No Surprises Act Archive
With so much information on surprise medical bills circulating, we have curated these resources to offer the most accurate and compelling views and analysis.
As the No Surprises Act now goes through legal challenges throughout the country, we have expanded this resource center to share key filings, letters, and other documents from concerned stakeholders.
Legal Challenges
Congressional Leaders
January 12, 2022 // Amicus brief filed by 11 Members of Congress, all of whom are healthcare providers, in support of plaintiffs in American Medical Association, American Hospital Association, et al v. U.S. Department of Health and Human Services, et al.
26 National and State Medical Organizations
January 7, 2022 // Amicus brief filed by a group of prominent medical organizations, including the American Association of Neurological Surgeons, the American Association of Orthopaedic Surgeons, the American College of Surgeons, the American Osteopathic Association, and many state medical associations in support of plaintiffs in American Medical Association, American Hospital Association, et al v. U.S. Department of Health and Human Services, et al.
College of American Pathologists
December 23, 2021 // Amicus brief filed by CAP in support of plaintiffs in American Medical Association, American Hospital Association, et al v. U.S. Department of Health and Human Services, et al. In its brief, CAP warns the government’s actions will cause substantial harm and further drive more physicians out of their patients’ health plan networks.
American Society of Anesthesiologists, American College of Emergency Physicians, and American College of Radiology
December 22, 2021 // Lawsuit filed by ASA, ACEP, and ACR in District Court for the Northern District of Illinois against the federal government. This case charges that the interim final rule on surprise medical billing goes against the language of the No Surprises Act and will ultimately harm patients and access to care.
Action for Health
December 17, 2021 // Amicus brief filed by Action for Health in support of plaintiffs in Texas Medical Association, et al v. United States Department of Health and Human Services, et al. This briefs seeks to aid the court by highlighting both the patient experience and Congress’ intent with respect to its enactment of the No Surprises Act.
Physicians Advocacy Institute and 13 State Medical Associations
December 17, 2021 // Amicus brief filed by PAI and the medical societies of California, Connecticut, Georgia, Kentucky, Massachusetts, Nebraska, New Jersey, New York, North Carolina, Oregon, South Carolina, Tennessee, and Washington in support of plaintiffs in Texas Medical Association, et al v. United States Department of Health and Human Services, et al.
Emergency Department Practice Management Association
December 17, 2021 // Amicus brief filed by EDPMA, the Texas College of Emergency Physicians, and the Virginia College of Emergency Physicians in support of plaintiffs in Texas Medical Association, et al v. United States Department of Health and Human Services, et al.
National Hospital Associations
December 15, 2021 // Amicus brief filed by the Federation of American Hospitals, the Association of American Medical Colleges, America’s Essential Hospitals, the Catholic Health Association of the United States, and the Children’s Hospital Association in support of plaintiffs in American Medical Association, American Hospital Association, et al v. United States Department of Health and Human Services, et al.
American Medical Association and American Hospital Association
December 9, 2021 // Lawsuit filed by AMA and AHA in DC District Court over the misguided implementation of the No Surprises Act. The associations are joined in the suit by plaintiffs including Renown Health, UMass Memorial Health, and two physicians based in North Carolina. The lawsuit challenges a narrow but critical provision of a rule issued on September 30, 2021 by HHS and other federal agencies. The provision being challenged ignores requirements specified in the No Surprises Act and would result in reduced access to care for patients.
Association of Air Medical Services
November 16, 2021 // Lawsuit filed by AAMS in DC District Court challenging interim final regulations implementing the No Surprises Act. The IFRs issued by the Departments of Labor, Treasury, and HHS ignore Congress’ intent, instead focusing on a single factor - the Qualified Payment Amount (QPA), or the insurer’s median in-network rate for only a subset of their contracts for a given service in each area. The QPA is to be the overriding factor in this decision-making process. This means that insurers will be able to know exactly how the IDR entities will resolve these disputes, making the IDR and the open negotiation that precedes it a forgone conclusion. Insurers will also leverage that QPA against future payments, lowering all payments, both in-and-out-of-network, over time.
