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Congressional Dish

A News, Politics and Government podcast featuring Jennifer Briney
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Congressional Dish is a twice-monthly podcast that aims to draw attention to where the American people truly have power: Congress. From the perspective of a fed up taxpayer with no allegiance to any political party, Jennifer Briney will fill you in on the must-know information about what our representatives do AFTER the elections and how their actions can and will affect our day to day lives.
Hosted by @JenBriney.

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200 episodes

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Special Announcement
In this special announcement, Jen explains a temporary schedule change to the Congressional Dish community, designed to facilitate a renewed focus on increasing the quality of future episodes and the creation of the CD green room. Also, Jen shares an exciting announcement about an upcoming appearance on her favorite channel! Please Support Congressional Dish - Quick Links Click here to contribute a lump sum or set up a monthly contribution via PayPal Click here to support Congressional Dish for each episode via Patreon Send Zelle payments to: Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Use your bank’s online bill pay function to mail contributions to: 5753 Hwy 85 North Number 4576 Crestview, FL 32536 Please make checks payable to Congressional Dish Thank you for supporting truly independent media! ______________________________________________________ Recommended Congressional Dish Episodes CD199:Surprise Medical Bills CD196: Mueller Report CD195: Yemen CD190:A Coup for Capitalism CD187: Combating China CD186: National Endowment for Democracy CD176:Target Venezuela: Regime Change in Progress CD167: Combating Russia(NDAA 2018) Live CD160: Equifax Breach CD155: FirstNet Empowers AT&T CD147: Controlling Puerto Rico CD131: Bombing Libya CD129: The Impeachment of John Koskinen CD128: Crisis in Puerto Rico CD108: Regime Change CD105: Anthrax CD102: The World Trade Organization: Cool? CD098: USA Freedom Act: Privatization of the Patriot Act CD048: The Affordable Care Act (Obamacare) CD003: The Free Market vs. US     ___________________________________________________ Community Suggestions See Community Suggestions HERE. Cover Art Design by Only Child Imaginations _____________________________________________________
CD200: How to End Legal Bribes
The currently legal ability of obscenely rich people to bribe lawmakers and law enforcers is the source of many - if not all - of our political problems. In this episode, get an update on the few democracy-enhancing bills that have moved in this Congress and Jen speaks to Sam Fieldman - the National Counsel at Wolf-PAC - who explains how we can constitutionally end the role of money in politics by going around Congress. Joe Briney joins Jen for the thank you's. Please Support Congressional Dish - Quick Links Click here to contribute a lump sum or set up a monthly contribution via PayPal Click here to support Congressional Dish for each episode via Patreon Send Zelle payments to: Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Use your bank’s online bill pay function to mail contributions to: 5753 Hwy 85 North Number 4576 Crestview, FL 32536 Please make checks payable to Congressional Dish Thank you for supporting truly independent media! ______________________________________________________ Recommended Congressional Dish Episodes CD129:The impeachment of John Koskinen CD192: H.R. 1 Outline Recommended Reading Article: Ensuring elections 'free from foreign intrusion' by John Sarbanes and Brian Frosh, Baltimore Sun, July 3, 2019 Article: Alexander-Murrary Bill, by Donald Shaw,, June 10, 2019. Article: Microsoft and Election Guard by Whitney Webb, MPN News, May 24, 2019. Document: Ballot-Marking Devices (BMDs) Cannot Assure the Will of the Voters    SSRN, May 21, 2019 Article: DHS to Assess Risks Posed to Ballot-Marking Devices by Mark Niese, GovTech, May 2, 2019. Article: DHS, FBI say election systems in all 50 states were targeted in 2016 by Sean Gallagher, ARS Technica, April 10, 2019. Article: Amid Election Integrity Criticism, Georgia Governor Signs Bill to Replace Voting Machines by Greg Bluestein and Mark Niesse, Governing, April 5, 2019.  Article: Firm’s close ties to Georgia stir concerns about voting system purchase by Mark Niesse, Atlanta Journal, January 30, 2019 Article: “Our best friend in this debate is the public,” House Minority Leader Nancy Pelosi (D-CA) told reporters on Friday. by Ella Nilsen, Vox, January 04, 2019. Article: How the GOP is using the Help America Vote Act to block voting, by Thom Hartmann,, November 23, 2018. Article: The Latest: Some Georgia Statewide Races Too Close to Call  U.S. News, November 7, 2018. Article: VOTING MACHINES ARE STILL ABSURDLY VULNERABLE TO ATTACKS by Lily Hay Newman, Wired, September 28, 2018. Article: Top Voting Machine Vendor Admits It Installed Remote-Access Software on Systems Sold to States by Kim Zetter, Vice News, July 17, 2018. Article: Alexandria Ocasio-Cortez Ran—and Won—as a Movement Candidate, by DD Guttenplan, The Nation, June 27, 2018. Article: Voting machine vendor treated election officials to trips to Vegas, elsewhere  by Greg Gordon, Amy Renee Leiker, Jamie Self and Stanley Dunlap, McClatchy DC Bureau, June 21, 2018. Document: LD-2 Lobbying Report Disclosure Form Secretary of the Senate Office of Public Records, 2018 Data: Lobbying Spending Data:Lobbyists representing Election Systems & Software, 2018, 2018. Article: The Fraud Behind Article V Convention Opposition  by Sam Fieldman,, October 12, 2017. Article: Some Machines Are Flipping Votes, But That Doesn't Mean They're Rigged  by Pam Fessler, NPR, October 26, 2016. Document: 2012 REDMAP Summary Report  Redistricting Majority Project, January 4, 2013. Document: Report on Proper Use of Campaign Funds and Resources  Committee on Ethics, January 4, 2013. Document: Title 36 organizations  Every, June 17, 2011.  _____________________________________________________ Bill Outline H.R. 2722: SAFE Act Sponsor: Zoe Lofgren of northern California 74 pages Passed the House on June 27, 2019 225-184 Only GOP yes: Newbie Rep. Brian Mast - 38 year old wounded Afghanistan war veteran representing the Palm Beach area Went to the Committee on Rules and Administration in the Senate Title 1: Financial Support for Election Infrastructure Subtitle A: Voting System Security Improvement Grants Sec. 102: Paper ballot requirements “The voting system shall require the use of an individual, durable, voter-verified paper ballot of the voters’ vote that shall be marked and made available for inspection and verification by the voter before the voter’s vote is cast and counted, which shall be counted by hand or read by an optical character recognition device or other counting device." “The voting system shall provide the voter with an opportunity to correct any error on the paper ballot…” Recounts: The paper ballot “shall constitute the official ballot and shall be preserved and used as the official ballot for purposes any recount or audit conducted with respect to any election for Federal office in which the voting system is used.” Sec. 104: Durability and readability requirements for ballots Ballots must be on “durable” paper, which means it is capable of withstanding multiple recounts by hand without compromising the fundamental integrity of the ballots” and they must maintain readability for 22 months. Sec. 105: Recycled Paper Ballots must be printed on recycled paper starting on January 1, 2021. Sec. 107: These rules will apply “for any election for Federal office held in 2020 or any succeeding year.” Grandfathered equipment: Districts using machines that print paper ballots with the votes already tallied can use those machines until 2022, but they must offer every voter the opportunity to vote using a blank paper ballot, which are not allowed to be designated as provisional. Sec. 111:Grants for equipment changes Federal tax money will be given to states to replace their voting system, if needed. Grant amount: At least $1 per the average number of people who voted in the last two elections To use these grants, the states can only buy voting equipment from a vendor “owned and controlled by a citizen or permanent resident of the United States” The vendor must tell government officials if they get any part of their election infrastructure parts from outside the United States Authorizes (but doesn’t appropriate) $600 million