WASHINGTON, D.C. – (August 25, 2023) – Patient, consumer, and employer groups issued statements in response condemning the recent decision rendered in the Texas Medical Association v. United States Department of Health and Human Services case (TMA III), which challenged provisions of the final rule issued on the No Surprises Act.
The groups renewed their calls for supporting and strengthening the No Surprises Act, which has prevented roughly 20 million surprise medical bills
“This ruling is bad for patients, jeopardizing their protections under the No Surprises Act and very likely raising costs. The No Surprises Act has prevented roughly 20 million surprise bills – a small fraction of which have been subject to arbitration and thus affected by the three other lawsuits filed by Texas physicians.” The Coalition Against Surprise Medical Billing (CASMB)
“Yesterday’s ruling in favor of the plaintiffs in “TMA III” challenging how the qualifying payment amount is calculated is distressing & could have massive implications for patient cost-sharing protections & directly raise costs for families protected under the No Surprises Act.” Tweet from Families USA
“The Texas court is muddying the waters with this decision. It could mean that providers can charge our health plans whatever they want because they can expect few to no guardrails if a dispute reaches the arbitration process. Those of us with health insurance could then bear the burden in higher premiums and cost-sharing.” Patricia Kelmar, U.S. PIRG’s Health Care Campaigns Senior Director
“Our organizations were vocal supporters of The No Surprises Act as it was being debated in Congress, and we have continued to defend the Act against profit-driven attacks by filing amicus briefs. As our brief in this case explains, the Act was passed to achieve two important goals: 1) protect patients from surprise medical bills in the most common out-of-network cases and 2) lower or at least contain rising healthcare costs. The means of achieving these goals were highly contested, and the IDR process including the QPA was agreed on as a compromise to carry out the purposes of this bipartisan legislation.
We are deeply concerned that the decision issued on Thursday to strike down the QPA calculation rule puts the interests of a select group of providers, who seek to maintain the status quo of runaway healthcare costs, ahead of the needs of consumers and patients. While the No Surprises Act has prevented an estimated 20 million surprise bills and will continue to do so, Thursday’s ruling could mean patients will pay more when they receive out-of-network services in emergencies and other situations through no fault of their own.” Joint letter from CancerCare, Epilepsy Foundation, Families USA Action, Hemophilia Federation of America, National Patient Advocate Foundation, The ALS Association, The Leukemia & Lymphoma Society, U.S. PIRG