Physician groups play hardball opposition against surprise billing fixes

Physician groups are willing to make the entire effort go down in flames rather than have their income limited.

By Marlene Satter | August 29, 2019 at 12:03 PM

Men at business meeting According to one congressional aide close to the negotiations, "it's not a matter of tweaks to get providers to stand down, it's that provider groups don't want to see a solution here. They want the status quo."

Congress may be attempting to take action against surprise bills that prove to be the financial undoing of so many consumers, but not if physician groups have anything to say about it.

And they're saying as much as they can, as loudly as they can, according to a report in Modern Healthcare. In fact, according to congressional staff, physician groups are willing to make the entire effort against surprise billing go down in flames rather than find themselves on the receiving end of efforts to curtail how much money they can make.

Related: What to do about surprise bills? It's not so clear-cut.

According to Modern Healthcare, it's not just physician groups' public relations and advertising that's pushing back hard against any sort of action. There's also lobbying and the influx of dark money, too, to ads against lawmakers, particularly vulnerable senators, in their home districts. And the American Hospital Association is asking members to "go directly to their representatives and senators to lobby against the benchmark proposal."

According to one congressional aide close to the negotiations, "it's not a matter of tweaks to get providers to stand down, it's that provider groups don't want to see a solution here. They want the status quo. They've charted out where Congress could end up, and they are ready for the whole thing to come down. For them, surprise billing can stay in the mix."

Another staffer said that the massive effort is causing policy aides to doubt whether providers actually want any action at all. That staffer is quoted saying, "Our question is, what happened to their commitment to protecting the patients? It shows just how big of a cash cow this practice is, that they're willing to pour millions of dollars into fighting these bills."

Provider groups deny that, with Chip Kahn, CEO of the Federation of American Hospitals, which represents for-profit hospitals, quoted saying, "We want to see legislation. It's a problem we can't solve ourselves—I wish we could—and we need legislation to ensure patients don't suffer from sticker shock, that their copayments are reasonable and within the bounds of their coverage."

But neither the proposed "benchmark" solutions proposed by Senate and House health committee leaders, nor a limited arbitration proposal, are making much headway at present, with efforts focused in apparent ploy to keep votes from occurring at all. The benchmarking proposals are being characterized in ads and other campaigns as "rate-setting," and efforts focused on Democrats say that benchmarking could "undercut the health safety net."

Even lobbyists are somewhat concerned about the turn the battle is taking, with the report quoting one who said, "The fact that industry on both sides could scare Congress into inaction on an issue that is financially ruining Americans through no fault of their own is unconscionable." That provider lobbyist, the report adds, "wants a 'split the baby' policy that 'doesn't destabilize the relationship between providers and payers.'"

"What we've seen (from industry) is, 'First, protect me financially. And to the extent we can then take patients out of the middle, that's great," Shawn Gremminger, senior director of federal relations for the consumer advocacy group Families USA told Modern Healthcare.

Millions and millions are being spent on this August push against surprise billing legislation. The losers are sure to be consumers.

NOT FOR REPRINT

© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.

Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.

By Alan Goforth | May 16, 2025

Seventy-one percent of Gen Z, 68% of millennials and 69% of Gen X report experiencing anxiety over finances.

Record financial anxiety grips U.S. adults, taking toll on mental and physical health

By Allison Bell | May 16, 2025

The common theme at the maker of Wegovy and at UnitedHealth may be investors' sudden awareness of cost-cutting pressure.

Health care giant, Novo Nordisk, pushes its CEO out

By Allison Bell | May 16, 2025

California's governor vetoed an earlier private equity health care deal bill in 2024.

California Assembly approves private equity health care deal reporting bill
Address Your Clients' Evolving Long-Term Care Needs Effectively link

Guide

Sponsored by Trustmark Voluntary Benefits

Demographic shifts and rising costs make long-term care (LTC) a critical concern for employees of all ages. Equip yourself with insights into the LTC challenge and discover flexible hybrid solutions to help your clients prepare.

Broker's Guide to Mastering Client Open Enrollment & Boosting Employee Experiences link

Guide

Sponsored by isolved

Your HR clients often face common open enrollment pitfalls, such as administrative burdens and inadequate employee communication--leading to negative employee experiences. Learn how you can help your clients address these gaps. This guide offers brokers actionable insights to advise on streamlined processes and effective communication plans that will foster employee (and client!) satisfaction.

Employer Trends Across the Benefits Landscape: An HR Pulse Survey link

Report

Sponsored by New Benefits

Rising costs & low engagement challenge employers. This HR Pulse Survey reveals key trends from HR leaders across various industries and looks at the opportunities for brokers to elevate service, address pain points, and demonstrate ROI, especially with non-insured benefits.