for 2019 and $175 million for each even number election year through 2026 Subtitle B:Risk-Limiting Audits Sec. 121: Risk-limited audits required for all elections for Federal office State election officials will make the rules for how these will be done Sec. 122: Federal government will pay for audits Authorizes “such sums as are necessary” Title II: Promoting Cybersecurity Through Improvements in Election Administration Sec. 201: Voting system cybersecurity requirements Vote counting machine rules Machines that count ballots must be built so that "it’s mechanically impossible for the device to add or change the vote selections on a printed or market ballot” The device must be “capable of exporting its data (including vote tally data sets and cast vote records) in a machine-readable, open data standards format” The device’s software’s source code, system build tools, and compilation parameters must be given to certain Federal and State regulators and “may be shared by any entity to whom it has been provided… with independent experts for cybersecurity analysis.” The devise must have technology that allows “election officials, cybersecurity researchers, and voters to verify that the software running on the device was built from a specific, untampered version of the code” that was provided to Federal and State regulators. Loophole for moles: The Director of Cybersecurity and Infrastructure Security can waive any of the requirements other than the first one that prohibits machines that can change votes. The waivers can be applied to a device for no more than two years. The waivers must be publicly available on the Internet. Not effective until November 2024 election. Ballot marking machines and vote counters can’t use or “be accessible by any wireless, power-line, or concealed communication device” or “connected to the Internet or any non-local computer system via telephone or other communication network at any time.” Effective for the 2020 general election and all elections after Ballot marking devices can’t be capable of counting votes States may submit applications to Federal regulators for testing and certification the accuracy of ballot marking machines, but they don’t have to. Sec. 202: Testing of existing voting systems 9 months before each regularly scheduled general election for Federal offices, “accredited laboratories” will test the voting system hardware and software with was certified for use in the most recent election. If the hardware and software fails the test, it “shall” be decertified. Effective for the 2020 General Election. Sec. 203: Requiring use of software and hardware for which information is disclosed by manufacturer “In the operation of voting systems in an election for Federal office, a State may only use software for which the manufacturer makes the source code… publicly available online under a license that grants a worldwide, royalty-free, non-exclusive, perpetual, sub-licensable license to all intellectual property rights in such source code…." …except that the manufacturer may prohibit people from using the software for commercial advantage or “private monetary compensation” that is unrelated to doing legitimate research. States “may not use a voting system in an election for Federal office unless the manufacture of the system publicly discloses online the identification of the hardware used to operate the system” If the voting system is not widely-used, the manufacture must make the design “publicly available online under a license that grants a worldwide, royalty-free, non-exclusive, perpetual, sub-licensable license to all intellectual property rights…” Effective for the 2020 General election Sec. 204: Poll books will be counted as part of voting systems for these regulations Effective January 1, 2020 Title III: Use of voting machines manufactured in the United States Sec. 301: Voting machines must be manufactured in the United States HR 391: White House Ethics Transparency Act of 2019 Pdf of the bill Reported June 12, 2019 out of the House Committee on Oversight and Reform 23-16 On January 28, 2017 - a week after taking office - President Trump issued an executive order that requires all executive agency appointees to sign and be contractually obligated to a pledge that… The appointee won’t lobby his/her former agency for 5 years after leaving Will not lobby the administration he/she previously worked for Will not, after leaving government, “engage in any activity on behalf of any foreign government or foreign political party which, were it undertaken on January 20, 2017, would require me to register under the Foreign Agents Registration Act of 1938” Will not accept gifts from registered lobbyists Will recuse themselves from any matter involving their former employers for two years from the date of their appointment If the appointee was a lobbyist before entering government, that person will not work on any matter that they had lobbied for for 2 years after the appointment BUT Section 3 allows waivers: “The President or his designee may grant to any person a waiver of any restrictions contained in the pledge signed by such person.” Sec. 2: Requires any executive branch official who gets a waiver to submit a written copy to the Director of the Office of Government Ethics and make a written copy of the waiver available to the public on the website of the agency where the appointee works. Backdated to January 20, 2017 (President Trump’s inauguration) H.R. 745: Executive Branch Comprehensive Ethics Enforcement Act of 2019 Reported March 26, 2019 out of the Committee on Oversight and Reform 18-12 Pdf of the bill  Sec. 2: Creates a transition ethics program Requires the President-elect to give Congress a list of everyone in consideration for security clearance within 10 days of the applications submission and a list of everyone granted security clearance within 10 days of their approval. Requires the transition team to create and enforce an “ethics plan” that needs to describe the role of registered lobbyists on the transition team, the role of people registered as foreign agents, and which transition team members of sources of income which are not known by the public Transition team members must be prohibited by the ethics plan from working on matters where they have “personal financial conflicts of interest” during the transition and explain how they plan to address those conflicts of interest during the incoming administration. The transition team ethics plan must be publicly avail on the website of the General Services Administration Transition team members need to submit a list of all positions they have held outside the Federal Government for the previous 12 months -including paid and unpaid positions-, all sources of compensation that exceed $5,000 in the previous 12 months, and a list of policy issues worked on in their previous roles, a list of issues the team member will be recused from as part of the administration. Transition team members that do not comply will not be granted any access to the Federal department or agency that isn’t open to the public. S. 195 : Creates a transition ethics program: Access to Congressionally Mandated Reports Act Pdf of the bill   Reported 4/10/19 out of the Committee on Homeland Security and Governmental Affairs. On Senate Calendar Sec. 2: Definitions “Congressionally mandated report” means a report that is required to be submitted to Congress by a bill, resolution, or conference report that becomes law. Does NOT include reports required from 92 nonprofit corporations labeled as “Patriotic and National Organizations” (“Title 36 corporations”) Sec. 3: Website for reports 1 year after enactment, there needs to be a website “that allows the public to obtain electronic copies of all congressionally mandated reports in one place” If a Federal agency fails to submit a report, the website will tell us the information that is required by law and the date when the report was supposed to be submitted The government can’t charge a fee for access to the reports The reports can be redacted by the Federal agencies Resources Twitter Link: Rachel Maddow Twitter Link  Twitter. Employment Profile: Employment History for Richardson, Sean J Employment Profile: Employment History for Jen Olson Email Link: Sam Fieldman Email at Wolf-PAC   PDF Email: Email with Eli Baumwell of the W.V. ACLU Volunteer Link: Volunteer for Wolf-PAC Resource Link: Article V Wolf-PAC Resource Link Documentary: Wolf Pac Documentary Congressional Dish Interview: Interview with Sam Fieldman from Wolf-PAC Preet Bharara Podcast: Taking Trump to Court (with David Cole) YouTube Video: