D.C. can learn from Washington in fight against surprise billing

2020 was a year of reckoning in Washington state. As the coronavirus took its toll on the state, from the first confirmed case in January, to the first death in February and beyond, the pandemic exposed the stark realities of the country’s healthcare infrastructure. Even more so, it exposed the risk that out-of-pocket costs can have on the well-being of all Americans. Across the country, COVID-19 forced the issue of surprise bills like never before, as case counts and hospitalizations rose to numbers not before seen.

Already, the federal government, with the support of Washington’s Democratic Senator Patty Murray, has taken some steps to address the issues that plague the insurance market and healthcare system. At the end of 2020, Congress enacted a law that beginning in 2022 will protect consumers from surprise bills. And now, Congresswoman Jaime Herrera Beutler, a Republican representing Southwest Washington, and Democratic California Rep. Katie Porter are looking to take steps to protect new mothers from the harm of surprise billing, with a

push for federal legislation to simplify the health-insurance enrollment process for newborns, including creating a standard 30-day coverage period under a mother’s health insurance plan, and a 60-day period to enroll a newborn in their own plan. A worthy plan that Sen. Murray should sign on to, given her support for ending surprising billing practices.

Beyond that, the state of Washington has some of the strongest statewide surprise billing rules in the entire country, with a new law on the books last year banning balance billing; executive orders banning surprise billing and lab fees for COVID-19 tests and vaccines; and a law prohibiting the sale of medical debt to a collection agency for 120 days, and reporting of debt to credit bureaus for 180 days.

The rest of the country has trailed behind Washington. Over the last year, even though COVID-19 testing and treatment is required by federal law to be covered, insurers have been finding loopholes to saddle patients with surprise bills, a practice that the federal government and regulators need to work to stop.

There have been stories in nearly every state of the surprise bills. From the $52,000 charge in Pennsylvania for an air-ambulance ride, to the $4,000 charge for accidentally seeing out-of-network doctors at an in-network facility in Texas, Americans far and wide are impacted by surprise bills and the toxic collection practices that come with them: 35 percent of Americans have reported that they or a loved one received a surprise bill, while 20 percent of nonprofit hospitals will sue for non-payment.

Only 17 states have surprise-billing laws that are stronger than the federal guidance – Washington being one of them – so it’s on Congress and the White House to fill the gap. More needs to be done to ensure transparency in billing and end balance billing. By 2022, there should be strong rules and oversight in place to protect consumers from surprise billing, however, consumers will still have to be vigilant against hospitals that conduct financially toxic debt collection practices against patients.

Washington can serve as a roadmap for further changes at the federal level, particularly around debt collection. And the federal government can continue to push for changes to protect all Americans, including the parents of newborns, from the harmful effects of surprise billing. Vaccines are being administered in record numbers, states are beginning to offer vaccines to all of their residents, and this pandemic will end. What matters next is how our nation’s healthcare system responds to the fault lines that have been made even more clear. Common sense reforms are necessary, and at the top of that list needs to be a focus on reducing out-of-pocket-costs, chiefly with more changes and more accountability around surprise billing.

David Hall is the President of TRIO, an independent, not-for-profit, international organization committed to improving the quality of life of transplant candidates, recipients, their families and the families of organ and tissue donors.