This is a season in which we are supposed to be prepared for surprises. But Congress caught us with the COVID relief bill that was hammered out over the weekend.
It’s not just that it passed any kind of bill at all – no sure thing just a few days earlier. But tucked into the nearly $900 billion package announced Sunday night was a piece of health financing regulation that has little to do with COVID relief, but will make life a lot less stressful in the new year. It’s an end to a practice known as surprise billing.
It fixes a problem in a health care system that tries to use market forces to control costs. Insurance plans negotiate rates with providers, and penalize consumers who get services from outside the network. But often a patient doesn’t know that they have done that until they get their bill.
Sarah Kiff, of The New York Times, recently reported about a comatose patient who had to be transferred from one in-network hospital to another. But the helicopter ambulance service used was out of network, as the patient found out when she recovered from her coma and opened a bill for $52,000.
Similar stories are heard from a wide range of patients who find out after an emergency or a planned surgery that someone involved in their care had no relationship with their insurance company and would be billing them directly. The patients are charged the full sticker price for the service, not the rate an insurance company would pay. Academic researchers estimate that 20 percent of emergency department visits result in a surprise bill, a problem that affects millions of patients every year.
Surprise billing will be forbidden for doctors, hospitals and air ambulances (but not ground ambulances) under the new law, which won’t go into effect until 2022. Instead of billing patients directly, out-of-network providers would be required to work with the patient’s insurance company to get compensation for their services. If they fail to come to terms, the case will go to arbitration.
This is the kind of sensible reform with bipartisan appeal that should be easy for Congress. But nothing should be taken for granted these days.
It took six months for negotiators to come to terms on a COVID relief bill that could get the support of a majority of Senate Republicans. Millions of unemployed workers saw federal benefits expire at the end of July, while the Senate had no response to two relief bills passed by the House, one in May and the other in October. A bipartisan group in the Senate, which included both of Maine’s senators, put together a framework that became the structure of the final deal.
Even at nearly $900 billion, the package is likely too small to offset the loss of economic activity caused by the pandemic. The housing provisions are short term and the government will still need to act to head off mass evictions later this winter. It doesn’t include aid to states and localities, which could lead to layoffs of teachers, firefighters, police officers and other public-sector employees.
But passing no bill would be much worse than passing nothing at all. The surprise medical billing reform shows that there are still important issues that are not so polarized that they cannot be addressed by a divided government.
As we head into a new year, this ending gives us a reason to hope.
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