Texas Medical Association
October 28, 2021 // Lawsuit filed by TMA and Dr. Adam Corley in Texas’ Eastern District Court, Tyler Division. This is the first case brought against the government related to the No Surprises Act stemming from the Biden administration’s failure to follow clear direction from Congress about how to implement the dispute resolution process set forth in the law. This lawsuit ensures that the protections for patients against balance bills will go into effect on January 1, 2022, while seeking to stop the imminent harm to physicians and hospitals created by an unfair arbitration process.
Requirements Related to Surprise Billing; Part II
26 U.S. Senators
December 28, 2021 // Significant letter spearheaded by Sens. Bill Cassidy (R-LA) and Roger Marshall (R-KS) and signed by 26 senators. Writing to Secs. Becerra, Walsh, and Yellen, they attest, “We are very concerned that the outcome of [your] approach will be markedly like that of a benchmark payment in clustering rates around the median in-network or below, a policy which Congress debated and ultimately rejected because of concerns it created around rural access and narrow networks…We urge you to revise the IFR released on September 30 to better reflect the law that Congress passed in developing a framework that protects patients while being fair to stakeholders.”
Sen. Mike Braun (R-IN)
December 6, 2021 // Terrific letter from Sen. Braun to CMS Administrator Chiquita Brooks-LaSure. The senator writes, “This rule creates a de-facto benchmark, disincentivizing payers to negotiate with providers to bring them into their networks. In other words, this gives an unfair advantage to insurers who are given authority through this rule to set artificially low payment rates for health care services, likely leaving patients with less in network options for their health care… Through this rulemaking process, the Administration blatantly favored insurers’ revenue over providers and their patients’ health care access.”
21 Surgical Organizations
December 6, 2021 // Letter from the nation’s leading surgeon groups to Secs. Becerra, Walsh, and Yellen offering comments on the No Surprises Act’s Part II regulations. “Our most significant concerns relate to the many instances woven throughout the rule where the IFR favors plans and issuers over providers, which could reduce physician networks and jeopardize access to care for patients.”
Medical Society of the State of New York
November 29, 2021 // Letter from MSSNY President Dr. Joseph Sellers to Secs. Yellen, Walsh, and Becerra outlining the needed revisions to these Part II regulations for the No Surprises Act. Commenting on the impact on patient access, Dr. Sellers writes, “Most importantly, we are concerned that these one-sided provisions contained within the IFR may have a significant adversely impact on patient access to needed emergency specialty care in hospitals as fewer physicians may be available to be “on call”.
Stakeholders Praise Bipartisan Letter to Biden Administration Regarding No Surprises Act Interim Final Rule
November 19, 2021 // Statements from key stakeholders regarding a bipartisan letter led by Reps. Brad Wenstrup, D.P.M. and Tom Suozzi and 150 of their colleagues to the Biden administration demanding that the interim final rule (IFR) for surprise medical bills reflect the landmark No Surprises Act as written.
American Association of Neurological Surgeons and the Congress of Neurological Surgeons
November 8, 2021 // Press statement from AANS and CNS, “Neurosurgeons Agree that Biden Administration Must Fix Surprise Medical Billing Regulation”, which states, “Unfortunately, this rule directly conflicts with both the letter and intent of the law by prioritizing median in-network payment rates. It is therefore incumbent upon the Biden Administration to revise the new rules
before they take effect on January 1.”
152 Members of Congress
November 5, 2021 // Groundbreaking, bipartisan letter led by Reps. Suozzi (D-NY), Ruiz (D-CA), Wenstrup (R-OH), and Bucshon (R-IN) and signed by more than 70 Democrats. Sent to Secretaries Becerra, Yellen, and Walsh, it urges the Biden administration to “revise the IFR to align with the law as written by specifying that the certified IDR entity should not default to the median in-network rate and should instead consider all of the factors outlined in the statute without disproportionately weighting one factor.” Lawmakers further point out, “The parameters of the IDR process in the IFR released on September 30 do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes.”