Wolf PAC Call for Volunteers - Get Money Out of Politics! YouTube Video: Mike Monetta On Why Wolf-PAC Is Making A Movie YouTube Video: Wolf PAC Resolution Passes New Jersey Senate  YouTube Video: Fight Against Money In Politics: Cenk Uygur (Wolf-PAC Presentation) YouTube Video: Republican Vermont Representative Vicky Strong YouTube Video: Americans for Prosperity testify in New Jersey YouTube Video: Hawaii Senate Judiciary Hearing on 2018 SCR 76, Wolf-PAC YouTube Video: Cenk Uygur's Speech at The Conference to Restore the Republic YouTube Video: Article V Debate Document: Case Docket: Citizens United v. Fed. Election Comm'n Document: Brief by ACLU in support of Citizens United Document: Brief by former members of the ACLU in support of neither party Document: Essay on Term Limits Document: Article V of the US Constitution - Overview Document: Virginia Plan (First draft of the Constitution) Document: Full Text of Congressional Regulations on Article V Document: 1984 Version of Congressional Regulations on Article V Document: 1987 Version of Congressional Regulations on Article V  Document: Congressional Record Archive Copy of Congressional Regulations on Article V Document: The Fix It America Constitutional Amendment Document: Take Back our Republic Document: Role of Congress Document: American Promise 28th Amendment Document: United for the People Amendments Reference Website: Massachusetts Commission Govtrack: H.R. 2722 Document: H.R. 391 Document: H.R. 745 Document: H.R. 745 Document: H.R. 964 Document: S. 195   Sound Clip Sources Watch on C-Span: House floor debate on HR 2722 June 27,2019 sound clip transcripts pdf Watch on C-Span: William Barr Testifies on Mueller Report Before Senate Judiciary Committee May 1, 2019 1:57:55 Sen. Amy Klocuchar (MN): For the last two years, Senator Lankford and I, on a bipartisan bill with support from the ranking and the head of the intelligence committee; have been trying to get the Secure Elections Act passed. This would require backup paper ballots. If anyone gets federal funding for an election, it would require audits, um, and it would require better cooperation. Yet the White House, just as we were on the verge of getting a markup in the rules committee (getting it to the floor where I think we would get the vast majority of senators), the White House made calls to stop this. Were you aware of that? Attorney General William Barr: No. Sen. Amy Klocuchar (MN): Okay, well that happened. So what I would like to know from you as our nation’s chief law enforcement officer if you will work with Senator Lankford and I to get this bill done? Because otherwise we are not going to have any clout to get backup paper ballots if something goes wrong in this election. Attorney General William Barr: Well, I will… I will work with you, uh, to, uh, enhance the security of our election and I’ll take a look at what you’re proposing. I’m not familiar with it. Sen. Amy Klocuchar (MN): Okay. Well, it is the bipartisan bill. It has Senator Burr and Senator Warner. It’s support from Senator Graham was on the bill. Senator Harris is on the bill and the leads are Senator Lankford and myself, and it had significant support in the house as well. Hearing: Committee on Oversight and Reform:Strengthening Ethics Rules for the Executive Branch, February 6, 2019 Watch on Youtube *28:00 Rep Jordan (OH): 2013 we learned that the IRS targeted conservative for their political beliefs during the 2012 election cycle systematically for a sustained period of time. They went after people for their conservative beliefs, plan in place, targeted people. They did it. The gross abuse of power would have continued, if not for the efforts of this committee. 2014 the Obama Administration doubled down and attempted to use the IRS rule making process to gut the ability of social welfare organizations to participate in public debate. Congress has so far prevented this regulation from going into effect, but HR 1 would change that. Hearing: Judiciary Committee For The People Act Of 2019, January 29, 2019  Witness: Sherrilyn Ifill - President and Director-Counsel, NAACP Legal Defense and Educational Fund Watch on YouTube 32:00 Sherrilyn Ifill: Well before the midterm election, in fact, Georgia officials began placing additional burdens on voters, particularly black and Latino voters, by closing precincts and purging. Over half a million people from the voter rolls the voter purge, which removed 107,000 people, simply because they did not vote in previous elections and respond to a mailing was overseen by the Republican candidate for governor Brian Kemp, who was also the secretary of state. LDF and a chorus of others called on him to recuse himself from participating in the election. But he refused.  ______________________________________________________ Community Suggestions See Community Suggestions HERE. Cover Art Design by Only Child Imaginations ______________________________________________________ Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)
CD199: Surprise Medical Bills
Almost 40% of Americans WITH health insurance reported they had received a surprise medical bill in the past year from a doctor or hospital for a service they thought was covered by their insurance plan. Why is this happening? And what can we do about it?  Please Support Congressional Dish - Quick Links Click here to contribute a lump sum or set up a monthly contribution via PayPal Click here to support Congressional Dish for each episode via Patreon Send Zelle payments to: Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Use your bank’s online bill pay function to mail contributions to: 5753 Hwy 85 North Number 4576 Crestview, FL 32536 Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Additional Reading Article: Went to the ER? You may be hit with a surprise medical bill by Tami Luhby, CNN, June 20, 2019. Press Release: House Supports Porter Amendment to Improve Affordable Care Act Enrollment by Representative Katie Porter, Porter House News, June 13, 2019. Article: Alexander-Murrary Bill, by Tammy Luhby, CNN, May 23, 2019. Bill: Bill S. 1531 Stopping The Outrageous Practice of Surprise Medical Bills Act of 2019 by Senator Bill Cassidy,, May 16, 2019. Press Release: Trauma Coalition Press Release, by Trauma Association of America, May 16, 2019. Article: Trump calls for an end to surprise medical bills by Tami Luhby, CNN, May 9, 2019. Article: UnitedHealth's David Wichmann buys record $4.6 million worth of UNH stock by Alex Wittenberg, Biz Journals, May 7, 2019. Article: After Vox reporting, California moves forward on plan to end surprise ER bills by Sarah Kliff, Vox, April 24, 2019. Article: How to fight an outrageous medical bill, explained by Sarah Kliff, Vox, April 1, 2019 Bill: Bill S. 1266 Protecting Patients from Surprise Medical Bills Act 116th Congress, March 1, 2019. Bill: Bill H.R. 861 End Surprise Billing Act of 2019  116th Congress, January 30, 2019. Article: A $20,243 bike crash: Zuckerberg hospital’s aggressive tactics leave patients with big bills by Sarah Kliff, Vox, January 24, 2019.  Article: After Vox story, Zuckerberg hospital rolls back  by Sarah Kliff, Vox, January 24, 2019. Document: NBER Working Paper No. 23623 Surprise! Out-of-Network Billing for Emergency Care in the United States by Zach Cooper, Fiona Scott Morton and Nathan Shekita, NBER, January 2019 Article: LifePoint merges with RCCH, goes private by Ayla Ellison, Becker Hospital Review, November 16, 2018. Article: “It’s unacceptable”: Sen. Maggie Hassan explains her plan to end surprise ER bills by Sarah Kliff, Vox, October 29, 2018. Article: Gov. Rick Scott took responsibility? No, he took $300 million | Randy Schultz by Randy Schultz, Sun Sentinel News, October 2, 2018. Article: UnitedHealthcare issues warning to hospitals about out-of-network coverage for ER physicians by Susan Morse, Healthcare Finance News, September 25, 2018. Article: Three Ways Self-Insured Plans Can Leverage State Laws to Protect their Members from Balance Billing  by Matthew Albright, The Self-Insurer, September 2018. Article: The Last Company You Would Expect Is Reinventing Health Benefits  by Reed Abelson, NY Times, August 31, 2018. Article: As Health and Financial Challenges Grow, More Older Adults File for Bankruptcy by Lindsey Copeland, Medicare Rights Center, August 9, 2018. Article: A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill by Jenny Gold, Kaiser Health News and Sarah Kliff, Vox, July 20, 2018. Article: Air Ambulances Are Flying More Patients Than Ever, and Leaving Massive Bills Behind  by  John Tozzi, Bloomberg News, June, 11 2018. Case Docket: Case