After facing billions of dollars in surprise medical bills, consumers and employers now have protection against these unfair charges. Yet, a series of legal threats from providers, hospitals and air ambulance companies threaten the core elements of the No Surprises Act (NSA) that will lower health care costs for patients.
In response to the first legal challenge from the Texas Medical Association (TMA), congressional leaders and groups representing policy experts and millions of Americans across the country filed amici briefs in support of the Biden administration’s rulemaking process and the protections included as part of the No Surprises Act. Highlights from their briefs are included below:
- “Congress sought to address two interconnected issues in passing the NSA: patients often receive unaffordable, unexpected medical bills and the cost of health care in the United States has risen dramatically in the last decade. Addressing the former without consideration of the latter would merely pass the costs of surprise medical bills onto patients, employers, and the government in the form of higher insurance premiums—an unacceptable outcome to amici and the other leaders of the effort. To ensure any legislative fix would not balloon health insurance premiums and instead drive down health care costs, each committee considering the issue reached the same conclusion: regardless of the specific process used, median in-network rates should play a significant role in determining payment amounts in the event of disputes between out-of-network providers and payors. As a result, this solution, in the form of the QPA, became a central component of the final legislation. In implementing the law, the agencies have correctly given the QPA priority in the arbitration (IDR) process.”
- “Tying the IDR process to the QPA will help ensure that the premiums patients pay will remain steady or decline, one of Congress’s express intentions when drafting the NSA. Moreover, the September IFR provides greater predictability as to the result of the IDR process, which in turn will encourage parties to settle without resorting to IDR as often and lessen the administrative costs borne by the system. And, contrary to plaintiffs’ assertions, focusing primarily on the QPA will not result in providers receiving below-market payment for their services, nor will it reduce patients’ access to in-network providers. Instead, the September IFR ensures that the NSA corrects the longstanding market inefficiencies that Congress sought to eliminate.”
American Benefits Council, Business Group on Health, Council of Insurance Agents and Brokers, DFW Business Group on Health, ERISA Industry Committee, HR Policy Association, Houston Business Coalition on Health, National Alliance of Health Care Purchaser Coalitions, National Retail Federation, Purchaser Business Group on Health, Self-Insurance Institute of America, Texas Business Group on Health, UniteHere
- “The IDR process set out in the IFR is necessary to ensure that the NSA protects against premium increases and results in lower health care costs as Congress intended. This is because the IDR process under the IFR, which like the statute gives the QPA a central role, will help protect against incentives for providers to leave or remain out of networks which in turn will eliminate unnecessary costs and premium increases for the consumer by correcting the market- failure that allowed providers to charge inflated rates, as intended by the NSA.”
Leukemia & Lymphoma Society, The ALS Association, Cancer Support Community, Community Catalyst, Crohn’s & Colitis Foundation, Epilepsy Foundation, Every Texan, Families USA Action, Hemophilia Federation of America, The Mended Hearts, Inc., National Multiple Sclerosis Society, National Patient Advocate Foundation
- “Vacating the challenged portion of the Rule, as Plaintiffs seek, would result in an unpredictable and administratively burdensome IDR process, the costs of which will be borne directly by patients and their families in the form of higher premiums. Without the Rule’s presumption that the QPA is the appropriate payment amount in most cases, arbitrators would be left without a clear, consistent way to balance the statutory factors. Both providers and payers would lose the uniform expectations that the Rule’s IDR process establishes, leading to less predictable outcomes and increasing the likelihood of above-market payments to out-of-network providers. Providers would then be incentivized to remain out of network and use the IDR process to obtain a higher payment instead of negotiating for a reasonable, market-based payment. These higher payments, combined with the administrative costs associated with the IDR process, would be passed along to patients in the form of higher premiums. Vacatur of the Rule would thus perpetuate the cost crisis that the NSA was expressly designed to remedy.”
- “AHIP strongly supports Congress’s decision in the No Surprises Act to fix the market dysfunction that saddled patients with exorbitant medical bills for services they had no opportunity to turn down. AHIP also agrees with Defendants’ legal arguments that the Act’s fix hinges on anchoring disputed out-of-network rates to the qualifying payment amount’ (QPA), absent credible information otherwise. The QPA reflects competitive, fair market rates, and Plaintiffs’ unbounded alternatives would create the very problems the Act aims to remedy.”
- “The plaintiffs here complain that the primary role of the QPA in the IDR process will affect the market landscape for healthcare services. But this argument misses the point. Congress fully understood that the status quo is a market highly susceptible to distortion by the inability of patients to choose their providers based on cost, and that Surprise Billers have exploited that opportunity in a manner that has inflated healthcare costs for patients. Congress rejected that status quo, and the IFR ensures that patients will enjoy the benefits that Congress intended.”
To learn more about the importance of No Surprises Act’s consumer protections, click here.