September 18, 2023

The Honorable Kevin McCarthy                                             The Honorable Charles Schumer
Speaker of the House                                                              Senate Majority Leader
United States House of Representatives                               United States Senate
Washington, DC 20515                                                            Washington, DC 20510

The Honorable Hakeem Jeffries                                             The Honorable Mitch McConnell
House Minority Leader                                                            Senate Republican Leader
United States House of Representatives                               United States Senate
Washington, DC 20515                                                            Washington, DC 20510     

Dear Leaders:

No one should ever receive a surprise medical bill that can lead to financial ruin. The Coalition Against Surprise Medical Billing – representing unions, employers, and health insurance providers working hand in hand with patients and health care consumers – came together in 2019 to advocate for legislation to protect Americans from surprise bills while also lowering costs.

At the time, certain health care providers were adding $40 billion in unnecessary costs to the health care system through out-of-network charges, and millions of Americans were facing the financial burden and stress of unexpected and unfair surprise medical bills.

Anesthesiologists were charging, on average, 5.8 times the Medicare reimbursement rate, and emergency medicine physicians and pathologists were charging, on average, 4 times the Medicare rate. One study showed assistant surgeons were charging 2600% of what Medicare reimbursed for the same service. These exorbitant costs were foisted on unsuspecting patients, in many instances tipping them into bankruptcy, and were otherwise absorbed in the form of higher premiums.

Thankfully, bipartisan members of Congress listened and passed the No Surprises Act in 2020 to tamp down on this practice by removing consumers from the surprise billing equation and putting affordability and patient needs first.

The No Surprises Act protected Americans from 9 million surprise medical bills in the first 9 months of implementation – about 1 million surprise medical bills a month. By the end of 2023, it is likely that nearly 24 million bills will have been prevented.

However, numerous lawsuits and private-equity backed lobbying groups continue to threaten the law and its cost-lowering measures, including the four recent decisions in favor of the Texas Medical Association. Patients and consumer responded to the most recent ruling:

“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

Voters are concerned over these lawsuits and 82% worry that private equity-backed groups will weaken the patient protections included in the No Surprises Act.

The administration and Congress should celebrate these 24 million victories for patients rather than defend bad actors that are wrapping the arbitration process in red tape and lawsuits. The No Surprises Act should be implemented as Congress intended – to protect patients while lowering costs.


The Coalition Against Surprise Medical Billing