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Surprise Medical Billing


The Brief

Our members chose surprise medical billing as one of three topics to work on this year.  That meant that we developed a thorough brief that reviewed the strongest arguments for and against each of the five bipartisan bills before Congress as well as a review of the available data.

View Brief

Members Review

Then, one-third (more than 4,000) of our more than 14,000 members were randomly assigned to spend 90 minutes reviewing the brief before indicating whether they supported or opposed each bill. They also answered open-ended questions.

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We announced our results during “Healthy Bipartisanship in the Time of COVID-19.”  This special Facebook Live event on April 23, 2020 included an impressive lineup of former lawmakers and cabinet members. We’ve had over 250,000 views.

View EventFull Results

December 21, 2020 Update: Congress passed legislation ending surprise medical billing

The program has now had more than 250,000 views.

Former Lawmakers and Cabinet Members


Mike Leavitt

Mike Leavitt

Former Secretary of Health and Human Services

Sylvia Burwell

Sylvia Burwell

Former Secretary of Health and Human Services

Gabby Giffords

Gabby Giffords

Former US Representative

Jeff Flake

Jeff Flake

Former US Senator

Tom Daschle

Tom Daschle

Former US Senate Majority Leader

Christie Todd Whitman

Christine Todd Whitman

Former Cabinet Member

Highlights from the Healthy Bipartisanship Event

Full Results


H.R. 5800*

Do you support or oppose H.R. 5800?

  • Combined
  • Payment Standard: 2019 median in-network, indexed
  • IDR: $750 minimum
  • Not covered:  Ground ambulances (but study)

H.R. 2328

Do you support or oppose H.R. 2328?

  • Combined
  • Payment Standard: 2019 median in-network, indexed
  • IDR: $1250 minimum
  • Not covered:  Ground and air ambulances

S. 1895

Do you support or oppose S. 1895?

  • Payment Standard Only
  • Standard: Median in-network calculated each year
  • Not covered: Ground ambulances

H.R. 5826*

Do you support or oppose H.R. 5826?

  • IDR Only
  • Benchmarks: 2019 median in-network, indexed, information from parties re final offer
  • Not covered: Ground ambulances, air ambulances (but study)

H.R. 3502

Do you support or oppose H.R. 3502?

  • IDR Only
  • Benchmarks: Median in-network all plans; case severity, provider training; 80th percentile billed charges
  • Not covered: Ground ambulances, air ambulances, post-emergency stabilization

* The two bills receiving the most attention

Support for Ending Different Types of Surprise Bills

Emergency Services

96% Support

Ancillary Services

97% Support

Ground Ambulances

94% Support

Air Ambulances

94% Support

Post Emergency Stabilization

94% Support

Support for Independent Dispute Resolution (IDR) Limits


What are the most important reasons for the positions you’ve taken?

The most obvious and overwhelming responses were expressions of urgency in ending surprise billing. Regardless of which bills they support or oppose, the overwhelming majority express their deep frustration, often in vivid angry terms, that surprise billing is allowed.

Examples of responses indicating simply the need to end surprise billing:


Independent, California

“Regardless of the bills proposed there is a need to address this issue. Indiscriminately charging a person for emergency or ancillary services at rates that are excessive is unethical especially in cases where the patient has no ability to render a decision.”


Democrat, New Mexico

“Unfortunately, I have used emergency services such as ambulances and air transport for my infant son. The resulting bills came at a time of trauma and hardship. These bills were inappropriately timed and arrived when, mentally and emotionally, the family was not able to deal with insurance and investigation. We had to do it, however, since they amounted to over $1 million. During my fact-finding phone calls, I spent outrageous amounts of time on hold. It was immense, overwhelming and lacked empathy for the patient. I am grateful (extremely grateful!!) for the medical expertise which saved my son’s life, but I am confident that there is a more responsible way to approach billing and payment for these services.”


