of Austin, Texas, said that after a heart attack 2 years ago, "although I had insurance, I was still billed $110,000 ... I feel like I was exploited at the most vulnerable time in my life just having suffered a heart attack, so I hope Congress hears this call to take action, close loopholes, end surprise billing, and work toward transparency."
Paul Davis, MD, of Findlay, Ohio, said that his daughter was billed nearly $18,000 for a urine drug screening test. "She had successful back surgery in Houston and at a post-op visit, because she was given a prescription for narcotic pain relief -- which she used as directed -- the doctor said, 'Oh, by the way, I'd like to get a urine specimen.' Fine; she did it. A year later, a bill showed up for $17,850."
He noted that her insurance company's Explanation of Benefits said that the insurer would have paid $100.92 for the test had it been done by an in-network provider. "This type of billing is all too common ... The problem of improper billing affects most [of] those who can afford it least. We must put aside any differences we have to work together to solve this problem."
"Today I'm asking Democrats and Republicans to work together; Democrats and Republicans can do this and I really think it's something [that is] going to be acted on quickly," Trump said.
Healthcare groups responded positively to the announcement, with one caveat. "The AHA commends the Administration and Congress for their work to find solutions to this problem," Rick Pollack, president and CEO of the American Hospital Association (AHA), said in a statement. "The AHA has urged Congress to enact legislation that would protect patients from surprise bills. We can achieve this by simply banning balance billing. ... Untested proposals such as bundling payments would create significant disruption to provider networks and contracting without benefiting patients."
"ACEP appreciates the White House weighing in on this important issue and welcomes congressional action to address surprise medical bills," said Vidor Friedman, MD, president of the American College of Emergency Physicians (ACEP), in a statement. "Emergency physicians strongly support taking patients out of the middle of billing disputes between insurers and out-of-network medical providers."
"ACEP is concerned about the administration's call for a single hospital bill," he continued. "Such a 'bundled payment' approach may seem simple in theory for voluntary medical procedures. But if applied to the unpredictable nature of emergency care, this untested idea opens the door to massive and costly disruption of the health care system that would shift greater costs to patients while failing to address the actual root cause of surprise bills -- inadequate networks provided by insurers."
The president also mentioned another one of his administration's healthcare initiatives. "We may allow states to buy drugs in other countries ... because the drug companies have treated us very, very unfairly and the rules and restrictions within our country have been absolutely atrocious," he said. "So we'll allow [states], with certain permission, to go to other countries if they can buy them for 40%, 50%, or 60% less. It's pretty pathetic, but that's the way it works."
“We're determined to end surprise medical billing for American patients and that's happening right now.”
President Donald Trump
Photo credit: Evan El-Amin / Shutterstock
In emergency care situations, patients should never have to bear the burden of out-of-network costs they didn't agree to pay.
When patients receive scheduled non-emergency care, they should be given a clear and honest bill up front.
Patients should not receive surprise bills from out-of-network providers that they did not choose themselves.
Legislation should protect patients without increasing federal healthcare expenditures.
All types of health insurance -- large groups, small groups, and patients on the individual market -- should be included in the legislation.