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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Surprise medical bills are now illegal -- but some patients don't know that yet

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Good morning. It’s a somber day for the United States: The first anniversary of the Jan. 6 insurrection at the U.S. Capitol. Law enforcement officials didn’t urgently respond to warnings about violence before the attack. During it, Trump had direct warnings of the risks but stood by for 187 minutes. Afterward, Republican efforts to undermine the 2020 election restarted immediately after the siege. 

That’s according to an investigation by The Post detailing the attack. If you're on the Hill today, check out the series in print: it will be inserted into 2,700 copies of the newspaper delivered to Capitol Hill offices.

Today, in health care news:

‘Surprise’ medical bills are now illegal

Consumer alert: Patients can no longer get hit with pricey surprise medical bills — the beginning of a major consumer protection Congress passed back in 2020.

Now, federal officials, the health-care industry and advocates are working furiously behind the scenes to ensure patients get the new protections, which went into effect Jan. 1. They’re planning educational campaigns, providing technical training and disseminating materials on how to comply with the law. 

  • “I certainly have some nerves about the logistics of this all working out, and not because of malintent, just because I am skeptical that every doctor in the country knows about the protections,” said Loren Adler, an associate director of the USC-Brookings Schaeffer Initiative for Health Policy.

The Kaiser Family Foundation

Spreading the word

Providers are no longer allowed to send eye-popping bills to insured patients who inadvertently get care from an out-of-network provider. 

But if they do send such a bill? It’s up to the patient to try to get it fixed. Roughly 10 million surprise bills had been typically sent out a year, according to the Kaiser Family Foundation, meaning hundreds of thousands of problems could arise even if compliance with the new law is high. 

The law required the Biden administration to set up a national consumer complaints system, where patients can call a toll-free number or submit a complaint online and get federal help investigating the bill. The help line has received over 300 calls since it launched Jan. 1, mostly from consumers wanting to learn more about the new ban, according to a Department of Health and Human Services spokesperson. 

“It’s really going to be critical that the public’s aware of their rights,” said Jane Sheehan, the director of federal relations at Families USA, a consumer health advocacy group.

  • Sheehan teased an upcoming public education campaign but declined to share details.
  • Before the law took effect, the federal health department conducted trainings about the ban with consumer advocates, unions, providers, legal aid organizations and more.
  • Groups, like the American Hospital Association, say they’ve discussed the ban extensively with their members and are holding office hours to answer questions on certain facets of the law.

If past is prologue: At least 18 states already had comprehensive bans on surprise billing in place before the federal law, and the health industry tended to comply with the rules, according to Adler. Advocates will be watching closely to ensure that’s the case, and providers that don’t comply can be hit with a fine up to $10,000 for each violation.

  • “Doctor offices are running businesses, and insurance companies are large regulated businesses, they both have pretty strong incentives not to run afoul of the law,” he said

Though the law is in effect, the fight isn’t over. Major hospital, doctor and air ambulance lobbies sued the administration over its surprise billing rules late last year.

The move is reminiscent of the fiery debate in Congress over how to resolve payment disputes between providers and insurers, as powerful health care giants poured millions into avoiding picking up the bulk of the tab. 

The lawsuits target the payment amount a mediator considers when they’re resolving billing disputes, and won’t impact patients’ bills. The trade groups insist the federal government didn’t adhere to Congress’ intent when drafting the law’s regulations, an argument that’s divided even the lawmakers who wrote the bill. Some consumer and employer groups contend providers are attempting to “preserve their profits.”

Meanwhile, some advocates hope a major gap in the law can get addressed soon. Congress didn’t bar ground ambulances from sending patients surprise medical bills — the median of which amounts to $450 — and instead created a federal advisory committee to study the issue. 

  • “As an advocate, I think that that’s an unacceptable half measure,” said James Gelfand, an executive vice president of the ERISA Industry Committee, which represents large employers.

CMS Administrator Chiquita Brooks-LaSure

On the Hill

More coronavirus relief on its way? Democratic and Republican lawmakers have held early discussions about another round of coronavirus stimulus dollars aimed at helping an array of businesses — including restaurants and gyms — to weather the impact of surging coronavirus cases, our colleague Tony Romm reports.

Sens. Ben Cardin (D-Md.) and Roger Wicker (R-Miss.) have come up with the outlines of a roughly $68 billion proposal, two people familiar with the matter told The Post. The money would include a mixture of new spending and repurposed dollars from previously authorized relief packages.

