This week, U.S. Rep. Ross Spano, R-Fla., doubled down on his proposal to add more transparency to medical billing.
Back in early May, U.S. Sen. Rick Scott, R-Fla., unveiled the “Protecting Patients from Surprise Medical Bills Act,” which, he insisted, will “promote transparency in hospital billing and empower patients to fight against hospital price gouging.” The bill protects patients from being “charged more than in-network rates for emergency services and covered non-emergency services” and makes medical providers and insurance companies hash out disputed claims. Scott’s proposal would also make health plans update and release lists of in-network providers on a monthly basis to their customers.
“Healthcare in this country is too expensive,” Scott said when he introduced the bill. “We have to find ways to drive down the costs for American families. One way to do that is to force hospitals to be more transparent in their medical billing. There is no reason patients should be surprised by unconscionable charges for simple procedures and every patient should know what the price will be up front. Services at the hospital should mirror a free market system. We must ensure that prices and quality outcomes are aligned so Americans receive the best care possible when they visit a healthcare facility.
“I fought for and signed similar legislation as governor of Florida, and I am bringing a common-sense idea to Washington to help all American families,” Scott added.
While Scott says his bill will help more than 100 million Americans, it has not gained much momentum in the Senate. He has not reeled in any cosponsors and the bill has sat before the U.S. Senate Health, Education, Labor, and Pensions Committee since he brought it out.
Last month, Spano introduced the companion bill and he went to bat for it this week in a piece published in the Orlando Sentinel on Monday.
“This companion bill to legislation introduced by Sen. Rick Scott in the Senate seeks to do for America what he and I did for Florida while I served in the Florida House — offer some relief by cutting surprise medical bills,” Spano wrote. “Surprise medical billing has for decades been a known trap in our healthcare system. Like the story my constituent shared with me, there are countless other stories of insured patients going in for both emergency and routine visits and leaving with thousands of dollars in unexpected and unwarranted medical bills. No one who has taken the necessary steps to obtain health insurance should ever have to worry about incurring crippling debt and additional stress when seeking medical care.”
Spano, who is expected to be a top target for Democrats next year, also highlighted his record on the matter in Tallahassee.
“In 2016, I cosponsored Florida HB 221, legislation spearheaded by then-Gov. Scott aimed at combating surprise medical billing. Surprise billing often takes the form of “balance billing,” a legal and routine practice that bills a patient as an out-of-pocket expense for the difference, or balance, between what a healthcare provider charges and an insurer agrees to reimburse. Surprise!” Spano wrote.
“HB 221 directly addressed this problem by prohibiting out-of-network healthcare providers from balance billing patients with certain healthcare plans under a variety of scenarios. Therefore, within Florida and for the health insurance plans regulated by the state, patients will never again have to fear surprise medical bills for emergency services, or for unknowingly receiving out-of-network treatment at in-network hospitals,” Spano added. “Unfortunately, healthcare plans regulated by the federal government, such as employer-sponsored healthcare plans, fall outside state regulations like HB 221. The bills Sen. Scott and I have introduced would apply the solution that has worked for Florida at the federal level. They both greatly reduce balance billing for many patients and take them entirely out of billing disputes. This is a proven, common-sense solution to a common, yet unnecessary problem.”
Spano’s bill is before the U.S. House Education and Labor Committee. So far, Spano has not found any cosponsors in the House.
Other members of the Florida delegation are behind a similar proposal. Earlier this year, U.S. Rep. Donna Shalala, D-Fla., teamed up with members of both parties on the “Protecting People from Surprise Medical Bills Act” which would end balance billing.
While she was elected to Congress for the first time last year, Shalala does have experience on the healthcare front, including serving eight years as U.S. secretary of Health and Human Services (HHS) under President Bill Clinton.
Shalala threw her support behind U.S. Rep. Raul Ruiz’s, D-Calif., proposal which has the support of key Republicans including U.S. Rep. Phil Roe, R-Tenn., and U.S. Rep. Neal Dunn, R-Fla. U.S. Rep. Darren Soto, D-Fla., and U.S. Rep. Bill Posey, R-Fla., are also backing the proposal which has almost 80 cosponsors.
“Under the Protecting People from Surprise Medical Bills Act, the practice of balance billing would be banned” Shalala’s office noted. “Patients would be held harmless and would not be responsible for 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 South Florida Democrat’s office added.
Shalala weighed in on why she was backing the proposal.
“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 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.”
Reach Kevin Derby at email@example.com.