“Mystery Group Puts $13 Million Into Ads On Surprise Health Bills”

Below is an excerpt from Bloomberg Government

A shadowy group has spent more than $13 million since July advertising in states with vulnerable senators to oppose legislation that would rein in medical bills that take patients by surprise.

The campaign by a group calling itself Doctor Patient Unity, playing out on television, radio, and on social media in more than 20 states, is helping muddy the congressional debate over how to combat surprise medical bills and could make it harder to pass legislation this year, congressional aides familiar with the issue said in interviews, speaking on condition of anonymity.

The ad buys represent the most-expensive campaign on any health-related topic Congress has taken on this year, according to data from Advertising Analytics and Federal Communications Commission filings. That they’re targeting lawmakers up for re-election in 2020 sends the message that deep-pocketed interests are paying attention to how lawmakers vote on the issue.

“Ads like these with large budgets behind them effectively serve as a warning that even more money could be used to unseat the legislator if they vote the opposite way,” said Erika Franklin Fowler, who directs the Wesleyan Media Project, which tracks and analyzes political advertising in real time during elections.

The group has made seven-figure advertising purchases in seven states and six-figure buys in six more states. They all warn against “rate setting” and the group’s website urges listeners to contact lawmakers to oppose “stand up to the insurance industry and demand they pay for their fair share.”

Dark Money

Who is ultimately paying for these ads is shrouded in secrecy. The television ads are known as “issue ads” and therefore don’t require Federal Election Commission disclosure.


Fight Over Medical Billing

The ads come amid a flurry of activity on surprise medical billing. House and Senate committees have approved legislation to ban what’s known as balance billing, where a provider seeks payments directly from patients for charges their insurers won’t cover.

Both the House and Senate bills, H.R. 3630 and S. 1895, would require health-care providers in certain emergency circumstances to accept a set rate, based on median rates for those services, when they treat patients as out-of-network providers.

Some senators, including some of those targeted by Doctor Patient Unity such as David Perdue (R-Ga.), have backed surprise medical billing legislation (S. 153) that takes a different approach, empowering a third-party arbitrator to settle billing disputes. While the group’s purpose in targeting a lawmaker who opposes rate-setting isn’t clear, it’s a matter subject to change in any compromise measure.

Sen. Thom Tillis (R-N.C.) in a statement said he’ll work to “improve and finalize” the Senate’s surprise medical billing legislation. His office didn’t respond to a request to clarify whether he supports the arbitration or rate-setting approach.

Health-care provider and hospital groups have also pushed back on the rate-setting approach, claiming it unfairly favors insurers and warning it could discourage doctors from practicing in certain areas where the rates would be lowest. These groups have spent heavily to influence the bills this year.

The American Hospital Association has spent almost $10.2 million on lobbying in the first half of 2019, about $1 million more than at the same time in 2018, according to congressional filings. The American Medical Association likewise shelled out $11.5 million on lobbying in the first half of 2019, about a $1 million more than at the same point in 2018.

Health-care providers, particularly specialists, have a lot of money at stake. The Senate version would cut enough costs from the health-care industry to lower insurance premiums nationwide by about 1%, the Congressional Budget Office estimates.

Some lawmakers worry that private companies with lots of capital, such as private equity firms that own health-care provider staffing groups, could be putting their money into opposing the surprise billing legislation.

The private equity firm KKR bought Envision Healthcare, a hospital-based physician group, in 2018 for about $10 billion and Blackstone Group bought TeamHealth, another hospital-based physician group, for $6.1 billion in 2016.

Yale University health economists in 2018 looked at two emergency room outsourcing companies, EmCare and TeamHealth, and found they took advantage of an environment where they could either charge high out-of-network rates to patients or negotiate higher in-network rates with insurers.