America’s Essential Hospitals
October 26, 2021 // Call to action from the association in support of Congress’ recent letter to the Tri-Departments. “The interim rule does not accurately reflect congressional intent. Instead, it includes a lopsided IDR method that favors insurers.”
American College of Radiology
October 14, 2021 // Detailed summary from ACR that explicitly states that it “is disappointed that the regulations violate the intent of the No Surprises Act (NSA) by making the Qualified Payment Amount (QPA) the primary determinant of physician payment rates in the independent dispute resolution process.”
Medical Society of the State of New York
October 8, 2021 // In a Dear Colleague, MSSNY President Dr. Joseph Sellers writes, “Instead of following the statutory language, HHS and other federal agencies designed an IDR process that heavily favors health insurance companies in payment disputes. The language in the rule directs the IDR arbiter to give priority to the insurer-calculated median in-network amount — called the qualifying payment amount (QPA)… This effectively ties the hands of the arbiter… HHS needs to take their thumb off the scale in favor of insurance companies—and instead prioritize the health of all Americans.”
American College of Emergency Physicians
October 7, 2021 // Must read post from ACEP, “Breaking Down the Concerning and Flawed Second Interim Final Reg Implementing the No Surprises Act.” Jeffrey Davis, director of regulatory and external affairs at ACEP, writes, “The wording of the No Surprises Act was specifically designed to avoid making the QPA the de-facto benchmark amount for out-of-network services. In all, we believe that this approach will lead to narrower provider networks and lower reimbursement rates — which will eventually significantly impact access to care. It will also cause many small emergency physician groups to go out of business, resulting in more provider consolidation (and, ironically, higher healthcare costs, something the Departments purported in the IFR to be trying to lower by using this aggressive approach).”
Medical Society of the State of New York
October 6, 2021 // Call to action from MSSNY to its members urging Congress to urge HHS to revise its independent dispute resolution (IDR) regulations.
American Medical Association
October 5, 2021 // In its summary of the No Surprises Act (NSA) Interim Final Rule (IFR) Requirements Related to Surprise Billing: Part II, the AMA “strongly disagrees with the Departments interpretation of the Statute as it relates to the use of the QPA in the IDR process and believes that the negative, long-term impact of this “anchoring” of out-of-network rates to the QPA on independent practices, fair contracting, and eventually access to care will overwhelm any perceived benefits of this statutory interpretation.”
Reps. Richie Neal (D-MA) and Kevin Brady (R-TX)
October 4, 2021 // Letter to Secretaries Becerra, Yellen, and Walsh regarding implementation of the No Surprises Act. The leaders of the House Ways and Means Committee state, “Despite the careful balance Congress designed for the IDR process, the September 30, 2021 interim final rule with comment strays from the No Surprises Act in favor on an approach that Congress did not enact in the final law and does so in a very concerning manner.”
California Medical Association
October 4, 2021 // Post from CMA warning that the Administration’s part two rule “is a complete giveaway to the insurance industry”.
Rep. Brad Wenstrup, DPM (R-OH)
October 1, 2021 // Press statement from Dr. Wenstrup, where he emphasizes, “This HHS Second Rule on surprise billing is a disaster for patient access. Congress was very clear that we did not intend to create a de facto benchmark for negotiations when creating the arbitration process in the historic, bipartisan No Surprises Act… If unchanged, this rule will disincentivize insurance companies from keeping providers in their networks, limiting care for Americans and threatening the health and safety of our nation.”
