Editor’s Note; This article was updated after press time to reflect congressional passage of the bill that includes the spending package..
Congress has sent President Donald Trump a giant spending and coronavirus relief package, the Consolidated Appropriations Act, 2021 (CAA 2021) package, that includes a sweeping health insurance agent and broker compensation disclosure provision.
- A collection of documents related to the version of the Consolidated Appropriations Act, 2021, package that the House Rules Committee took up is available here.
- The 5,593-page PDF file that contains the health agent and broker compensation disclosure provision, on page 4,475, is available here.
- An article about a 2019 surprise medical bill hearing is available here.
Congress broke the CAA 2021 package into parts when voting on it.
Members of the House voted 359-53 for the section containing the health insurance producer compensation disclosure section.
Members of the Senate approved the section by a 92-6 vote.
The parts of the CAA 2021 package getting the most attention would provide funding for COVID-19 pandemic response efforts, such as extra funding for public health programs, an extra $300 per week in unemployment benefits for displaced workers, and one-time cash payments of $600 to taxpayers to Americans who earn less than $75,000 per year.
The heart of the package is appropriations provisions, or the statutes that give the U.S. Treasury Department, the U.S. Defense Department, the U.S. Department of Health and Human Services and other federal departments and agencies permission to spend the money necessary to stay in operation.
Health insurers, health care provider groups and others have given some attention to the No Surprises Act section. The No Surprises Act section is part Division BB of the bill, which has the title “Private Health Insurance and Public Health Provisions.”
The No Surprises Act Section
Drafters of the No Suprises Act section want to eliminate situations that lead to patients with health coverage getting huge, unexpected medical bills, or “surprise bills,” and going after patients for the balance between what the health insurers will pay and the full charges.
The No Surprises Act would keep out-of-network providers at in-network hospitals, air ambulance service providers, and other emergency services providers from “balance billing” patients for amounts far over typical in-network provider rates. The section would also set up an arbitration-based system for resolving rate disputes between insurers and out-of-network providers.
America’s Health Insurance Plans, a group for health insurers, has said that it likes much of the CAA 2021 package but believes the dispute resolution provision could make administering out-of-network claims more difficult and drive up costs.
The Comp Disclosure Section
The health agent and broker comp disclosure provision is in a bundle of health care price transparency provisions that comes after the No Surprises Act section.
The health agent and broker comp provision is based on language that has been under serious discussion in the Senate since at least May 2019.
The provision is the fruit of efforts by Sen. Lamar Alexander, R-Tenn., the chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, and Sen. Patty Murray, D-Wash., to lead a bipartisan effort to come up with ideas for improving the U.S. health care delivery and U.S. health care finance systems.
Another provision in the transparency section would ban price information confidentiality clauses in health coverage arguments.
AHIP and some independent antitrust experts have argued that, in some cases, bans on gag clauses could encourage health care providers to bid up their fees and drive up health care costs, rather than doing much to help patients shop for cheaper care.
The agent and broker comp disclosure provision is in Section 202 of Division BB.
The section would apply to a producer or entity expecting to earn more than $1,000 in direct or indirect compensation for selling or administering individual or group health coverage. ”Compensation” would mean “anything of monetary value,” but would not include “non-monetary compensation valued at $250 or less.”