An ambulance pulls into the Dallas Fire-Rescue station 37 in Dallas, Wednesday, Oct. 1, 2014.
Photo by LM Otero/AP

As policymakers tackle ‘surprise’ medical bills, ambulances get a pass


In recent months, the policy debate surrounding “surprise” medical bills has spread with impressive speed. The House held its first-ever hearing on the issue in April; federal legislation was unveiled in May; and at the state level, five legislatures have approved new measures just this year.

The heart of the debate is relatively simple: Americans often go to emergency rooms in a crisis and assume their visit will be covered by insurance. But as part of their emergency care, patients are often treated by out-of-network medical professionals, who don’t have contracts with the relevant insurer, which means consumers end up receiving “surprise” invoices, which can be quite expensive.

Policymakers have explored a variety of remedies, mostly dealing with price caps and negotiated pricing among hospitals and insurers, but the New York Times had an interesting piece today noting that none of the proposals deal with ambulatory care – which happens to be the largest part of the “surprise”-bill debate.

Congress has shown little appetite to include ambulances in a federal law restricting surprise billing. […]

Patient groups elsewhere also say they ran into political trouble. Of the five states that passed surprise billing regulations in 2019, only Colorado’s new law takes aim at ambulance billing — not by regulating it, but by forming a committee to study the issue.

“The surprise bills laws are hard enough to get,” said Chuck Bell, program director for advocacy at Consumers Union, who worked to pass a Florida surprise billing law in 2016. “You’re struggling with health plans, hospitals and doctors and other provider groups. At a certain point you don’t want to invite another big gorilla in the room to further widen the brawl.”

In time, I imagine some kind of consumer protections will take shape, though it’s anyone’s guess when.

But NBC News’ Benjy Sarlin raised an important point: “If you want a sense of how hard even the most modest Democratic health care plans will be to pass, look at how much industry resistance politicians are facing just to stop surprise out-of-network bills from ambulances.”

Quite right. In fact, we can also safely take the next step and note that fights like these further strengthen the hand of the most ambitious Medicare-for-All advocates, who’ll likely look at a story like this one and argue, “Let’s just remove private insurance companies from the system altogether.”

Or as Bloomberg News’ Sahil Kapur put it, “For those who don’t understand the resonance of candidacies like Bernie Sanders and Elizabeth Warren, this is a good example. The feeling that the entire system is corrupt because there’s always some special interest with the money and power to block popular policy change.”