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Comparing Federal Surprise Medical Bill Proposals: How Do Consumers and Families Fare in the Current Debate?

03.17.2020

The current Congress, with the support of the Administration, is taking real action to ban the abusive practice of surprise billing. No Surprises: People Against Unfair Medical Bills assesses various legislative proposals based on three clear principles:

Principle 1: Protect patients in all care settings

All of the proposals ban surprise bills in hospitals, clinics, and doctors’ offices, where most surprise bills occur. Two out of four bills — those passed by the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Education and Labor (E&L) Committee — ban surprise bills by air ambulance companies. Disappointingly, none of the bills bans surprise billing by ground ambulances.

Principle 2: Do not increase health care costs across the system

The Senate HELP, House Energy and Commerce (E&C), and House E&L committees’ legislation all save at least $24 billion in federal spending. The House Ways and Means (W&M) Committee’s proposal still saves a significant amount — $18 billion — but its savings is roughly one-quarter less than that of the other committees due to a meaningful difference in how it manages payment disputes between plans and providers (more on that below).

Principle 3: Apply to all private insurance plans

All of the bills meet this principle, applying patient protections to all private insurance plans. (Medicare and Medicaid already prohibit surprise billing.)

Over the past several months, all four committees with jurisdiction over aspects of surprise medical bills have marked up their own versions of legislation to ban surprise bills. Lawmakers and stakeholders alike have worked to understand the differences between the pieces of legislation and to assess which of the proposals are best for consumers. The chart below provides a quick thumbnail sketch of the primary differences between these bills.

Click the download button below to view the Analysis.