College of American Pathologists
October 1, 2021 // Statement from CAP that “strongly opposes new federal regulations that give insurance companies the upper hand during what should be an impartial independent dispute resolution (IDR) process as set in the No Surprises Act. The interim final rule for the IDR process, released on September 30, disregards Congress’s intentions of creating a fair system where physicians and health insurers can resolve disputes without one single factor having more weight than another.”
California Medical Association
October 1, 2021 // In a statement from CMA President Dr. Peter Bretan, he states, “The interim final surprise billing rule issued this week to implement the No Surprises Act is a grave disappointment to California physicians. It will allow the multi-billion insurance industry to continue to reduce their physician networks, hurting patients who need frontline physicians when an emergency strikes. Ironically, these guidelines will ultimately harm patients by further jeopardizing access to care and increasing health care costs through consolidation.”
American Medical Association
October 1, 2021 // Article from AMA Senior News Writer Andis Robeznieks entitled, “Don’t skew surprise-billing regulations in health plans’ favor”.
American Medical Association
October 1, 2021 // Press statement from AMA calling “the Biden Administration’s interim final rule on surprise billing an undeserved gift to the insurance industry that will reduce health care options for patients.”
Association of American Medical Colleges
October 1, 2021 // Post from AAMC on the part two regulations. “The AAMC has concerns with this approach and believes that it is inconsistent with the intent of Congress.”
American Hospital Association
October 1, 2021 // Special bulletin issued by AHA on the Administration’s part two regulations for the No Surprises Act.
American Hospital Association
September 30, 2021 // Post from AHA, entitled, “Agencies issue ‘part 2’ of regulations banning surprise medical billing”.
American Hospital Association
September 30, 2021 // In a statement from AHA Executive Vice President Stacey Hughes, she warns, “The Administration’s rule has moved away from Congressional intent and brought new life to harmful proposals that Congress deliberately rejected. Today’s rule is a windfall for insurers. The rule unfairly favors insurers to the detriment of hospitals and physicians who actually care for patients. These consumer protections need to be implemented in the right way, and this misses the mark.”
Federation of American Hospitals
September 30, 2021 // FAH President and CEO Chip Kahn forcefully calls out the Administration in a statement, saying, “The interim final regulation issued today to implement the No Surprises Act is a total miscue. It inserts a government standard pricing scheme arbitrarily favoring insurers. For two years, hospitals and other stakeholders stood shoulder to shoulder with lawmakers to develop legislation that would protect patients from surprise medical bills, and last December, Congress passed a bill with a fair and balanced payment dispute resolution process. This regulation discards all of that hard work misreads Congressional intent, and essentially puts a thumb on the scale benefiting insurers against providers and will over time reduce patient access.
American College of Radiology
September 30, 2021 // In a poignant statement, ACR President Dr. Howard Fleishon states, “Making a health plan’s calculated ‘qualifying payment amount’ — which does not reflect real world payment rates — the primary factor in independent dispute resolution arbitration will…reduce patient access to care, regardless of their insurer. This rule violates the intent, if not the actual letter, of the No Surprises Act and shatters a rare bipartisan, industry-wide agreement for equitable provider-insurer dispute resolution.”
Requirements Related to Surprise Billing; Part I
Grassroots Emergency Medicine
Follow their timeline to see deadlines for the legislation’s key regulatory issues.
American Medical Association
Letter from AMA CEO Dr. James Madara to Administrator Brooks-LaSure focusing on the implementation of the independent dispute resolution (IDR) process, the notice and consent requirements, and the determination of a specified state law.
Letter from AMA CEO Dr. James Madara to Administrator Brooks-LaSure offering comments on sections 111 and 112 of the No Surprises Act — the advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements.
Letter from AMA CEO Dr. James Madara to Acting Administrator Richter providing input on the Qualifying Payment Amount (QPA) and related calculations in the No Surprises Act.
