Purpose of Bill: A rare bipartisan effort to end surprise medical billing—which is what happens when an insured patient is inadvertently treated by an out-of-network provider due to no fault of their own, and then is charged the difference between the rate their insurer pays the provider and the provider’s billed charge—is currently being discussed in the U.S. Senate.
- The Senate bill S.1531: Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 was introduced by Sen. Bill Cassidy (R-LA) on May 16. This bill aims to “to amend the Public Health Service Act and title XI of the Social Security Act to protect health care consumers from surprise billing practices…” according to the bill’s text. To See Full Text of Bill: https://www.congress.gov/bill/116th-congress/senate-bill/1531
- Why does AMHP Support H.R. 1046?
Surprise billing is a widespread problem, and it occurs for people in all types of health insurance plans. Even among large employer plans, nearly one-in-ten elective inpatient procedures involved a potential surprise bill. We believe successful legislation to stop surprise bills should:
- Fully Protect Consumers: Legislation should ensure that consumers are held harmless from surprise bills that they incur due to no fault of their own. Consumers should not receive surprise bills and should not have to take any action to receive protection from surprise out-of-network billing. In a surprise billing situation, insured consumers should never have to pay more than their normal in-network cost-sharing requirement for a service. Legislation should be explicit that in-network costs that consumers pay in surprise bill situations accrue to in-network deductibles and out-of-pocket caps. To ensure full protection for consumers, successful legislation should apply to all providers that may surprise bill consumers, including all out-of-network providers and services in in-network facilities (including use of equipment, devices, telemedicine services, or other treatments or services) and services provided post-stabilization after admission through an emergency department. Finally, while consumers should be allowed to see out-of-network providers if they choose, legislation should have strong notice requirements for non-facility-based providers. Ideally, legislation should require at least 7-days advance notice of a provider’s network status, and notice should provide the cost of out-of-network care. A number of states have already passed surprise bill prohibitions. We recommend that Federal law allow state laws to stay in place if they have equally strong or stronger consumer and cost protections.
- Hold Costs Down: A key consideration in Congress is how much the insurer must pay the out-of-network provider in a surprise billing situation. We believe it is critical that the payment mechanism – however set – does not inflate health care costs, as consumers ultimately bear these costs. We are open to various mechanisms to determine payment, but are deeply concerned about any mechanism that uses billed charges as a basis for setting payment. Billed charges are often several times higher than the rates providers actually receive for delivering care and would inflate costs throughout the system, ultimately raising premiums for consumers.
- Apply to All Insurance Plans: Successful legislation should prohibit surprise billing in all health insurance plans, including individual, small group and large group plans, and self-insured plans. This will ensure people are protected from surprise bills regardless of where they live.
- Current Status of Bill:
“Read twice and referred to the Committee on Health, Education, Labor, and Pensions” by U.S. Senate, according to the U.S. Congress website.
- How can you participate within the issues of surprise medical bills?
Contact your U.S. Senator here before September 29 and article the importance of eliminating surprise medical billing, a symptom of the nation’s unwieldy health-care system that saddles people with massive, unexpected financial debts stemming from the care they receive by cosponsoring S.1531. If your U.S. Senator is already co-sponsoring the bill, thank her/him and then encourage her/him to call for a vote on this bill.
Also, consider contacting your State Representative/Senator to pass a comprehensive surprise bill protection as did 13 states this year.
Revisiting “Shadow Immigration Enforcement and its Constitutional Dangers,” a journal article by Maureen A. SweeneyBilal Abbas, MPA, MSW
Maureen A. Sweeney addressed the rising role local governments are starting to play in enforcing immigration law, a function that the federal government has been tasked with. The academic terms this as ‘shadow immigration enforcement,’ since it is essentially for lack of better words, an overtly covert operation, and one that has been publicly acknowledged, but remains ‘under the table.’ She raises constitutional concerns due to racial profiling. The two enforcement agencies carrying out the tasks also leads to a lack of unity in command and confusion in goals and objectives, especially with collaboration leading to sharing of evidence which is impermissible. This is explained as such according to the ‘Silver Platter’ ruling, where federal courts cannot benefit from evidence illegally obtained by state actors. Moreover, an ‘under the table’ nature of practice raises questions about incentives in place alongside ethical ones.