Independent, Illinois

“It is nefarious to take advantage of someone in such a tenuous position as when they are in an emergency room. No, they cannot discuss their bill while they are receiving emergency services. They cannot shop around to find a better price or a provider who is in network. How could an ethical business charge people for these things?”


Republican, Arizona


Republican, Washington

“I believe the surprise billing process is predatory in nature and preys on those unable and incapacitated to make decisions for themselves. No one is given an option in these billings, no prices are given, and “shopping around” isn’t an option. Asking the government to step in and tell this business to treat people fairly in this situation is reasonable and responsible.  Using a human tragedy or suffering as a means to a major profit line is not only irresponsible, but in my opinion almost criminal.”


Independent, Michigan

“Surprise billing is another form of bait and switch. It is unbelievable that someone can be forced to pay for something that they did not agree to purchase. That needs to be outlawed.”


Independent, Indiana

“Surprise billing for medical care is ridiculous. It should end immediately.”


Democrat, California

“I have had to deal with this before. It is NOT a fair practice, especially to people who are already ill/injured.  It has to stop!”


Independent, Colorado

“Surprise billing for medical care is ridiculous. It should end immediately.”


Independent, Michigan


Independent, Oregon

“This is especially needed ASAP now! After an emergency hospitalization of 4 days, I ended up with over $200,000 in bills.  I could have filed bankruptcy as I was making around $28,000 per year and was already spending about $3,000 a year on co-pays.  But, I was able to make arrangements to make payments.  It took me 10 years, but I got them all paid off.”

To flesh out their reasoning for supporting or opposing H.R. 5800 and H.R. 5826 (the two bills receiving the most attention), we sorted for those who both support one and oppose the other. Below are some typical responses to the question, “What are the most important reasons for the positions you’ve taken?”

Those who support HR 5800 and oppose HR 5826


Democrat, Ohio

“After reading about each of the five bills, HR 5800 seems to be the bill with the best approach. It draws on the successful aspects of the two largest state laws and, on paper at least, most effectively mitigates the drawbacks. Using the median price for insurers and indexing it to inflation makes good sense to me. Limiting IDR claims to bills $750+ will decrease the number of submissions while allowing specialties that cost less a seat at the table.”


Independent, Michigan


Independent, Georgia

“We are having this debate because the market has failed. Leaving all factors up to the market will result in more failure, so there needs to be some intervention with price controls. Middle-men and insurance companies are going to be driven by profit. Limiting unnecessary bureaucracy while allowing for arbitrators is a compromise that allows the market to work but has protection for the common man.”


Independent, Massachusetts


Republican, Maryland

“HR 5800 has the optimum balance to leverage market forces. Avoids inflexible government price setting, excessive provider leverage, and insurer manipulation. Provides medical providers reasonable protection where circumstances warrant. Seems to combine strengths of the others.”


Democrat, Oklahoma

“I could support either of the house bills that use the combined approach but prefer the one that includes a study of ground ambulance services.”


Independent, Pennsylvania

“Trying to keep the government out of it as much as possible,  while protecting the consumer from unfair billing and keeping quality services available.”


Republican, Indiana

“To create no surprises to consumers, while still maintaining adequate profit margins to maintain excellent medical choices and care, without raising insurance costs, deductibles and copays, with as little government involvement as possible.”

Those who support HR 5826 and oppose HR 5800


Independent, Missouri

“I feel that H.R. 5826 promotes more of a free market position. I am adamantly opposed to price fixing by government for anything.  This is the surest way to reduce availability of services.  If providers cannot have a say in what they can afford to provide a service for, they will indeed stop providing or the quality of those who continue to provide will decline.”


Independent, Idaho

“We forget that emergency services are required to care for all and be available at all times. This is expensive. We need to make a distinction between normal healthcare and emergency services and realize their inherent value. If they aren’t paid fairly, there will be no more available to help.”

Dee Ann

Independent, Alabama

“Sometimes Federal government intervention makes a problem worse. (Law of Unintended Consequences applies.) This country is not a ‘one size fits all’ country.”