House and Senate lawmakers who have been fighting the brick wall of Mitch McConnell in trying to fix the problem of surprise medical billing see another opportunity—the HEROES Act, or whatever the next coronavirus response bill will be. The CARES Act, the last bill, got rid of surprise billing for coronavirus testing, shifting the cost for testing out of network onto insurance companies instead of the patient. That's a crack that lawmakers want to wedge open to cover coronavirus treatment, and as long as they're doing it for that illness, they just as well do it for everything.
Surprise billing is what happens when a patient is treated in an in-network facility by a not-in-network provider; for example one member of a surgical team, say the anesthesiologist, might work at the hospital that is in the patient’s insurance network but not be individually in that network. Payment for their services can be totally on the patient, and a big unwelcome surprise. One of the problems, besides the heavy-duty lobbying from all sides who don't want to be the ones left holding the bag, is that hospitals that are already struggling because of the COVID-19 crisis could end up with even higher costs.
One of the primary problems for hospitals, even if they're not overwhelmed by coronavirus patients, is that they've had to cancel so many other procedures because of lockdowns. They're simply not getting enough business to pay for operations. The solution there seems obvious—bail hospitals out. Give them the money they need to continue to operate, to keep staff on board and to be ready to treat all the pent-up demand for care once the crisis has abated. And figure out how to fix surprise billing the most straightforward way—rate setting. Give the hospitals all the money in exchange for them backing off and agreeing to a set rate for all procedures and all providers, even if it means some hospitals and some doctors earn a little less.
It's never that easy, however, not when you've got a Mitch McConnell in the pocket of the private-equity backed firms that own so many physician practices and have been spending millions on fighting this simple solution. They're ready to pick up their multimillion-dollar lobbying campaign again, if they have to, to stop it.
Not dealing with it makes no sense, even some Republicans say. "There's a certain irony here that we were able to put into statute that you can't surprise-bill a COVID patient and nobody objected, but if you have a heart condition that pops up and you're out of network, it's okay? I don't think so," Rep. Greg Walden of Oregon, the top Republican on the House Energy and Commerce Committee, told the Wall Street Journal. "We've won the intellectual argument." Perhaps, but not the political one, not yet.