Proceeding Air Medical Group, KKR North America, and AMR Holdco, In the Matter of Federal Trade Commission, May 3, 2018. Article: Are Physician Staffing Companies Killing the Patient Experience and Bottom Line? by Berta Bustamante, InsideArm, April 10, 2018. Press Release: Ambulance Companies Air Medical Group Holdings, Inc. and AMR Holdco, Inc. Agree to Divest Air Ambulance Services in Hawaii as a Condition of Merger  Federal Trade Commission, March 7, 2018. Document: Letter to Christopher Holden-President and Executive Officer for Envision Healthcare US Senate, September 20, 2017 Bill: California Assembly Bill 72 by Ann Whitehead,JD,RN.,CAP Physicians, August 30, 2017. Report: AIR AMBULANCE Data Collection and Transparency Needed to Enhance DOT Oversight  Government Accountability Office, July 2017. Article: The Company Behind Many Surprise Emergency Room Bills by Julie Creswell,Reed Abelson and Margot Sangor-Katz, NY Times, July 24, 2017. Article: AB 72: No More Balance Billing for Out-of-Network Care In-Network by Staff, Word&Brown, July 14, 2017. Report: Health Policy Report Up in the Air: Inadequate Regulation for Emergency Air Ambulance Transportation Consumer Reports, March 2017. Article: One In Five Inpatient Emergency Department Cases May Lead To Surprise Bills by Christopher Garmon and Benjamin Chartock, Health Affairs, January 2017. Article: Trauma fees growing across the nation at 'absurd' rate by Alexander Zayas and Kris Hunley, Tampa Bay Times, November 21, 2014. Article: 10 Things to Know About HCA Becker's Hospital Review, April 16, 2014. Article: HCA to Eliminate Trauma Fees for Uninsured Patients Becker's Hospital Review, April 10, 2014.   Resources Profile Link: Connie Potter Profile, RN, BSN, MBA-HCA Link  Linkedin. Profile Link: Sherif Zaafran Profile, MD, FASA  Linkedin. Contact Us: Physicans for Fair Coverage  End of the Insurance About Us: Independence Company (IBX) Document: License Agreement: Use of Current Procedural Terminology, Fourth Edition ("CPT®")  Centers for Medicare and Medicaid Services 2013-2018 Contributor List: Sen. Rick Scott Election Contributor List Campaign Money Data Table: David Wichmann Political Campaign Contributions 2016 Election Cycle  Campaign Online Review Score: Regence Health Plan Company Profile Review False Claims Act: Nation’s Largest Healthcare Fraud Settlement Doesn’t Stop Medical Behemoth, Visual Resources   Sound Clip Sources Hearing: NO MORE SURPRISES: PROTECTING PATIENTS FROM SURPRISE MEDICAL BILLS, Not on C-Span, Committee on Energy and Commerce, June 12, 2019. Watch on Youtube Witnesses: Sonji Wilkes: Patient Advocate Sherif Zaafran, MD: Chair of Physicians for Fair Coverage Rick Sherlock: President and CEO of Association of Air Medical Services James Gelfand: Senior Vice President of Health Policy at The ERISA Industry Committee Thomas Nickels: Executive Vice President of the American Hospital Association Jeanette Thornton: Senior Vice President of Product, Employer, and Commercial Policy at Americas’ Health Insurance Plans Claire McAndrew: Director of Campaigns and Partnerships at Families USA Vidor E. Friedman, MD: President of American College of Emergency Physicians Transcript 47:54 CEO Rick Sherlock: Emergency air medical services are highly effective medical interventions appropriate in cases where getting a patient directly to the closest most appropriate medical facility can make a significant difference in their survival in recovery. Today, because of air medical services, 90% of Americans can reach a level one or level two trauma center within an hour. However, since 2010, 90 hospitals have closed in rural areas and an estimated 20% more are at risk of closing. Our members fill the gap created by closures, but this lifeline is fraying as 31 air medical bases have also closed in 2019. 48:31 CEO Rick Sherlock: Emergency or medical providers never make the decision on who to transport. That decision is always made by a requesting physician or medically trained first responder. Air medical crews then respond within minutes, 24 hours a day, seven days a week without any knowledge of a patient’s ability to pay for their services. 48:45 CEO Rick Sherlock: Our members are unique in the healthcare system. The services heavily regulated by the states for the purposes of healthcare, as ambulances and the federal government for aviation safety and services as air carriers. It is their status as air carriers that allow rapid transport of patients over significant distances. Over 33% of our flights cross state lines every day. For that reason, the Airline Deregulation act uniform authority over the national airspace is essential to the provision of this lifesaving service. Exempting air medical services from the ADA would allow states to regulate aviation services, including where and when they’re able to fly, limiting access to healthcare for patients in crisis. 49:54 CEO Rick Sherlock: To prevent balance billing, our members are actively negotiating with insurance companies to secure in-network agreements. One member alone has increased their participation from 5% to almost 43% in the last three years. Despite that, some insurers have refused to discuss in-network agreements. That hurts both patients and caregivers. 50:30 CEO Rick Sherlock: Uh, covering air medical services in full, represents about a $1.70 of the average monthly premium. 51:50 CEO Rick Sherlock: $10,199 was the median cost of providing a helicopter transport. While Medicare paid $5,998, Medicaid paid $3,463 and the uninsured paid $354. This results in an ongoing imbalance between actual costs and government reimbursement and is the single biggest factor in increasing costs. 53:45 Senior VP James Gelfand: We’re focused on three scenarios in which patients end up with big bills they couldn’t see coming or avoid. Number one, a patient receives care at an in-network facility, but is treated by an out of network provider. Number two, a patient requires emergency care, but the provider’s facility or transportation are out of network. And number three, a patient is transferred or handed off without sufficient information or alternatives. It’s usually not the providers you’re planning to see. It’s anesthesiologists, radiologists, pathologists, or emergency providers or transport or an unexpected trip to the NICU. Many work for outsourced medical staffing firms that have adopted a scam strategy of staying out of networks, practicing at in-network facilities and surprise billing patients. It’s deeply concerning, but the problem is narrowly defined and therefore we can fix it. 54:40 Senior VP James Gelfand: The No Surprises Act nails it. It takes patients out of the middle and creates a market based benchmark rate to pay providers fairly. The benchmark is not developed by government and it is not price setting. The committee might also consider network matching. It’s simple. If a provider practices at an in-network facility, they take the in-network rate or they go work somewhere else. Or base the benchmark on Medicare, you could set the rate higher, say 125% of Medicare and still make the system more affordable, sustainable and simpler. These approaches will eliminate the surprise bills. That’s a huge win for patients. 54:50 ** Senior VP James Gelfand: But not everyone wants to stop the surprise bills. Some provider specialties are saying, “let us keep doing what we’re doing, just use binding arbitration to make someone else pay these bills”. They’re asking for a non- transparent process that could force plans and employers to pay massive and fake medical list prices. It’s essentially setting money on fire. Funds that would have been used to pay for healthcare will instead be spent on administrative costs such as lawyers, arbitrators, facility fees, and on reasonable settlement amounts. Make no mistake, patients will pay these costs. 55:20 Senior VP James Gelfand: The ground and air ambulance companies are asking Congress to let them keep surprise billing too. Do nothing, wait for another study, another report, and there have already been four. They know patients cannot shop for them and many participate in no networks. State insurance commissioners are begging for help with air ambulances, but Congress has tied their hands. Employers think Congress should end this. Treat medical transport the same as emergency care. We should end surprise billing in the ER and on the way there. 