November 28, 2019

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Health November 28, 2019

Future Of Surprise Medical Billing Legislation Remains Uncertain

The summer kicked off with a blitz of government activity to end surprise medical billing, but lobbying, impeachment, and policy arguments have left the future of the legislation up in the air.



ARI SHAPIRO, HOST:

Surprise medical billing was supposed to be the easy health care fix that Washington could get done this year. In May, President Trump urged Congress to come up with a solution.

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PRESIDENT DONALD TRUMP: No American mom or dad should lay awake at night worrying about the hidden fees or shocking, unexpected medical bills to come.

SHAPIRO: Bills were introduced and advanced. Democrats, Republicans, senators, House members – practically everyone agreed the practice was bad and it should stop. Now Congress is getting ready to wrap up the year and still hasn’t passed legislation. NPR’s Selena Simmons-Duffin explains what’s going on.

SELENA SIMMONS-DUFFIN, BYLINE: This is an easy thing to get worked up about. It just seems so unfair. The classic scenario is this – you go to an emergency room, even one that’s in your insurance company’s network. A doctor working there is not in your network and consults with you or treats you. That doctor can bill you what’s called a balance bill. So the insurance company tells the doctor, we’ll pay $1,000. The doctor says, well, I’m going to charge $5,000, and you are on the hook for that difference.

ERIN FUSE BROWN: There’s a lot of agreement that this is a broken part of the health care system that everyone agrees the market can’t fix by itself.

SIMMONS-DUFFIN: Erin Fuse Brown is a law professor at Georgia State University. Because so many members of Congress in both parties agree that it’s outrageous and a place where the government needs to step in, this seemed doable.

FUSE BROWN: Absolutely doable. It’s not fixing the whole health care system.

SIMMONS-DUFFIN: It’s like low-hanging fruit.

FUSE BROWN: Yes.

SIMMONS-DUFFIN: But there are two problems – agreeing on how to get it done and getting passed a flood of lobbying money. Anna Massoglia is a researcher with the Center for Responsive Politics. And she says, at the end of July, a group with the friendly sounding name Doctor Patient Unity came out of nowhere.

ANNA MASSOGLIA: Doctor Patient Unity, practically overnight, spent about $28 million on ads.

SIMMONS-DUFFIN: Ads like this one.

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UNIDENTIFIED PERSON: Congress is working to end surprise medical billing, and that’s a good thing. But that fix cannot include government rate setting, a slippery slope toward doctor shortages…

SIMMONS-DUFFIN: Massoglia says it was clear this was a front group for industry, but there was very little information about who was funding it. The mystery lasted until September, when the group revealed themselves to reporters at The New York Times. It turns out…

MASSOGLIA: Private equity-backed firms were some of the entities bankrolling the operation.

SIMMONS-DUFFIN: Private equity had been buying up physician groups. Surprise bills were part of their business model to bring in profits for investors, and they jumped in to defend that business model. While social media and TV got bombarded, Dan Auble, who’s also from the Center for Responsive Politics, says Congress was getting bombarded, too. Last year, only a few dozen groups lobbied on surprise billing. This year?

DAN AUBLE: We’ve seen 340 groups mention it on their lobbying reports, and they’ve hired 1,200 lobbyists to do that work.

SIMMONS-DUFFIN: But the lobbying and ads are not the whole story here. The other big issue is how to fix the surprise billing problem, says Fuse Brown.

FUSE BROWN: The disagreement really comes down to how to determine the amount that the health insurance company is going to pay the out-of-network provider.

SIMMONS-DUFFIN: So remember – if the doctor wants to charge $5,000 and the insurer wants to pay $1,000, how do you settle on the amount?

FUSE BROWN: There’s this hot debate about where do you set the payment amount and what role does the government have in actually setting it or does it just sort of set up a mechanism for some third party to decide?