According to my synopsis, the roots of the issues being addressed in this article are at the very core of the system of government that this country was founded upon. The system of federalism is one of checks and balances, of separation of powers between the executive, judiciary and the legislative branches of government. However, this separation of powers is not limited to that. While drafting the constitution, in being vary of possible tyrannical ambitions of a ‘larger’ government, the framers had the insight to divide state and federal governments as well. This latter form of separation of powers was implied so that government does not infringe on daily living affairs of locals, however with the caveat that in ruling, the federal trumps its junior counterpart, ensuring unity, law and order.
Having said that, because of the larger role, there are certain services or responsibilities that the federal government is tasked with, that state governments do not answer for. Immigration authority, for example, is one such function which falls under the Federal Department of Homeland Security. This article highlights the rise of local police enforcement feigning powers granted under their purview, such as routine traffic stops, to target those that may appear to be of foreign ethnic backgrounds. The most common method of intelligence gathering has been sanctioned by the Arizona Supreme Court, and entails police officers gathering information about immigration status of the populous and informally passing on the information to the Department of Homeland Security officers, despite having no immigration enforcement training, experience or authority. Department of Justice studies also found that Latino drivers were targeted between four and ten times greater than non-Latino drivers.
Evidence provided as a separate illustration includes Transportation Security Administration employees at airports who were found engaging in discriminatory practices. Latinos and African Americans were specifically targeted in hopes that searches would yield drugs, weapons, or other paraphernalia leading to arrests. As many as 80 percent of those searched were minorities, and the Newark International Airport Transportation Security Administration employees were notoriously dubbed “the Great Mexican Hunters” for their discriminatory practices. Maureen (2014) indicates that their superiors tasked them to “look for behaviors that could be justified as suspicious,” for making referrals to immigration authorities.
A question of constitutionality is raised. The fifth and fourteenth amendment make for equal protection of laws to all persons. Policies that differentiate or categorize people according to their race or ethnicity are subject to strict scrutiny.
Further evidence indicates that police officers have been encouraged, in part by their superiors to enforce immigration enforcement and in part by the immigration authorities who turn a blind eye to this overreach. Apart from adding strain due to undue mandates added to local law enforcement tasks, the federal government does not provide additional funding or explicit language allowing for this, which may protect against lawsuits. Also, if immigration enforcement is assigned as state law enforcement tasks, then local taxpayer monies are being used inappropriately. The silver platter doctrine, which has been struck down by courts entails that the federal courts cannot profit from evidence illegally seized by state officers. However, by allowing such evidence in immigration cases, there is certainly a double standard on display. Illegal immigration is not a phenomenon that can be understood through a punitive lens alone, as it is comprised of much more complex issues including social, economical, familial, opportunity, discrimination and liberty.
Sweeney calls for a higher level of awareness among constituencies, and all government agencies involved. There is a call for vigorous advocacy, due to the public mood and political climate resulting from higher rates of immigration in recent decades. It is suggested that the issue be aggressively addressed by activists, judges, law enforcement administrators, government officers, and attorneys who should use all tools in their repertoire to ensure everyone is granted equal protection and equitable treatment.
This article was published in 2014, and there could not be a more appropriate time to revisit it than today. The public mood has rapidly traveled into directions in which the author had suggested in regard to both shadow enforcement, and fearless activism. There have been immigration policy agendas that were floated in the media to test public opinion, including bans, the construction of walls and mass deportations. Some deemed these acceptable, mainly due to economic stress and safety concerns. Now that the officials have been elected on their policy platforms, they are advancing their agendas, as was promised to the public.
The United States is a beacon of hope, and arguably the most blessed country on earth. What makes this country great is that there are individuals like the author of this article, who will always refer to the constitution, the framers, and the very fabric of the principles with which this country was founded upon.
Reference
Sweeney, M. A. (2014). SHADOW IMMIGRATION ENFORCEMENT AND ITS CONSTITUTIONAL DANGERS. Journal of Criminal Law & Criminology, 104(2), 227-282.
