In a new letter to the Biden Administration, more than 60 organizations – including AFL-CIO, AFSCME, American Benefits Council, Business Group on Health, Families USA, HR Policy Association, National Education Association, National Retail Federation, Purchaser Business Group on Health, U.S. PIRG, and the Leukemia and Lymphoma Society – applauded the Administration’s ongoing efforts to protect patients from surprise bills. The groups urged the Administration to maintain the vital consumer safeguards included as part of the recent interim final rules for the No Surprises Act.
The letter comes following legal challenges by the Texas Medical Association and Association of Air Medical Services that would undermine and potentially delay implementation of the federal law and consumer protections against an expansive and costly arbitration process.
Highlights from the letter are included below:
- “With the rulemaking process nearing completion, we write to urge the Administration to maintain the vital consumer protections that have been included as part of the recent interim final rules for the No Surprises Act (‘Requirements Related to Surprise Billing; Parts I and II’). These reforms, particularly related to limiting abuse of the independent dispute resolution process (IDR), are essential for promoting comprehensive safeguards against out-of-network charges and lowering health care costs for working families.”
- “Given the recent push by some groups, including those representing Wall Street-backed providers, to reverse or undermine those consumer protections, we want to overwhelmingly express the need for them to be preserved as part of the implementation process. The rules guiding independent dispute resolution cannot be separated from consumer protections; indeed, the thoughtful approach to IDR in the interim final rules is a form of consumer protection.”
- “Surprise medical billing not only represented a widespread market failure, but it reinforced a deeply flawed and exploitative business practice championed by many private equity firms. Research has consistently shown these Wall Street-backed providers, including many specialists, routinely operated out-of-network to demand above-market reimbursement and discourage access to affordable, in-network care. As a result, the over-reliance on out-of-network charges extracted maximum costs from patients, employers and the health system writ large, ultimately driving up premiums for millions by adding more than $40 billion in additional spending each year for those with employer-sponsored insurance.”
- “The experience in the states has been illustrative of the inherent risks to patient access and affordability as a result of the rampant misuse of the IDR process by these same out-of-network providers and private equity firms. In New York, Texas, and New Jersey, consumers have faced inflationary cost pressures as a result of out-of-network doctors and specialists repeatedly relying on IDR to bolster their bottom lines, often leveraging their size and market concentration to the detriment of many, including multi-employer health plans financed by worker contributions.”
- “The No Surprises Act intended to correct this longstanding market failure while also meaningfully lowering premium costs for Americans and preventing abuse of the IDR process. The latest rulemaking faithfully aligns with the statute, particularly with the direction that those involved with the arbitration process ‘must begin with the presumption that the [qualifying payment amount] (QPA) is the appropriate [out-of-network] amount.’”
- “The approach taken in the most recent interim final rules chose patients over private equity and is a meaningful step towards lower health care costs for millions. It preserves the right of all parties to have their unique circumstances heard by an independent dispute resolution entity, recognizes the nuances of health care pricing, and should ensure use of arbitration is limited in practice. The end result will be more in-network care at more affordable rates for workers and their families.”
To view the full letter, click here.