56:30 Senior VP James Gelfand: Other providers figure they’re willing to stop surprise billing, but only if they can increase in-network rates. They’re calling for network adequacy rules to force insurers and employers to add more providers to their networks, even if those providers demand astronomical payments. Does anyone here actually believe that these hospital based doctors who services cannot be shopped for, who are guaranteed to see our patients, are begging to be included in our networks, but nobody will return their calls? That they have no choice but to go and join these out of network Wall Street owned firms? It doesn’t make sense. 57:00 Senior VP James Gelfand: Employers design health benefits to help our beneficiaries. We don’t sell insurance. We want networks that meet our patients’ needs. Why would we want to cover an operation, but leave out the anesthesia? We want our employees to be able to afford their health insurance too, and that means we must be able to say no when providers are gaming the system. 1:08:10 Dr. Vidor Friedman: Unlike most physicians, emergency physicians are prohibited by federal law from discussing with a patient any potential costs of care or insurance details until they are screened and stabilized. This important patient protection known as Emtala, ensures physicians focus on the immediate medical needs of patients. However, it also means that patients cannot fully understand the potential cost of their care or the limitations of their insurance coverage until they receive the bill. 1:10:40 Dr. Vidor Friedman: The goal should be a system in which everyone is in-network, or essentially that. That requires a level playing field between providers and insurers. Insurers are concerned that benchmarking the even median charges, favors providers. Providers are concerned that benchmarking the median in-network rates, favors insurer’s. What’s Congress to do? ACEP supports a system that has already proven to be balanced between insurers and providers. That is a baseball style independent dispute resolution process similar to that used in New York and noted in the legislative proposal put forth by Doctors, Ruiz Rowe and Busan. 2:02:30 Rep. Brett Guthrie: If there does become a federal arbitration system, what do you think congressional oversight should be? And I don’t know if that should be something that I’m supposed to talk about or…Sonji Wilkes: Well, I’ve been sitting here listening, thinking I pay my insurance premiums, I do my part and I expect the bill to be paid. I mean, there’s only so much I can do to control that and I don’t really care how the reimbursement works. And quite frankly, I think the insurance industry is doing probably better in their bottom line than my bottom line. Um, I want to go to the best provider possible and I want the best care possible. I don’t really care how the payment works. 2:34:50 Dr. Sherif Zaafran: Well, I can tell you that from the physician’s standpoint, for emergency room physicians for example; the average weighted cost of every visit is about $155. 3:49:00 CEO Rick Sherlock: The median cost of a helicopter air transport is $10,199 according to a study conducted in 2017. If you look at the cost of uncompensated care, because Medicare pays less than $.60 on the dollar of that 10,199. About $5,998, Medicaid pays significantly less than that. Less than $3,500 on average, and the uninsured pay about $350. Those make up…those three groups make up 70% of air medical transports. So when you take that cost of uncompensated care and you add it to the median cost of $10,200, that’s the average charge of $36,000 that the representative from New Mexico referenced earlier. When you…when those kinds of situations happen, no one in our industry wants to see a patient or their family placed in jeopardy because they’ve just had a health emergency. Our members will sit down with each individual and their families and work out a solution tailored for them. 3:54:30 Dr. Sherif Zaafran: Again, there is no such thing as an out of network provider. There is a provider who may happen to be out of network with that specific product. So the only one who knows what the product is, is of course the patient and the insurance carrier and they’re the only ones who really have the information as to whether they’re in-network or out of network. Hearing: The Need to Reauthorize the September 11th Victim Compensation Fund, June 11, 2019 Hearing: Hearing on September 11 Victims Compensation Fund, June 11, 2019 Hearing: Watch on CSPAN-Surprise Medical Bills House Ways and Means Subcommittee on Health-May 21, 2019 Committee website Watch on YouTube Witnesses: Rep. Katie Porter (CA) James Patrick Gelfand: Senior Vice President, Health Policy, ERISA Industry Committee Dr. Bobby Mukkamala: Board of Trustees, American Medical Association Tom Nickels: Executive Vice President, Government Relations and Public Policy, American Hospital Association Jeannette Thornton: Senior Vice President for Product, Employer, and Commercial Policy at America’s Health Insurance Plans (AHIP) Transcript *7:15 Chairman Lloyd Doggett (TX): Fortunately, there now appears to be a growing consensus. Most recently joined by president Trump that holding the patient harmless should form the foundation for any surprise billing proposal. Under the legislation that I advanced, patients would only be charged in network cost sharing rates in emergency situations and non-emergency situations out of network charges would be permitted only when the patient has agreed in advance after receiving effective notice regarding any providers and services together with estimated charges. No other bill addressing this issue has yet been filed here in the house, but there is a very useful discussion draft proposal that is being circulated on a bipartisan basis by the House Energy and Commerce Committee and there’s several proposals that have service in the Senate. While every proposal currently begins with the basic premise of the enterprise billing act, conflict remains over how to resolve insurer provider disputes. *13:40 Rep. Katie Porter (CA): I’m concerned about surprise billing, as someone who’s dedicated my life to protecting consumers, but also because I have had to fight my own battle with surprise billing. On August 3rd last year when I was on the campaign trail, I started to feel pain in my abdomen. At 1:00 PM I could not continue and I went home. At 4:31, I texted my campaign manager that I needed to go to the emergency room. I couldn’t safely drive through the pain and I remember sitting on my front porch, so if I lost consciousness, somebody might find me and I wouldn’t be home alone. I didn’t call an ambulance because I was concerned about the cost. I could not drive and I asked my manager to please take me to Hoag hospital. I chose that hospital even though it was farther away from other providers, because I knew Hoag was an in-network facility. When I got to the hospital, I waited six hours alone in the emergency exam room without treatment. When I finally went to surgery, my doctor told me it was nothing to worry about, just a routine appendectomy. I was given anesthesia and when I awoke, the team around me was panicking. They couldn’t get my temperature to drop and they couldn’t get my blood pressure to rise. My appendix had ruptured hours before causing an infection that was making my whole body very sick. I spent the next five days in the hospital receiving powerful IV antibiotics. A few weeks later, I received the bill from my insurance company. The idea of an astronomical hospital bill had weighed heavily on me and I was happy to see that the cost of my emergency room treatment and assessment and hospital charges, and nearly all of my inpatient services, were covered. I remember sitting at my kitchen table and taking a deep breath filled with relief, but a few days later I received another bill. This one from my surgeon. While the hospital I had gone to was in-network, the insurance company now claimed the surgeon was not, even though they had sent me a notification telling me that my surgeon was in-network . Enclosed in that bill for nearly $3,000, was a handout from my surgeon detailing the steps I would have to take while recovering in order to fight to have my insurance company cover the care. So many of his patients had been put in this situation, that this medical doctor had used his staff to address patient billing problems. That’s not what he trained for in medical school. Your so-called explanation of benefits and the surgeon’s handout explained that he was being treated as an out of network provider even though he was employed by and worked at an in-network hospital. As someone in an emergency situation, I had no ability to assess whether he was in or out of network, and in those cases insurers