As Congress Debates Fixes To Surprise Billing, Doctors Push To Protect Their Pay : Shots - Health News As lawmakers consider bills to protect patients against surprise medical bills, doctors have waged a stealth on-the-ground campaign to win over members of Congress. Here's how they did it.
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Doctors Push Back As Congress Takes Aim At Surprise Medical Bills

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Doctors Push Back As Congress Takes Aim At Surprise Medical Bills

Doctors Push Back As Congress Takes Aim At Surprise Medical Bills

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STEVE INSKEEP, HOST:

Today, a committee in the House of Representatives considers legislation that could change the price of your next hospital visit. Lawmakers are under pressure to protect patients against surprise medical bills. The idea here is to pass legislation that would guard you from paying quite so much when you have to get treatment that goes outside of your insurance coverage. Rachana Pradhan from our partner Kaiser Health News has been covering this story, and she's in our studios. Good morning.

RACHANA PRADHAN: Good morning.

INSKEEP: What's the problem?

PRADHAN: So in some situations, a patient will go to a hospital, for example. Their hospital's in network, and they think everything here is covered. Every doctor I see is in network. But as it turns out, that isn't always the case. So what happens is if there is a doctor that is out of network under their insurance, the patient doesn't have any knowledge, and then all of a sudden, they are facing this huge bill - it can often be in the tens of thousands of dollars - that they didn't know that they were going to have to pay.

INSKEEP: Key point here - this is something that happens without their knowledge until afterward. But what can legislation do about this?

PRADHAN: Well, Congress is pretty much in agreement that patients should not have to pay these kinds of bills because they can suffer so much financial pressure from them. They disagree when they're asked then, well, which part of the health care industry should have to pay for a fix if you were going to take the patient out of the middle?

INSKEEP: I guess, in that example, there's the hospital. There's the individual doctor. There is the health insurance company that didn't cover that particular treatment - lots of options here.

PRADHAN: Right. And also one big industry group that we should also mention in this are large companies, employers who pay for health insurance for their workers. They also have a very large financial stake in this debate.

INSKEEP: So there are different bills that would leave different groups on the hook, is that right?

PRADHAN: Yes. There are multiple proposals being considered in Congress at the moment. And they each treat this issue somewhat differently. The unifying theme is that patients are always held harmless. They will not have to pay these huge medical bills. But the question is then all the other details for who pays the price.

INSKEEP: You said that there is widespread agreement in Congress about which there's agreement about so little widespread agreement that something should be done. Why hasn't it been done?

PRADHAN: Well, one of the big reasons is there has been a very long influence campaign from doctors and hospitals who want lawmakers to develop proposals that wouldn't hurt them financially.

INSKEEP: You just said doctors are lobbying here. Is there something ironic? Because if people like anybody in the health insurance system, in the health care system, it is their individual doctor - their individual doctor is also campaigning to make sure that they still have to pay this bill?

PRADHAN: Right. Well, I think what's important to remember about this are two things. Hospitals and doctors, they have a lot of clout with lawmakers on Capitol Hill. And it is because they often provide lifesaving, very critical medical care when people need it, and that resonates very much with lawmakers on both sides of the aisle. This isn't a partisan issue at all. But they also have their financial interests. They operate in systems where they have to get paid. And so that also matters to these industries.

INSKEEP: Have you been able to track the way that doctors, groups, have been able to make their influence felt?

PRADHAN: So there are a few ways. One of the most splashy ways that we've seen is there have been a lot of TV ads and Internet ads that have been going on for months warning of the dangers of things like government rate setting and rural hospitals being in jeopardy depending on what the proposal is. But there are other ways, too, that don't get as much attention. Doctors, they will have fly-ins where they come into Washington and they meet with their lawmakers and talk to them about this. They'll host fundraisers. They will have dinner. Washington often functions on relationships. And I think that there's all this other work that happens more behind the scenes, I think, and doesn't get as much attention but is very effective.

INSKEEP: Is this a really subtle game in that each different interest group will get in there and say, listen, this is a real problem, we're happy to have you fix it, just hold us harmless?

PRADHAN: Yes. That's basically what has been going on now for more than a year. And there is momentum behind legislation. And I do think lawmakers are not that far apart as far as the policy details. But until you have an agreement, you don't have an agreement. And that's enough to derail anything in Congress. You need to have some widespread support usually for one measure. Otherwise, things don't happen.

INSKEEP: Rachana Pradhan of Kaiser Health News, thanks for the update.

PRADHAN: Thank you for having me.

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