Reps. Ruiz, Roe Introduce Clear Contrast to Senate Surprise Billing Legislation, Push for Strongest Patient Protections

Statement

oday, Representatives Raul Ruiz, M.D. (D-CA), Phil Roe, M.D. (R-TN), Joseph Morelle (D-NY), Van Taylor (R-TX), Ami Bera, M.D. (D-CA), Larry Bucshon, M.D. (R-IN), Donna Shalala (D-FL), and Brad Wenstrup, D.P.M. (R-OH) introduced the bipartisan Protecting People from Surprise Medical Bills Act, just as the Senate HELP Committee marked up a contrasting legislative proposal. The legislation is building support, with a total of 32 original cosponsors from both sides of the aisle on key committees of jurisdiction, including Republicans and Democrats on the Energy and Commerce, Ways and Means, and Education and Labor Committees.

"The Protecting People from Surprise Medical Bills Act is gaining momentum because it includes the strongest patient protections of any surprise billing legislation proposed in the House or Senate," said Dr. Ruiz. "Our bill creates the most fair and transparent system to end surprise bills -- without picking winners or losers. This bill is the best solution to protect middle-class families from the severe anxiety, depression, and financial ruin that can result from receiving an unexpected and very expensive bill from an out-of-network provider. I'm grateful to Dr. Roe, one of the 32 members who agree: this bill is the most effective legislation in Congress to end surprise billing once and for all."

"For far too long, families and patients have endured financial stress and other hardships because of costly surprise medical bills," said Rep. Roe. "Too many Americans are only a car crash away from financial ruin, and the time is now to ensure families have peace of mind. For this reason, I am proud to work with my colleague Dr. Ruiz on a bipartisan solution that will help end this practice and ensure providers and insurers can work out any payment disagreements through arbitration. Our legislation is based on a proven, tested model from New York state, and I am confident that if enacted, this will prove helpful for patients, providers, insurers, employers and taxpayers."

"Americans are already struggling to afford the continually increasing cost of health care -- they shouldn't be blindsided by unexpected and hyperinflated medical bills when they unexpectedly need to see out-of-network providers," said Congressman Taylor. He continued, "Reducing out-of-pocket health care cost isn't a partisan issue and I am proud to come together with my colleagues to introduce this commonsense legislation to end surprise billing and give more certainty to all Americans."

"The predatory practice of surprise billing is yet another example of why our healthcare system doesn't work for everyday Americans," said Rep. Morelle. "Patients in need deserve better than to be blindsided with a massive, unexpected medical bill in the middle of an emergency. I was proud to help pass measures to end surprise billing during my time in the State Assembly, and now I'm pleased to come together with my colleagues on both sides of the aisle to introduce similar legislation and bring much-needed peace of mind to families across the country."

"As a doctor, I believe patients should get the care they need and not get stuck with bills they had little control over," said Rep. Bera, M.D. "This bipartisan piece of legislation is based on the positive experience of the New York-based arbitration approach to surprise medical bills that has incentivized doctors and insurers to resolve their payment differences. We think this model is the best approach. No American should be stuck with a bill from an inadvertent visit to an out-of-network provider."

"The practice of surprise medical billing must stop - too many Americans are facing enormous medical bills for seeking treatment from a healthcare provider they did not know was outside their insurance network. There are a number of states that have already passed surprise medical bill legislation, and now it's time to have Congress take the steps necessary to protect all Americans," said Rep. Shalala. "I am proud to join my colleagues in introducing this bipartisan bill that will prevent patients from becoming saddled with unexpected bills after a medical procedure--emergency or otherwise."

"As a physician, I am proud to co-sponsor the Protecting People from Surprise Bills Act. I believe it is important that patients are not financially burdened with surprise medical bills for unanticipated out-of-network care," said Dr. Bucshon. "This legislation is significant -- instead of picking winners and losers, this bipartisan bill creates an independent dispute resolution process for the provider and the health plan that is mediated by an arbiter. Access to life saving care is critical for all Americans and it should not come with lifelong financial liabilities as a result of a surprise medical bill."

"While patients are recovering, the last thing they need is the added stress of expensive surprise medical bills when they weren't able to choose their doctor," said Rep. Wenstrup, D.P.M. Our bipartisan legislation protects patients and provides a clear backstop to resolve disagreements between providers and insurers without inserting price-setting by the federal government into the process."

Background

Today, Congressman Raul Ruiz, M.D. and Congressman Phil Roe, M.D. introduced the Protecting People from Surprise Medical Bills Act -- just as the Senate Committee on Health, Education, and Labor marked up a competing proposal, S. 1895, the Lower Health Care Costs Act. The legislation has the support of 32 members of Congress on key committees of jurisdiction, including Republicans and Democrats on the Energy and Commerce, Ways and Means, and Education and Labor Committees.

Under the Protecting People from Surprise Medical Bills Act, the practice of balance billing would be banned. Patients would be left out of the middle and would not be required to play any part in resolving payment disputes. The legislation sets forward the most robust patient protections possible, ensuring families struggling to get by are not bankrupted by surprise medical bills.

The Protecting People from Surprise Medical Bills Act takes a proven approach to protecting patients from surprise bills by adopting an arbitration model. Under this model -- similar to the one adopted by New York State in 2015 -- if providers and insurers cannot agree on a payment rate, they can engage in an independent dispute resolution process (IDR). Under IDR, a neutral arbiter chooses the fairer price between the provider charge and the payment by the insurer. This model creates an incentive for both parties to choose reasonable numbers to cover the cost of treatment. According to a 2018 study, out-of-network bills in New York declined 34 percent just three years after the state passed arbitration legislation.

The Protecting People from Surprise Medical Bills Act makes the following reforms:

Bans the practice of billing patients for unanticipated out-of-network care;
Implements a "baseball-style' arbitration model that identifies a reasonable payment rate when insurers and providers cannot agree on the cost of care;
Improves transparency by requiring health plans to clearly identify in-network providers and patients' deductibles.