No Surprises Act signed into law; insurers lose yearslong lobbying battle

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A measure to end surprise medical bills for emergency and scheduled care was passed Dec. 27 when President Donald Trump signed a $1.4 trillion year-end spending deal into law.

Throughout 2020, Democratic and Republican leaders of the House Energy and Commerce, House Education and Labor and Senate Health, Education, Labor and Pensions committees worked to pass a bill to reduce surprise medical billing. U.S. Rep. Richard Neal, D-Mass., chairman of the House Ways and Means Committee, stalled their efforts, favoring his own proposal aimed at reducing surprise medical bills.

The committees' proposal used an approach called benchmarking, in which payment rates are based on the median amount insurers in a given area pay in-network healthcare providers. It was supported by unions, insurers and consumer groups. 

The proposal brought forth by Mr. Neal and Rep. Kevin Brady, R-Texas, favored a process in which outside adjudicators would decide payment rates through arbitration. This approach was supported by hospital groups.

The No Surprises Act, the measure included in the year-end deal passed Dec. 27, employs an approach that is closer to Mr. Neal's bill, allowing providers to enter into arbitration to gain higher reimbursements. Arbitrators will consider factors such as median in-network rate, a provider's experience level, complexity of the medical care and the parties' market share.

Medical insurers will face a new payment process that could increase their expenses and create more administrative obstacles despite spending tens of millions of dollars on lobbying against the arbitration approach, according to The Hill.

 

 

 

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