Alexander, House Dem Surprise Billing Plot Foiled

Sen. Lamar Alexander (R-TN) will not privately negotiate with House Democrats to ram through his version of legislation to solve the “surprise medical billing” issue plaguing patients across the country. As we previously reported, Capitol Hill sources said Alexander had grown frustrated with his bill’s lack of momentum and was looking to hatch a plan with House Democrats to insert his controversial version of surprise medical billing legislation into the Medicare extenders package that must pass by the end of September.


But, we have learned that Senate Republican leadership has called on Alexander to stand down.

Conservatives aren’t signing on to Alexander’s Lower Health Care Cost Act because his bill would permit the federal government to set reimbursement rates for out-of-network care providers. This so-called “benchmarking” approach would necessarily reduce the amount providers can get paid. It would literally cap their compensation to the benefit of insurance companies.

As former Congressman Dick Armey writes in the Houston Chronicle:

Allowing government bureaucrats to set prices for out-of-network health care providers across the country is a total abandonment of the free-market values that have helped create such a robust health care system in which roughly 90 percent of Americans enjoy comprehensive health care coverage and benefits. This move toward increasing regulations and growing the size of the federal government is no solution — in fact, it would only create more problems than it solves.

Government rate-setting under this benchmarking approach would ignore the fact that the cost and level of difficulty for performing health care services and treatments varies greatly by region and facility. By setting artificially lower-than-market rates for these services, doctors would essentially be short-changed for the invaluable services they provide. These losses would simply be passed on to our nation’s hospitals and emergency rooms — threatening the financial stability of rural health care facilities in particular.


With Alexander’s legislation stalled, a new lobbying effort appears to be underway making the claim that physicians are attempting to protect the surprise medical billing practice. This is fake news as most physician groups are pushing to end surprise billing through an alternative approach – one they see as fairer to doctors, patients, and hospitals.

That approach would allow third-party arbitrators to settle billing disputes between providers and insurance companies without dragging patients into the middle of it. As Armey further explains:

Fortunately, there are other solutions in Congress that take a more pragmatic approach. Instead of benchmarking, legislation like S. 1531, the STOP Surprise Medical Bills Act, would seek to implement an Independent Dispute Resolution process in order to eliminate surprise medical billing. That’s the same process used in Major League Baseball to settle salary disputes between players and teams.

This approach incentivizes both parties to submit a fair offer for the price of medical services, which incentives them to keep prices down so their offer is chosen. This process takes about 30 days through an online portal, and the patient is left out of the process completely. Until such a time that a final payment is determined, insurers pay providers a temporary interim payment based on the fair market value of the services provided. That provides a layer of financial security that can make all the difference to rural hospitals that operate on razor-thin profit margins.


As insurance company lobbyists and politicians in both the House and Senate get increasingly desperate, expect the attack to continue. Physician groups are not responsible for surprise medical bills. No, surprise billing was created by a flawed health insurance system that offers limited options, narrow coverage networks, and high deductibles. In other words, it is another unpleasant byproduct of ObamaCare. If Congress doesn’t have the stomach to repeal ObamaCare — and it’s obvious it does not — then it should fix surprise medical billing the right way.


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