On Thursday, President Trump pushed to fight health care “sticker shock” by limiting “surprise medical bills,” which are unexpected charges insured patients face when a health care professional who is not in their insurer’s network treats them. According to The Associated Press, senior administration officials said that President Trump will outline principles he can support as part of legislation to limit these type of billing practices. Democratic and Republican lawmakers have attempted to make progress on this topic for several months, and the White House support will only improve the chances of achieving something.
Patients who are being treated for medical emergencies are typically not in the position to contact their insurance companies to make sure that their anesthesiologists or surgeons are covered in their network. Trump wants to make it so that patients receiving emergency care shouldn’t be smacked with charges that exceed the amount paid to providers in their network.
These “surprise” bills tend to amount to tens of thousands of dollars and hit families in their most vulnerable times, after surgery or a near-death experience. Patients are often able to negotiate lower charges by working with their insurance company, but the process usually takes months of anxiety and stress to complete.
Officials have said that the legislation should also protect patients that are seeking elective care by ensuring that they’re fully informed before they schedule their appointments about which providers are out of their network and what the extra costs would be. The officials also spoke on the condition of anonymity because before Trump made his announcement, they weren’t authorized to speak about the matter publicly.
This effort from the White House is part of Trump’s plan to increase transparency within the health care system. As of Wednesday, the administration finalized the regulations for drug companies requiring them to disclose their list prices of medications that cost more than $35 a month. President Trump will also make the case that legislation shouldn’t lead to even more costs for taxpayers.
Insurance companies form networks of hospitals and doctors in order to gain leverage for negotiating reimbursements. Typically, patients are responsible for paying a bigger share of the bill for any kind of care that is found outside of the network. Unfortunately, more often than not the patients don’t even know that they received outside care until they receive their bill.
Last month, a House panel held a surprise hearing on medical bills. Trump was also present at a meeting in January with victims of surprise billing and health care advocates. Following the meeting, officials said that Trump made it clear that he wanted his administration to work on finding a solution for the situation.
Individual states have also been working to protect patients from surprise medical bills. According to a survey of states by Georgetown University, about half of the states have made some sort of action to protect patients, but some states, like California, Florida, and Connecticut, have the most extensive protections put into place.
Unfortunately, states don’t have jurisdiction over most health care plans that are sponsored by large employers. A coalition between business groups, consumer organizations, and major insurers have been pressing Congress for federal legislation. This would include informing patients when a doctor or service provider is out-of-network.
One of the biggest hang-ups has been agreeing on payment rates for out-of-network services that are acceptable to insurers, medical specialists, and hospitals. Last month, research professor emeritus at Georgetown, Jack Hoadley, told lawmakers that unexpected medical bills are a huge concern for patients. He said programs like Medicare and Medicaid protect people from surprise bills, but the same protections don’t exist for those with private insurance.