“It’s unacceptable”: Sen. Maggie Hassan explains her plan to end surprise ER bills

There is a growing outcry on Capitol Hill over surprise emergency room bills — and more senators on both sides of the aisle who want to do something about it.

Here’s the basic problem: As Vox and others have reported, in-network emergency rooms are often staffed by out-of-network doctors. This can lead to hefty bills for patients who think that their providers are covered.

Sen. Maggie Hassan (D-NH) introduced a bill this month that would aim to end surprise emergency room bills. She says her bill was inspired by Vox’s database of 1,600 emergency room bills and the stories written about it.

Her bill follows on a separate proposal from a bipartisan group of senators including Sens. Bill Cassidy (R-LA) and Claire McCaskill (D-MO), which would also look to put a stop to big bills from out-of-network providers working at in-network emergency rooms.

While the two bills aim to do the same thing (prevent surprise bills in the emergency room) they take different policy approaches. The Cassidy-McCaskill proposal essentially bars out-of-network providers from billing patients directly. Instead, they would have to seek payment from the health insurer, who would be required to pay a price similar to local market rates. (I’ve written in greater detail about how this works here).

The Hassan bill also bars out-of-network doctors from seeking payments from patients. But what happens next is pretty different. The Hassan bill requires the provider and the insurer to go through a “baseball-style” arbitration process, named for the method that Major League Baseball uses to settle salary disputes.

Under her bill, both the insurance plan and the provider come up with a number they think is a fair price for the medical services provided. They are not allowed to change this number later; it is a final offer. An impartial arbiter then decides which price is the right one and issues a decision. The health plan then pays the provider the agreed upon amount.

“You tell each side you give us your best, final offer and we’ll decide between the two which one is reasonable,” Sen. Hassan said in a recent interview. “It reverses the incentive to quote the highest bill.”

Sen. Hassan’s proposal looks pretty similar to how some states deal with out-of-network bills. New York and (more recently) New Jersey both have similar, binding arbitration processes for resolving these type of disputes.

I recently spoke with Sen. Hassan about her new bill, where she thinks it’s heading next, and the role of Vox’s ER Billing Database in all this. What follows is a transcript of our conversation, lightly edited for clarity and length.

I’d like to start with how you got interested in emergency room billing. How did you decide that this is something you wanted to introduce legislation on?

It’s unacceptable that people in New Hampshire or anywhere in the country are faced with surprise medical bills, surprise bills for care they thought was covered or in-network. This is a fight between the insurance plan, and the provider with the patient stuck in the middle. It shouldn’t be an issue that the consumer gets stuck with. We know from recent surveys that surprise medical costs are one of the top issues facing consumers. And your reporting, I think, has helped bring attention to the issue. It really wasn’t getting enough attention from policymakers.

Let’s talk about the policy that you settled on, which is different from some other bills floating around on this topic, like the one from Sen. Cassidy that you mentioned. Your bill would require insurers and providers to go to an impartial arbiter, name what they think is a fair price, and let the arbiter decide which price to go with. Why is that a good policy solution?

I thought it was important to think of a way we could remove the consumer from what is really a dispute between a provider and a health plan. That requires some kind of mechanism to reach an agreement about what the bill should be. In a system where charges are often not connected to market forces, it seems like an opportunity for an independent dispute resolution process. You essentially use the baseball model [which gets its name from the way Major League Baseball settles payment disputes between players and teams].

This is pretty different from the idea that Sen. Bill Cassidy and Sen. McCaskill are proposing in their bill, which would essentially use existing health care prices to set limits on what out-of-network providers could charge. What do you like better about your approach?

First, I want to say that I appreciate there is bipartisan interest in this issue. And I really do look forward to working with my colleagues to address this issue in some kind of comprehensive package of legislation.

The thing that concerns me about their approach is that we have a baseline where the rates are already quite high. They’re using numbers that are already detached from market forces, and too high in many instances. So I’m concerned we might just end up propping up health care inflation if we go that route. They might have comments on our approach too.

So where do things go from here? How does something like this make its way to becoming law?

We have senators and staff talk through the issue. I think what we’ll be looking for on the HELP committee is a hearing on some of these ideas. We’ve had a number of hearings on health costs generally, but I think members of both parties will be asking to open up hearings on this specific issue of surprise billing. Given the bipartisan attention, the fact we’re hearing story after story about this, it needs to be addressed.

I recently had a constituent write in that she went to the ER with kidney stones, paid according to her in-network requirements, and all of a sudden several months later she gets a bill because the radiologist was out of network. We want somebody with kidney stones having to negotiate in the ER?

I think those kind of examples are going to bring a lot of policy makers to the table.

I don’t think the American public is used to Congress working together in a bipartisan way on health care issues. But it sounds like this could be different?

Well, the HELP Committee just passed comprehensive opioid legislation, we just did the Perkins bill, I think we have a good track record on working across the aisle.

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