Surprise Billing, Drug Prices Help Drive Health Lobbying Boost

• Groups on pace to spend millions more in 2019 on advocacy
• Specialists seen having large stake in surprise billing fix

Hospital and doctors’ groups are on pace to spend millions more dollars this year on lobbying than last year as Congress considers various hot-button health care issues, like surprise medical bills and drug pricing.

Some hospitals and doctors stand to lose millions of dollars in annual revenue from changes to restrict surprise medical billing, researchers say, namely for-profit hospitals and specialists like anesthesiologists that can charge the highest rates among providers.

“When you look at specialties you can’t choose, like emergency doctors, radiologists and ambulances, the trend is clear: they’re trying to get more and more money,” Martin A. Makary, a professor of surgery with Johns Hopkins School of Medicine who studies billing practices, said.

Andrew Harrer/Bloomberg via Getty Images

Groups representing hospitals and insurers have ramped up lobbying spending as Congress mulls a variety of health care issues, including surprise billing and drug pricing.

These industry groups have been pushing to get changes to the surprise medical billing legislation moving through the House (H.R. 3630) and Senate (S. 1895) this year, complaining both gave too much power to insurers to decide what doctors should be paid.

Both proposals ban what’s known as balance billing, where a health-care provider or hospital bills a patient directly for services their insurance carrier won’t pay for,such as emergency care. In instances where an insurer won’t pay the rate set by a doctor or hospital for out-of-network care, the Senate bill would force the provider to accept a payment based on local in-network rates.

Spending More

The American Hospital Association has spent nearly $10.2 million in the first half of 2019, about $1 million more than at the same time in 2018, according to congressional lobbying filings. The American Medical Association likewise spent $11.5 million on lobbying in the first half of 2019, about a $1 million more than at the same point in 2018.

The Federation of American Hospitals, which represents investor-owned hospitals, spent $1.9 million in the first half of 2019 and is approaching the $2.5 million it spent in all of 2018.

Insurers Anthem Inc. and UnitedHealth Group Inc., which employ more than 30,000 physicians, have spent about $4 million combined in the first half of 2019, close to what they spent the previous year.

America’s Health Insurance Plans, which represents major insurance carriers, has spent more than $5 million so far this year, well above the $3.69 million the group spent over the first six months of 2018.

The AMA, the two hospital groups and the insurance companies all noted that they lobbied on the surprise billing legislation in their second quarter filings. Other groups that disclosed lobbying on surprise billing included the American Benefits Council, the American Cancer Society, the American Clinical Laboratory Association, American Ambulance Association and American Society of Anesthesiologists.

Health-care providers, particularly specialists, have a lot of money at stake. The Congressional Budget Office estimates that S. 1895 could cut enough costs from the health-care industry to lower insurance premiums nationwide by about 1%.

The common feature of these doctors are patients don’t typically choose them, Ge Bai, an associate professor of accounting at the Johns Hopkins Carey Business School who has studied billing practices, said.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com

To contact the editors responsible for this story: Paul Hendrie at phendrie@bgov.com; Jonathan Nicholson at jnicholson@bgov.com; Bennett Roth at broth@bgov.com