are supposed to cover the costs, but I got that bill because my insurer put profits before patients. I called insurance company to request an appeal. The benefits manager kept asking me questions to guide me and coach me towards saying that it was my surgeon’s fault to blame him for overcharging me. She asked me to call the surgeon and attack my doctor for his bill. Apparently, to Anthem Blue Cross, $3,000 was too high a price for saving my life. The tens of thousands in premiums I’d paid to that company over the years were not enough to have them, cause them to cover the lifesaving care. Nearly five months after I was hospitalized, the surgeon simply requested payment, and at that point I reached out to my employer of the University of California Irvine. That’s when I learned that U.C. Irvine has a designated patient advocate, a medical doctor, whose sole job is to help university employees get the health insurance that the university and the employees pay for. Can we just reflect on that for a moment? The university is paying a medical doctor to do nothing but navigate insurance. Finally, the patient advocate, invoking the fact that I had just been just elected to Congress, was able to get the insurance company to agree to pay my surgeon’s bill. But here’s what I learned from getting sick. I am well educated. I had an employer prepared to help me. I have professional experience fighting for consumer rights, but there are thousands of Americans with fewer resources than me who are surprised with bills far more devastating than mine. I’m here today because they refuse to accept this as the status quo. I refuse to stand idly by while families go bankrupt because of surprise medical bills. Any solution to this issue must rely, must not rely, excuse me, on the patient’s ability to go to war with the insurer or with their provider. That is not the solution. It’s time we start putting patients first. 31:00 Jeanette Thornton: We ask that federal legislation focus on four things. First, balanced billing should be banned in situations where inpatients are involuntarily treated by an out of network provider. This includes emergency health services at any hospital, any health healthcare services or treatment performed at an in-network facility by an out of network provider, not selected by the patient and ambulance transportation in an emergency. Second, health insurance providers should be required to reimburse out of network providers inappropriate and reasonable amount in those above scenarios. Third, state should be required to establish an independent dispute resolution process that works in tandem with the established benchmark. Fourth hospitals or other healthcare providers should be required to provide advanced notice to patients of the network status of the treating providers. We appreciate the health sub-committee chairman Lloyd Doggett has introduced legislation to end surprise billing act or HR 861, which would establish a role for hospitals in providing such notices, along with banning balanced billing. AHIP supports this bill. 46:00 Chairman Lloyd Doggett (TX): What I’m referring to is the difference… Dr. Bobby Mukkamala: Right. Chairman Lloyd Doggett (TX): …in charges and why one one price for those who are in network and another for those that are out. Dr. Bobby Mukkamala: Right. So there is a benefit for me to be in network with Blue Cross Blue Shield of Michigan for example. I get something from that. They sit with me, they show me their data. We had…we worked together on incentive programs to sort of curb costs. If there’s an insurance company that’s in town that does none of that activity to improve the care of the population in my town, but yet wants to benefit from the same rate of compensation to me, they’re doing nothing to earn that discount. Blue Cross sits across from me on a weekly or monthly basis to improve the care of my population. But Golden Rule insurance, that’s new in town for example, doesn’t do any of that work and yet wants to benefit from having the same provider rates. No, I mean, I take a discounted rate from Blue Cross because of all this other robust activity. But if you’re not offering me anything to participate in your network, then naturally, you should be expected to pay more for my services. Right? I get something from Blue Cross. I get nothing from Golden Rule. 53:05 Dr. Bobby Mukkamala: Medicare is usually sort of the foundation upon which all the other insurance companies tend to set their rates. So when I participate in network, like with Blue Cross Blue Shield of Michigan, it’s usually about 110/ 115% of Medicare rates. So that’s one step higher. If I don’t participate with Blue Cross Blue Shield of Michigan, then that rate is so I can get the assigned rate from them and then I have a choice about what to do with the balance. And usually in my practice, I write that off. I don’t balance bill the patient. Uh, but Blue Cross Blue Shield sort of sets their rate and that’s it. My point is that, if-in Blue Cross Blue Shield, I have a great relationship with, we do a lot of constructive work together. But if a new insurance company comes into town and puts up billboards and markets their product and says, here, come, come buy our policy, and then they get 15,000 patients to sign up, but has never come to my door to say, you know, when they have an ear, nose and throat problem, we’d like you to be in-network and provide their care. Why should they get the benefit of the in-network price that Blue Cross Blue Shield gets? So, my point, is that that out of network price for this new insurance company that wants me to take care of their patient, but never came to sit down with me to sign a contract, ought to be something that I negotiate with them, not something that’s dictated to me. 55:50 Rep. Mike Thompson (CA): A staff person of mine went to the emergency room. He has insurance. His insurance covered nearly everything, including a cat scan. But a few weeks later, he got two separate bills from physicians he never saw and didn’t ask to see. They reviewed some of his test results and the bill for those two physicians was larger than the bill for his total ER visit. 56:15 Rep. Mike Thompson (CA): It’s also alarming that, uh, according to one study, 20% of hospital visits, one of every five of those visits, uh, that began in the ER, resulted in a surprise bill. 58:30 Dr. Bobby Mukkamala: Uh, yes, sir. So, in answer to your question, there are multiple already cases documented of insurance companies shrinking their network in California because they can get the same service at that rate with physicians that are out of their network. And so, contracts are already not being renewed for physicians that have had contracts for 20 years, and then they go to renew it and they’re dropped from the network. 1:03:00 Dr. Bobby Mukkamala: My wife and I, we contract with probably about 30 insurance companies. When I take a kid’s tonsils out, one insurance company may be $200- may pay me $200, one pays me about $450 and everything in between. I can’t have a different fee in my fee schedule for each of those. So my fee for tonsillectomy is about $475, so that when I do it, I know that the highest paying payer, I’m still-they’re still within that threshold, right? Because if I charge $400, they’re not going to send me $450. They’re going to send me $400. 1:07:00 Jeanette Thornton: So it’s very interesting what we’ve seen and when it comes from a hospital perspective. It’s maybe only 15% of the hospitals nationwide that are causing this issue that results in, you know, 80% of the visits. One of the statistics had cited a lot that result in a surprise medical bill. So this is not every doctor. This is not every hospital that are resulting in these surprise medical bills. It’s really more of a targeted problem. 1:09:15 Tom Nickels: In terms of how much of this is really going on, I think there is a certain level of frustration. I don’t know that we all know with certainty. The only federal study that I’ve seen, that we’ve seen, is from the Federal Trade Commission, which basically said that they studied ambulances going to hospital emergency departments. 99% of hospital emergency departments in that study were in-network. So it’s not the hospital itself that is out of network. it is people, physicians who practice in our institution. 