Reps. Tom Suozzi, Brad Wenstrup, DPM, and 95 Other Members of Congress
Letter from 97 members of the House of Representatives urging Secretaries Becerra, Yellen, and Walsh to not only reflect congressional intent in their rulemaking by ensuring a balanced process to settle payment disputes between health plans and providers, but also ensure an IDR process that captures the unique circumstances of each billing dispute and does not cause any single piece of information to be the default one considered.
Medical Society of the State of New York
Letter from MSSNY President Dr. Joseph Sellers to Secretary Becerra, Secretary Yellen, Secretary Walsh, and Administrator Brooks-LaSure providing comments on the No Surprises Act.
U.S. House Committees on Ways and Means, Energy and Commerce, and Education and Labor
Joint document from three congressional committees of jurisdiction outlining specifically Congress’ intent regarding what the No Surprises Act does and does not do, as well as how the law works.
Centers for Medicare & Medicaid Services
Definition of “customary charges,” which, for these regulations, must be limited in definition to the current legal definition and commonly understood meaning.
Federation of American Hospitals
Letter from FAH President and CEO Chip Kahn to Secretaries Becerra, Walsh, and Yellen reiterating support of the No Surprises Act and offering recommendations for implementation of the independent dispute resolution (IDR) process under the law.
Letter from FAH President and CEO Chip Kahn to three members of President Biden’s Cabinet stating that it is imperative that the implementing regulations and dispute resolution process advance and actively maintain…fairness so as not to inappropriately advantage health plans at the expense of patients and their health care providers.
American Society of Anesthesiologists
Letter from ASA President Dr. Beverly Philip offering comments on the No Surprises Act, Public Law Number 116-260, as the Departments of Health and Human Services, Labor, and Treasury develop regulations to implement the new law.
American College of Radiology
Letter from ACR President Dr. William Thorwarth to Secretary Becerra submitting initial thoughts and input as the Departments of Health and Human Services, Labor, and Treasury begin implementation of the No Surprises Act.
Sens. Bill Cassidy, MD and Maggie Hassan
Letter from Sens. Cassidy (R-LA) and Hassan (D-NH) urging the Biden Administration to implement legislation to end the practice of surprise medical billing according to congressional intent. Sent to Health and Human Services Secretary Xavier Becerra, Treasury Secretary Janet Yellen, and Labor Secretary Marty Walsh, the senators highlight several key areas of the No Surprises Act, which passed as part of the Consolidated Appropriations Act of 2021.
American College of Emergency Physicians and Emergency Department Practice Management Association
Letter from ACEP President Dr. Mark Rosenberg and EDPMA Board Chairman Dr. Bing Pao to Secretaries Becerra, Yellen, and Walsh providing additional input to inform the departments’ deliberations as they draft the provisions related to IDR that
have yet to be released.
Letter from ACEP President Dr. Mark Rosenberg and EDPMA Board Chairman Dr. Bing Pao to Secretary Becerra providing technical comments on two important areas: 1.) information necessary to accurately bill patients for out-of-network emergency services; and 2.) important considerations regarding the timelines Included in the No Surprises Act.
Letter from ACEP President Dr. Mark Rosenberg and EDPMA Board Chairman Dr. Bing Pao to Secretary Becerra.
Reps. Raul Ruiz, MD and Larry Bucshon, MD
Letter from Reps. Ruiz (D-CA) and Bucshon (R-IN) to Secretaries Becerra, Walsh, and Yellen reaffirming congressional intent and asking the Administration to refrain from issuing guidance or taking any other action that would give preference to one arbitration factor over any of the others.
American Hospital Association
Letter from AHA offering initial recommendations to the Departments of Health and Human Services, Treasury, and Labor as they develop guidance to implement the No Surprises Act.
California Hospital Association
Public comments from CHA Vice President of Federal Policy Chad Mulvany to Secretaries Becerra, Yellen, and Walsh on the No Surprises Act’s Proposed Rule, “Requirements Related to Air Ambulance Services, Agent and Broker Disclosures, and Provider Enforcement”.