The two senators have also spoken with Sens. Maria Cantwell (D-Wash.), Mark R. Warner (D-Va.) and Susan Collins (R-Maine) in an attempt to build support. But the effort may face an uphill battle in a narrowly divided Senate, especially amid GOP concerns about adding to the federal deficit.


The CDC says all teens should get boosted

The Centers for Disease Control and Prevention recommended yesterday that all adolescents ages 12 to 17 receive a booster dose of the coronavirus vaccine, The Post's Lena H. Sun and Katie Shepherd report. The new guidance comes as kids return to school amid surging omicron cases.

Advisers weigh in: Earlier Wednesday, advisers to the CDC voted 13 to 1 to recommend a Pfizer-BioNTech coronavirus vaccine booster for all teenagers. The vote came after the FDA cleared an additional dose for kids ages 12 to 15 on Monday. 

The CDC had previously said 16- and 17-year-olds were eligible for a booster, but stopped short of saying they should get them. But agency Director Rochelle Walensky was quick to embrace the advisory panel’s recommendation that older teens should get the booster as well.

More fallout from the CDC’s isolation guidance

On Jan. 5, Dr. Rochelle Walensky defended the decision to omit testing, saying that rapid tests are “for qualitative purposes, not quantitative purposes.” (Video: Reuters)

The American Medical Association blasted the CDC’s guidance on isolation following a suspected or confirmed coronavirus infection as “confusing” and “counterproductive.” It was yet another piling on the CDC, which has come under fire the past week for reducing the recommended isolation time following an infection without requiring a negative test.

The AMA's position: The massive doctor lobby pointed out that the CDC’s own rationale for the change notes that some 31 percent of people may remain contagious after the fifth day following a positive test.

  • “Test availability remains a challenge in many parts of the country, including in hospitals. … But a dearth of tests at the moment does not justify omitting a testing requirement to exit a now shortened isolation” the AMA wrote in its statement.

Walensky on Wednesday denied that testing shortages were a motivating factor in the CDC's decision to omit a testing requirement for leaving isolation.

  • Divide within the Biden administration: Anthony Fauci, the nation’s top infectious disease expert, said that he did not see the final version of the guidance before it was released. Both he and Surgeon General Vivek Murthy were concerned that the guidance did not urge people to get a negative covid test before leaving isolation, The New York Times reported.
  • Repercussions for workers: Walmart announced that it was cutting the amount of paid leave that workers can receive after testing positive for the coronavirus from two weeks to one week, following the CDC’s new isolation guidance.

Here's what else you need to know: 

  • The Capitol Police chief says the coronavirus is hitting the department hard and exacerbating personnel shortages, according to our colleague Andrew Jeong.
  • Every U.S. cruise ship with passengers has coronavirus cases onboard. All 92 ships have met the threshold for investigation by the CDC, The Post’s Hannah Sampson reports. Last week, the public health agency warned travelers, including those who are vaccinated, to avoid cruise ships.
  • The world needs 22 billion more mRNA vaccine doses to protect vulnerable populations worldwide and tamp down on new variants, according to a new report prepared by a team of public health advocates and scientists, our colleague Dan Diamond writes.
  • Australia canceled the visa of top tennis player Novak Djokovic ahead of the Australian Open after authorities raised questions about the legitimacy of a medical exemption that would have allowed him to enter the tournament without a vaccine, The Post’s Liz Clarke, Cindy Boren and Des Bieler report.
  • The U.S. Postal Service has asked federal labor officials for a temporary waiver from President Biden’s coronavirus vaccine mandate, setting up a showdown between the White House and a large government agency, per The Post’s Jacob Bogage.

Chart check

The omicron variant, first identified in November, has quickly overtaken delta as the dominant variant around the world. Check out this chart from our colleagues Dan Keating, Madison Dong and Youjin Shin. 

(The chart represents countries where genomic sequences are publicly released, so some large countries are not included. Because it takes about a week for laboratories to identify virus variants, the data is time-lagged.)

Industry Rx

In other health news: Pfizer and German company BioNTech announced that they are teaming up to develop a shingles vaccine using mRNA technology — the breakthrough behind the companies’ successful coronavirus vaccine.

Sugar rush

Shepherd Wiebke Schmidt-Kochan on Jan. 3 herded sheep and goats to form a 330-foot syringe to promote coronavirus vaccines in Schneverdingen, Germany. (Video: Pulse of Europe Koblenz)

Thanks for reading! See y'all tomorrow.