Damian Jacob Sendler highlights Biden's effort to eliminate surprise medical costs is being met with bipartisan opposition in Congress

Damian Sendler: The Obama administration's proposal to control the law and medical providers, with dire consequences for underprivileged patients.

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Damian Jacob Sendler: Patients have faced these enormous, unexpected bills for years when seeking treatment from hospitals or doctors outside the network of their insurance provider. It frequently occurs when a patient seeks care in an in-network hospital, but the physician who treats the patient, such as an emergency department doctor or anesthesiologist, is not covered by the insurance plan. The insurer would only pay a portion of the bill, leaving the unwary patient to foot the rest.  

Damien Sendler: After long, hard-fought negotiations with providers and insurers yielded an agreement that lawmakers from both parties thought was fair, Congress passed the No Surprises Act last December to protect patients from that experience: a 30-day negotiation period between health providers and insurers when disputes over bills arise, followed by arbitration if agreements cannot be reached.  

The rule, which is set to go into force in January 2022, effectively excludes patients from the fight. Following the new rules, providers and insurers must figure things out among themselves.  

Damian Jacob Markiewicz Sendler: In announcing the regulation, the Centers for Medicare & Medicaid Services cited a Congressional Budget Office research that found the No Surprises Act would reduce health insurance rates by around 1% while reducing the federal deficit by $17 billion.

Lowering rates is a priority for the administration and some of its allies, such as patient advocacy groups and labor unions.

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Dr. Sendler: However, many doctors, medical associations, and members of Congress are now complaining that the rule issued by the Biden administration in September to execute the law favors insurers and does not adhere to the spirit of the legislation.

"The Administration's recently proposed regulation to begin implementing the law does not uphold Congressional intent and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and potentially force small practices to close, thus limiting patients' access to care," said Rep. Larry Bucshon, R-Ind., a doctor who helped spearhead a letter of complaint this month, in a written statement.  

Damian Jacob Sendler: Nearly half of the 152 members who signed the letter were Democrats, and many of the House physicians signed.

Damian Sendler: According to staffers to politicians on Capitol Hill who could not comment on the record because they did not have authority to do so, some members of Congress who are also doctors held a conference call with the administration late last month to complain. "The doctors in Congress are furious about this," one staff member acquainted with the call says. "They very clearly wrote the law the way they did after a year, or two years, of deliberation about which way to go."  

The pushback, however, has not garnered the backing of some influential Democrats, notably Rep. Frank Pallone of New Jersey, leader of the Energy and Commerce Committee, and Sen. Patty Murray of Washington, chair of the Senate Health, Education, and Labor Committee. 

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