H.R. 5826 would establish patient protections from surprise medical billing and establish a process to resolve disputes between health care providers and insurers that are unable to reach agreement on payments for out-of-network health care. In determining the most reasonable rates, dispute resolution entities would be instructed to look to the health plan’s median payment rate for in-network rate care.
CBO and JCT expect that under the bill, in facilities where surprise bills are likely, average payment rates for both in- and out-of-network care would move toward the median in-network rate, which tends to be lower than average rates. CBO and JCT estimate that in most affected markets in most years, lower payments to some providers would reduce premiums by between 0.5 percent and 1 percent. Lower costs for health insurance would reduce federal deficits because the federal government subsidizes most private insurance through tax preferences for employment-based coverage and through the health insurance marketplaces established under the Affordable Care Act.