SIMMONS-DUFFIN: There are bipartisan bills in the House and the Senate. There was momentum in the summer. In the fall, things seemed stalled. But congressional meetings are starting up again. So now the state of play is this – the White House and lawmakers mostly say they’re optimistic this can get done by Christmas. But there are still hurdles to clear. So even this low-hanging health policy fruit might not get picked this year.

Selena Simmons-Duffin, NPR News.

(SOUNDBITE OF JELLIS AND SUBSET’S “KYOTO”)

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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Business November 28, 2019

Supreme Court Hears Case Involving Blackbeard’s Ship, State And Property Rights

The Supreme Court recently heard arguments in a case that involved both a 300-year-old pirate ship — and a contemporary fight between two powerful forces: states’ rights and property rights.



ARI SHAPIRO, HOST:

The Supreme Court recently heard arguments in a case that involved both a 300-year-old pirate ship and a contemporary fight between two powerful forces in American law. Jacob Goldstein from our Planet Money podcast explains.

JACOB GOLDSTEIN, BYLINE: The ship belonged to the pirate Blackbeard. It sunk off the coast of North Carolina in the early 18th century. The person who brought the case to the Supreme Court is an underwater videographer named Rick Allen. Allen started filming the excavation of Blackbeard’s ship in the late 1990s.

RICK ALLEN: The first time I went down, it was like climbing into a washing machine, filling it with tea or coffee and then turning it on. There’s a lot of current. The visibility’s terrible. So I didn’t see a lot of the wreck. I just pretty much hung on for dear life.

GOLDSTEIN: But year after year for more than a decade, Allen kept diving and filming there.

ALLEN: We’re probably talking about 1,000, 2,000 hours on the wreck site.

GOLDSTEIN: The rights to the ship were owned by the state of North Carolina. Rick Allen had signed a deal where he would pay for the filming out of his own pocket, and he would own the copyright to the footage so he could license it to museums and for documentaries. The legal trouble started in 2013 when, Allen says, the state started posting his pictures and videos without his permission. The fight wound up in the Supreme Court this fall.

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JOHN ROBERTS: We’ll hear argument next in Case 18-877, Allen v. Cooper.

GOLDSTEIN: Allen’s argument relied heavily on a law Congress passed in 1990. It was called the Copyright Remedy Clarification Act. And the law said that federal copyright law applies to state governments just the same way it applies to everybody else. In other words, if a state posts your videos without permission, you can sue the state for damages just like you can sue anybody else.

North Carolina’s counterargument came down to this. That federal law Allen is relying on – it is unconstitutional, and the Supreme Court should strike it down. The state’s lawyer, Ryan Park, articulated the basis for North Carolina’s case in the first three words of his argument.

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RYAN PARK: State sovereign immunity is a fundamental feature of our Constitution’s structure.

GOLDSTEIN: State sovereign immunity – that’s it. That is North Carolina’s whole case, and it is a pretty strong case – strong enough to make it all the way to the Supreme Court. So here is what state sovereign immunity means. State just means any state in the union. Sovereign immunity means in most circumstances, you are not allowed to sue the federal government or state governments for money damages.

Ryan Park, North Carolina’s lawyer, suggested that sovereign immunity really does come down to money.

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PARK: I think the important understanding that the founders had is that when you sue a sovereign, on the opposite side of the judgment are the people and the people’s money.

GOLDSTEIN: When you’re suing the state, you are suing the people. You’re suing for taxpayer dollars. And Park is saying we, the people of North Carolina – not the federal government – should be allowed to decide when and whether we are on the hook for damages in court.

In the end, this case comes down to a fight between states’ rights – North Carolina’s sovereign immunity – and property rights – Rick Allen’s copyrights on the videos of Blackbeard’s ship. A decision in the case is expected sometime before the end of the court’s term next June.

Jacob Goldstein, NPR News.

(SOUNDBITE OF DAWN AVERY’S “ZUSESKA (SNAKE) BATTLE”)

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

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