Lawmakers, Leading Consumer Organizations, Employer Groups, Policy Experts, and Health Insurance Providers React to Recent Ruling in Texas Medical Association v. the United States Department of Health and Human Services

Last week, a federal judge in Texas overturned a key component of the No Surprises Act, striking part of the regulations that govern how much health insurance providers will pay doctors once the patient is taken out of the middle.

The lawsuit, one of six filed by health care providers challenging the No Surprises Act, undermines important parts of the law that were written to shield patients from the higher costs that have resulted because of surprise medical bills, which for years have brought financial hardship to Americans and their families. If the ruling prevails, private equity and out-of-network providers will succeed at the expense of patients and families who deserve affordable access to high-quality care.

Lawmakers, leading organizations representing patients, employees, union members, and health insurance providers reacted to the ruling, expressing their concern how any efforts to change provisions in the law or implementing regulations could result in serious financial harm to patients.

 

 

• “Yesterday’s ruling on implementation of the No Surprises Act threatens patient protections against surprise medical bills and will raise health care costs for Americans at a time inflation is already soaring. I am disappointed in the court’s decision to block the rule. As the Committee of jurisdiction over employer-sponsored health plans, the Committee played a leading role in the development of the No Surprises Act. It was always Congress’ intent to protect patients and properly balance the interest of all stakeholders, which is what the rule accomplishes. The courts should not delay in expeditiously overturning this misguided ruling.” – Representative Virginia Foxx (NC-05)

 

• “The decision in Texas Medical Association v. the United States Department of Health and Human Services is extremely disappointing and puts the interests of some select providers and their private equity allies over those of patients, consumers, and families. By removing important guardrails from the payment dispute resolution (IDR) process, it increases the risk that providers will try to obtain higher, inflated rates, leading to increased health care costs and higher premiums for consumers. The No Surprises Act is a landmark law that protects people from egregious provider payment abuses, while ensuring fair payment for health care services. This lawsuit was a clear attempt to water down the law and chip away at the critical protections it provides for so many families who have been devastated by a surprise bill. We’re still evaluating the full impact on families across the country, and while patients will maintain the hard-fought protections from out-of-network balance bills, this decision will likely cause higher premiums down the line. At Families USA Action, we believe that no one in America should face financial ruin simply because they received care at a hospital that wasn’t in their insurance network. We will continue to work with stakeholders and the Biden administration to put patients’ rights over industry profits, and ensure the law works, as intended, to fully protect patients and their families from unfair, surprise medical bills and related increased costs.” – Families USA Action

 

• “The Eastern District of Texas court’s interpretation of the Biden Administration’s regulation will have significant potential to increase overall healthcare costs by allowing providers to essentially demand payment at whatever rate they want with no regard for market dynamics. This will undermine the efforts employers have been taking for years to lower – or at best stabilize – healthcare costs. The actions by one judge in one federal judicial district may be far-reaching and make healthcare access and affordability even worse for American families. As a stakeholder in the Coalition Against Surprise Medical Billing, the National Alliance calls for an end to predatory price gouging as patients deserve affordable access to high-quality care. If this decision were to stand, employees and their families would face a continuation of indefensible and surprising healthcare bills and continued rising healthcare premiums.” – National Alliance of Healthcare Purchaser Coalitions

 

• “While the ultimate impact will depend significantly on how arbitrators tend to decide arbitration claims, unless the Texas Medical Association ruling is overturned or removed by future rulemaking, the likely impact is higher costs for employers, employees and their families. An arbitration system that fails to anchor decisions around the market rate will likely lead to more decisions being made in favor of providers with offers well above the market rate, and those decisions will lead to substantially enhanced leverage for providers in contract negotiations. Why go in-network at market rates, when you can stay out of network and achieve significantly higher prices through arbitration? To cope with this dysfunctional system, self-insured employers will be forced to increase their own in-network payment rates for specialties capable of surprise billing, driving up costs and ultimately harming employees and their families.” – Purchaser Business Group on Health

 

• “Prior to the bipartisan No Surprises Act, which went into effect on Jan. 1, 2022, millions of patients received surprise medical bills each year through no fault of their own, exposing them to unaffordable out-of-pocket costs and increasing premiums for everyone. Powerful hospitals and provider groups — many of which are private-equity-backed — are now suing to water down the law’s consumer protections. This subset of providers is attempting to maintain the profits they have made off the predatory practice of surprise billing at the expense of patients and families. Based on evidence from the states, yesterday’s decision will make health care more expensive for consumers and employers and only serves to benefit providers who are focused on protecting their profits. According to congressional committee chairs in the House and Senate with jurisdiction over the No Surprises Act, the Administration has implemented the law consistent with congressional intent. We continue to support the efforts of the Administration to implement these important patient protections in a way that improves the affordability and accessibility of health care.” – Arnold Ventures

 

• “For years patients have been hit with surprise medical bills from private-equity backed providers. By taking away the protections of the No Surprises Act, patients and families will see higher premiums and higher out-of-pocket costs because of predatory price gouging. Yesterday’s decision hurts patients by making health care more expensive and benefits private-equity and out-of-network providers, whose court challenges demonstrate they care more about protecting their own profits. Patients deserve affordable access to high-quality care, not being saddled with the higher costs that will undoubtedly result if this lawsuit prevails.” – Coalition Against Surprise Medical Billing

 

• “No one should ever face a surprise medical bill that can lead to financial ruin. Before the No Surprises Act went into effect on January 1st, millions of patients faced surprise medical bills they did not expect from doctors they did not choose at prices they could not afford. Congress passed the No Surprises Act overwhelmingly on a bipartisan basis to ensure patients would be protected from surprise medical bills, while also ensuring that health care remained affordable and accessible for everyone. Unfortunately, private-equity-backed providers and others, like hospitals and emergency room physicians, who have long profited from sending patients surprise bills are doing everything they can to protect their profits. They have sued to stop the implementation of rules that would lower the cost of health care for everyone, defending their own financial interests over the consumers and patients they serve. And this wrong and misguided ruling will result in higher health care costs and premiums for consumers and businesses – once again threatening health care affordability and access for all Americans. It is unconscionable for providers to fight to weaken protections for patients who deserve to be protected from surprise medical bills, and to exploit the arbitration process to pad their bottom lines. AHIP continues to fully supports the Administration in its defense of the No Surprises Act and the interim final rule, and we will continue to support the Government’s defense of the rules in other courts.” – AHIP

 

• “The No Surprises Act protects patients from costly and unanticipated surprise medical bills. This lawsuit could have real implications, and the Texas court’s decision risks the affordability and accessibility of health care for everyone. The American people want affordability in the health care system, and they support Congress’s actions in passing the No Surprises Act. We disagree with this lawsuit and will continue to support the administration’s approach in the interim final rule.” – Blue Cross Blue Shield Association 

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