1:22:20 Tom Nickels: The federal government-state government need to acknowledge that they underpay. I mean, Medpack and others acknowledges that this isn’t just industries talking about ourselves. AMA has said the same thing on the physician side, but I think that the federal government and state governments have a responsibility to pay more adequately. The truth of the matter is, and we haven’t even talked about this, is the cost shift is that private insurers pay more than costs and the government pays less. That should end. The government should take responsibility. 1:38:00 Tom Nickels: We cannot force by law, physicians who are not employed by us to take in-network rates. That is-if we did that, um, we would be sued. It would be restraint of trade. Um, however, what we’re trying to suggest here and I think what the other panelists are trying to suggest, is we have a way to protect the patient from that surprise bill. To your question about who are these physicians that you don’t even know about who are treating you, if you come in in an emergency, you don’t know what’s going on. And you need to be taking care of it, who’s ever there is going to take care of you. The other situation which we’ve talked about is when you knowingly come into an inpatient in-network facility. You did all the right things, but an out of network physician, (anesthesiologists, perhaps radiologists, pathologists) takes care of you. And that’s where the, uh, the bill is generated from. So we cannot make people do that. We try to get physicians to be in our networks-in the same networks. But again, this is an issue of private contracting. 1:42:05 Rep. Mike Kelly (PA): I do agree with you. If there’s limited talent there to take care of that specific problem, there has to be a way of compensating for it. Because at the end of the day, it is a business. Dr. Bobby Mukkamala: Right. So the solution is if an insurance company is going to come into Flint, Michigan and sell insurance, they know that eventually they’re going to need a hand surgeon, right? How do they sell insurance to a town that’s an industrial based town, where there’s a lot of hand injuries and not have any hand surgeons in their network? When they put up the billboard saying, “we’re selling insurance here”, they should have at the same time look at their provider list and say, “you know what”?, we’re missing an orthopedic hand surgeon. "Let’s go find one and figure out how to get him in-network or get her in-network. Right? And that’s a step that’s skipped routinely, right? They’ll sell the product for years and then fill in this way with lack of a good provider network by trying to negotiate out of network rates that are the same as in-network because they’d skip that first step, right? Maintain a network adequacy-establish a network adequacy before you sell your product. 1:48:30 James Gelfand: Many of the hospitals are not doing what Zuckerberg hospital was doing. The hospital will be in-network, but they will have outsourced their emergency room to a Wall Street owned private company and that company won’t take insurance. And those guys are definitely making enough profits that Wall Street is suggesting that people should invest in those companies because of these relationships they have with the in-network hospitals and the out of network emergency rooms. Trump remarks on medical billing-Watch on C-SPAN, May 9, 2019 13:00 President Donald Trump: Today I’m announcing principles that should guide Congress in developing bipartisan legislation to end surprise medical billing. And these senators and congressmen and women that are with us today are really leading the charge. And I appreciate that they’re all here. Thank you all. Thank you all for being here. This is fantastic. And I think it’s going to be a successful charge. From what I understand, we have bipartisan support, which is rather shocking. That means it’s very important. That means it’s very good. But that’s great. First, in emergency care situations, patients should never have to bear the burden of out-of-network costs they didn’t agree to pay. So-called balance billing should be prohibited for emergency care. Pretty simple. Second, when patients receive scheduled, non-emergency care, they should be given a clear and honest bill upfront. That means they must be given prices for all services and out-of-pocket payments for which they will be responsible. This will not just protect Americans from surprise charges; it will empower them to choose the best option at the lowest possible price. Third, patients should not receive surprise bills from out-of-network providers that they did not choose themselves. Very unfair. Fourth, legislation should protect patients without increasing federal healthcare expenditures. Additionally, any legislation should lead to greater competition, more choice — very important — and more healthcare freedom. We want patients to be in charge and in total control. And finally, in an effort to address surprise billing, what we do is, all kinds of health insurance — large groups, small group, individual markets, everything. We want everything included. No one in America should be bankrupted and unexpectedly by healthcare costs that are absolutely out of control. No family should be blindsided by outrageous medical bills. And we’ve gone a long way to stop that. Examining Surprise Billing: Protecting Patients from Financial Pain-Not on C-SPAN, House Committee on Education and Labor, April 2, 2019 Watch on YouTube Witnesses: Christen Linke Young: Fellow at USC-Brookings Schaeffer Initiative on Health Policy Ilyse Schuman: Senior Vice President for Health Policy at American Benefits Council Frederick Isasi, Executive Director at Families USA Professor Jack Hoadley: Research Professor Emeritus at Georgetown University’s Health Policy Institute Transcript 7:15 Chairman Frederica Wilson (FL): This is the first hearing the United States Congress has held on surprise billing. 7:30 Chairman Frederica Wilson (FL): Surprise medical bills occur when patients covered by health insurance are subject to higher than expected out of pocket costs for care, received from a provider who is outside of their plan’s network. The victims of surprised medical billing often have no control over whether they’re medical provider is in or out of network. 8:15 Chairman Frederica Wilson (FL): A young San Francisco woman named Nina Dang suffered a severe bike accident. She was barely lucid when a bystander called an ambulance and took her to an emergency room at a nearby hospital. Before she knew it, doctors had done x-rays and scans and put her broken arm in a splint and then sent her on her way. A few months later, Nina was hit with a $20,000 medical bill because the hospital, which she did not choose, was an out of network facility. 8:30 Chairman Frederica Wilson (FL): But even patients who are able to take precautions to avoid out of network costs during a medical emergency, are not immune from surprise bills. Scott Cohan suffered a violent attack one night in Austin, Texas. He woke up in an emergency room with a broken jaw, a throbbing headache, and staples in his head. Despite his shock and immense pain, Scott took out his phone and searched through his insurer’s website to make sure he was laying in an in-network hospital bed. When he found out it was, he proceeded with unnecessary jaw surgery. Imagine Scott’s frustration and devastation when he received a surprise medical bill for nearly $8,000. It turned out that the emergency room was in his insurance network, but the oral surgeon who worked in the ER was not. 16:00 Rep. Tim Walberg (MI): 39% of insured working age adults reported they had received a surprise medical bill in the past year from a doctor, hospital, or lab that they thought was covered by their insurance. Of the 39% of individuals who received surprise medical bills, 50% owed more than $500. 27:05 Ilyse Schuman: While a number of states have sought to address this problem or risk that exempts self insured plans from State Insurance Regulations to ensure that national employers can offer uniform health benefits to employees residing in different states. Accordingly, the problem of surprise billing cannot be left to the states to solve. 33:20 Frederick Isasi: So what’s most important to remember about this issue? We are talking about situations in which families, despite enrolling in health insurance, paying their premiums, doing their homework and trying to work within the system, are being left with completely unanticipated and sometimes financially devastating healthcare bills. And this is happening in part, and I want to say this really clearly because hospitals, doctors and insurers are washing their hands of their patient’s interest. 