Letter from CHA Vice President of Federal Policy Chad Mulvany to Secretaries Becerra, Yellen, and Walsh offering 24 pages of technical recommendations for the No Surprises Act’s implementation.
Children’s Hospital Association
Letter from CHA Vice President of Policy Analysis Aimee Ossman to CCIIO’s Jeff Grant, Labor’s Ali Khawar, and Treasury’s Wally Adeyemo stemming from a providers’ stakeholder call on the No Surprises Act.
Association of American Medical Colleges
Letter from AAMC Chief Health Care Officer Dr. Janis Orlowski to Secretaries Becerra, Yellen, and Walsh providing initial input on implementation of the No Surprises Act.
American Association of Orthopedic Surgeons
Letter from AAOS President Dr. Joseph Bosco to Secretary Becerra and Acting Administrator Richter regarding the upcoming rulemaking on the No Surprises Act.
National Association of Freestanding Emergency Centers
Letter from NAFEC Executive Director Brad Shields to Secretaries Becerra, Walsh, and Yellen with initial comments regarding the implementation of the No Surprises Act.
California Medical Association
The California Medical Association (CMA)’s surprise medical bill letter to Congress offers a compelling case as to why policymakers must fix this issue the right way. CMA is urging Congress to develop a more balanced approach that ends balance billing but does not give insurers unilateral control of the market that causes more out-of-network care.
Warning of its own experience, CMA writes “Under California’s surprise billing law (AB 72, 2017), insurance company physician networks are diminishing, patient access to in-network physicians is declining, patient access to emergency physicians and on-call physician specialists is in jeopardy, patient deductibles for out-of-network care are increasing, and patient complaints about access to care have increased by almost 50%.”
Coalition Against Rate Setting
The Coalition Against Rate Setting (CARS) is an alliance of like-minded organizations that recognizes the perils of bureaucrats setting prices in the American healthcare system. The Coalition stands in opposition to rate-setting proposals by lawmakers and understands that price-fixing is no solution to the pressing problem of surprise medical billing.
The Coalition also seeks to educate members of Congress and patients about the unintended consequences of government meddling in medical decisions and present the perspectives of doctors and patients to policymakers.
International Union of Operating Engineers
Representing more than 400,000 members, the International Union of Operating Engineers (IUOE) wrote a compelling letter on surprise medical bill legislation to Speaker Nancy Pelosi and Minority Leader Chuck Schumer.
In it, IUOE President James Callahan states, “…It is not necessary to hamstring providers and hospitals in order to rein in surprise medical billing. The State of New York’s law, which creates an independent resolution process to mediate billing disputes, has saved residents more than $400 million and reduced out-of-network billing by 34%…” Callahan also expressed the union’s opposition to rate setting, saying that it “would impose devastating cuts to front line medical providers and tilt the playing field in favor of insurers.”
National Action Network
Addressing surprise medical bills, Rev. Al Sharpton stated in an opinion piece for Morning Consult, “These bills are on the rise – and insurance companies, whose purported role is to protect patients from these costly disasters, are the culprits driving the crisis. They are quietly working to cover fewer essential services, disproportionately harming minority and low-income communities that already suffer from a severe lack of access to healthcare and are more likely to be slammed with surprise medical bills they cannot afford.”
He continued by saying that bills in the U.S. House and Senate, “would set rates below the costs of services provided, meaning patients are on the hook and providers start to go out of business.”
Click below to see an excellent infographic from Rev. Sharpton’s National Action Network on surprise medical bills.
New York State Department of
Financial Services
New York’s Department of Financial Services (DFS) issued this report, New York’s Surprise Out-of-Network Protection Law: Report on the Independent Dispute Resolution Process. DFS worked with various stakeholders – including consumers, providers, and health plans – to pass and implement the groundbreaking out-of-network (OON) law in 2014.
From its implementation in March of 2015 through the end of 2018, the OON law has saved consumers over $400,000,000. The OON law reduced OON billing in New York by 34% and lowered in-network emergency physician payments by 9%.
