WHA on Capitol Hill to Discuss Surprise Billing

Asks to remove benchmark rate-setting provisions from legislation

July 23, 2019

WHA hosted a group of hospital and health system leaders in Washington, D.C., on Tuesday, July 16 to discuss proposed federal legislation on surprise billing with Wisconsin’s Congressional Delegation. The group met with all 10 of Wisconsin’s Congressional offices to voice their concerns about the unintended consequences of a provision that would set a benchmark rate for providers in an effort to avoid surprise medical bills being sent to patients.

The group started their day with Congressman Pocan, explaining that while WHA and its members support Congressional efforts to reduce instances of surprise medical bills, the benchmark provision could have the unintended consequence of decreasing access to patients’ preferred providers. Michelle Abey, a constituent of Congressman Pocan, described efforts that her hospital (Stoughton Hospital) already uses to avoid sending patients surprise medical bills. She also noted that insurers would have little incentive to continue contracting with providers who currently negotiate above the median in-network rate. This could lead to those providers being out-of-network if insurers decide to end their contract in order to save money, meaning patients would no longer have that provider in their network.

WHA’s advocates also had very productive conversations with Senators Johnson and Baldwin. Sen. Johnson expressed his desire to hear feedback from WHA and its members about how the bill might impact care delivery in Wisconsin. He noted the difficulty his Senate colleagues mentioned in finding funding to extend important health care priorities, and that this bill was supposedly designed to generate savings, but that Sen. Johnson would like to know our thoughts on the overall impact.

WHA’s group thanked Sen. Baldwin for her work on fighting to ensure strong reforms to bring more transparency and lower costs for prescription drugs, while also protecting the 340B program. Senator Baldwin acknowledged those priorities led to her vote to advance the bill through the committee, but that she was likewise interested in hearing concerns on other aspects of the bill.

Representative Kind let WHA and its advocates know that his Ways & Means health committee may be working on its own tweaks to legislation on this issue. He welcomes feedback as the process continues.

The group also met with Congressman Mike Gallagher, explaining the progress WHA members have made in recent years to give patients more tools to see what their care will cost up-front. Tiffany Huston, a constituent of Gallagher from Door County Medical Center, described their hospital’s new online tool that allows patients to plug in their insurance information and get not only an idea of what they will be charged for their health care, but also how much they will pay out of pocket. Huston also described how the median in-network benchmark rate could make it more difficult for rural hospitals that already struggle with workforce shortages and thin revenue margins.

Overall, the group had a very positive reception from Wisconsin’s Congressional delegation and their staff. WHA is continuing to follow the surprise billing issue closely as legislation continues to move through both the House and Senate.

Contact WHA’s Director of Federal and State Relations Jon Hoelter for more information.

This story originally appeared in the July 23, 2019 edition of WHA Newsletter