33:50 Frederick Isasi: Take for example, one significant driver of this problem. The movement of hospitals to offload sapping requirements for their emergency departments to third party management companies. These hospitals very often make no requirements of these companies to ensure the staffing of the ED fit within the insurance networks that the hospitals have agreed to. As a result, a patient who does their homework ahead of time and rightly thinks they’re going to an in network hospital, received services from an out of network physician and a surprise medical bill follows. 34:20 Frederick Isasi: Let me give you one real world example. Nicole Briggs from Morrison, Colorado outside of Denver. Nicole woke up in the middle of the night with intense stomach pain. She went to a freestanding ER. She was told she needed an emergency appendectomy. She went to a local hospital. She did her due diligence. Confirmed repeatedly that the hospital and its providers were in network. However, months later she received a surprise bill from the surgeon who ended up, was out of network. The bill to Nicole was $5,000. Nicole tried to work it out with her insurance company, but within two years, a collection agency representing the surgeon took her to court and won the full amount, including interest. As a result, a lien was placed on her home and the collection agency garnished her wages each month. This came right before Nicole was about to deliver a baby and go on maternity leave. And by the way, this investigation found that there were over 170 liens placed on people’s homes in the Denver area by emergency department physicians. 38:05 Professor Jack Hoadley: Our research shows that today, 25 states have acted to protect consumers from surprise bills in at least some circumstances. Nine of these 25 meet our standards as offering what we consider to be comprehensive protection. For protections to be comprehensive, we look to number one, whether they apply in both emergency situations and an in-network hospital setting, such as electing an in-network surgeon, but being treated by another clinician who’s out of network. Second, that these laws apply to both HMO’s, PPO’s and all other types of insurance. Third, that the law does address both insurers by requiring them to hold consumer’s harmless from balanced bills and providers by barring them from sending balanced bills. And fourth, that the laws adopt some kind of a payment standard. Uh, either a rule to determine payment from insurance provider or an arbitration process to resolve payment disputes. Although these four conditions don’t guarantee complete protection for consumers, they combine to protect consumers in most emergency and network hospital settings that the states can address. But as you’ve already heard, state protections are limited by federal law, ERISA, which exempt states from state regulation’s, self insured, employer sponsored plans. 43:30 Chairman Frederica Wilson (FL): Under current law, who is responsible for making sure that a doctor or a hospital is in-network? Is it the doctor, the insurance company or the patient themselves? Frederick Isasi: Uh, chairman Wilson, thank you for the question. To be very clear, it is the patient themselves that has a responsibility and these negotiations are very complex. These are some of the most important and intense negotiations in the healthcare sector between a payer and a provider. There is absolutely no visibility for a consumer to understand what’s going on there. And so the notion that a consumer would walk into an emergency department and know, for example, that their doctor was out of network because that hospital could not reach agreement on an in-network provider for the ED is absurd, right? There’s no way they would ever know that. And similarly, if you walk in and you received surgery and it turns out your anesthesiologist isn’t in-network, there’s no way for the consumer to know that. Um, and I would like to say there’s some discussion about transparency and creating, you know, sort of provider directories. We’ve tried to do that in many instances. And what we know is that right now the healthcare sector has no real way to provide real actual insight to consumers about who’s in-network, and who’s out of network. I would-probably everybody in this room has tried at some point to figure out if a doctor’s in-network and out of network and as we know that system doesn’t work. So this idea that consumers can do research and find out what’s happened behind the scenes in these very intensive negotiations is absurd and it doesn’t work. 46:30 Professor Jack Hoadley: Provider directories can be notoriously inaccurate. One of the things that, even if they are accurate, that I’ve seen in my own family is you may be enrolled in Blue Cross-You ask your physician, "are they participating in Blue Cross? They say “yes”, but it turns out Blue Cross has a variety of different networks. This would be true of any insurance company, and so you know, you may be in this one particular flavor of the Blue Cross plan and your provider may not participate in that particular network. 47:30 Christen Linke Young: Notice isn’t enough here. Even if a consumer had perfect information, which is not a reasonable expectation, but even if they did have perfect information, they can’t do anything with that information. They can’t go across town to get their anesthesia and then come back to the hospital. Um, their-even with perfect information, they may be treated by out of network providers. And so we need to set a standard that limits how much providers can be paid in these out of network scenarios that makes it sort of less attractive for providers to remain out of network. And so instead, they are subject to more normal market conditions. 1:01:25 Rep. Phil Roe (TN): I’ve had my name in networks that I wasn’t in. That you-that you use, and many of those unscrupulous networks, will use that too to get people to sign up because this doctor, my doctor is in there when you’re really not. 1:10:25 Frederick Isasi: Um, there is a concept here, which is, what does in network mean, right? When you sit down with your husband or your partner and decide what kind of insurance do we want for our kids, right? We want to make sure that they can go to the ED if they’re playing soccer, they get hurt, all those sorts of things. The question is when you make that decision and you say, "Oh, look, this hospital is in-network, right? But what does that mean? If you can go to that hospital and all the services they’re providing are out of network, right? And I think as you’ve said, and as we’ve heard from other folks, the patient is not the person who should be responsible for that. It’s the folks who are negotiating. It’s the hospital, it’s the doc’s and the payers that should bear that responsibility. So let’s start by clarifying what does in-network mean, so that we have some way of making educated decisions about the insurance that we’re purchasing and putting our trust in. 1:29:30 Professor Jack Hoadley: There may be instances where consumers get bills sent to them, aren’t aware that they don’t need to pay them, so don’t start the process. And that goes to this sort of point of how do you really make sure it’s not the consumer’s responsibility to figure out that, oh, I don’t, by law, I don’t actually have to pay this bill. Now what do I do to make sure that happens? If you don’t know that, uh, that doesn’t really help you. And so what some other states like California has done, is to include a provision that says the provider really can’t send a bill and if they do end up sending a bill and the consumer pays it, there’s an obligation on that provider to refund the amount that was paid back to the consumer. And that’s something we haven’t seen in some of the other states. 1:39:15 Rep. Joe Courtney (CT): ERISA really has to be dealt with if we’re going to really have a comprehensive solution for America’s patients. Is that correct? Ilyse Schuman: That’s exactly right. Um, for the self funded plan too 60% of employer based plans that are not subject to these state laws, like in Connecticut or other states, we have to have a federal solution that addresses ERISA, so that we deal with this problem in a uniform nationwide way. Documentary: This is a clip from the documentary: 911, Toxic Legacy which aired on Canadian CBC 9/10.2006, September 10, 2006 Community Suggestions See Community Suggestions HERE. Cover Art Design by Only Child Imaginations Music Presented in This Episode Intro & Exit: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio)


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Sep 16th, 2012
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