Out of the Middle
In a letter sent to Congress, nearly 900 smaller and independent physician practices across medical specialties outline the potentially devastating unintended consequences that certain legislative proposals to solve surprise bills could have on physicians’ ability to care for patients in our communities.
Smaller and independent physician practices are vital to our communities. In addition to employing thousands of people across the country, they often are the only source of care in rural and under-served areas.
Capital Policy Analytics
A selling point of recent attempts to end the incidence of "surprise" medial billing arising from the inadvertent use of out-of-network providers has been that it would increase tax revenue by reducing insurance costs, which would serve to boost (taxable) wage income.
However, that increase in income for employees is offset by an equivalent decrease in taxable income for providers, who are in a higher tax bracket. The offsetting tax revenue loss may completely offset any ancillary tax gains, argue Dr. Ike Brannon and Chester Kowalski of Capital Policy Analytics in their report, The Tax Consequences of Fixing Surprise Medical Billing are Slight.
Georgetown University Health Policy Institute
This study from the Institute’s Center on Health Insurance Reforms, New York’s 2014 Law to Protect Consumers from Surprise Out-of-Network Bills Mostly Working as Intended: Results of a Case Study, explains why New York State’s surprise medical bill law should be a model for the nation.
“New York’s law has been touted as a model for other states as well as potential federal legislation because of its unique “baseball-style” arbitration approach to settling payment disputes, which generated broad buy-in among a set of stakeholders that typically have strongly opposing views.”
Medical Society of the State of New York
New York’s state medical society has raised strong concerns with new surprise billing proposals coming out of Washington.
In a press statement, Dr. Art Fougner, the society’s president, affirmed, “New York’s dedicated physicians remain anxious to work with all parties to ensure a fair federal legislative solution to protect patients from surprise out of network bills. However, far more balance is needed in what has been put forward so far. The proposal released Friday by the US House Ways & Means provides a few marginal steps forward, but would still hand an enormous gift to already market dominant health insurance companies by tilting the factors in its dispute resolution mechanism towards the insurance industry. Even worse, it fails to provide meaningful steps to make sure health insurance physician networks are adequate, to help protect patients from finding themselves in the position in a hospital where they are treated by an out of network physician.”
NDP Analytics
This economic report examines the Congressional Budget Office’s (CBO) assessment of the Lower Health Care Costs Act (S. 1895, Section I) and identifies the unintended negative consequences of the bill. The Act was intended to address surprise medical bills, but in doing so sets price controls for all physicians. CBO’s assumptions are unrealistic, and the bill, if enacted, could have serious impacts on the quality of and access to healthcare.
In An Assessment of the CBO Cost Estimate of S. 1895: The Unintended Economic Consequences of the Proposed Healthcare Price Control System, the authors write, “The CBO cost-savings estimate is based on unrealistic assumptions and fails to account for the negative impact on the number of physicians nationwide. The number of available physicians will drop, and patient quality will be reduced.”
New York Health Plan Association
In a press statement, the New York Health Plan Association (NYHPA) praises hospital out-of-network legislation that will help protect patients from excessive emergency charges.
According to Eric Linzer, the Association’s CEO, “The existing Independent Dispute Resolution process has worked well to ensure reimbursements for emergency services are fair and reasonable whileholding individuals harmless. Unfortunately, the original law did not include charges from out-of-network hospitals, leaving patients saddled with significant unanticipated out-of-pocket costs from some institutions far in excess of what would be considered reasonable.”
Pegasus Institute
The Pegasus Institute, a Kentucky-based think tank, released a report on the nexus of price controls and surprise medical bills.
In this policy primer, “Price Controls and Surprise Billing in Healthcare”, the Institute writes, “Price controls distort the market forces of supply and demand, reducing the accuracy of information providers receive… Historically, price controls have led to consolidation, less innovation, and less access to goods and services…”